PRE-PA • BY ANNE, CCPA

Shadowing experiences are extremely valuable and something I wish I had taken advantage of when I was exploring different health care careers. As a shy, undergraduate student – I had the self-limiting belief that shadowing experiences were available only to those who were “well connected”, or those that had friends or family members who worked in health care fields that they could easily facilitate that connection. Now I know much better, and find that shadowing experiences may be available to you if you take initiative and are persistent. Also – shadowing experiences are not necessary to get into your program of choice, that a conversation with a PA can also be just as helpful.

For this post, I also did a Q&A with a Pre-PA Student Levine who writes about how she obtained her PA shadowing experience and what she learned. Jump to the bottom of this post to learn more!  Don’t forget to grab your freebie for this post. 

• Rather than reading about what health care professions do, you are given the opportunity of an inside look as to what the day to day of a PA would look like.
• Seeing a PA work will deepen your understanding of the PA profession and help you better determine if the profession is a good fit with your values, education, skills and long-term goals.
• Shadowing a PA can reinforce (or change your mind – both good things!) whether or not you’d like to pursue a career as a PA. Admissions for any health care program takes time and money, and you want to know where best to focus your energy. A shadowing experience can help with this.
• You can get a first person look at how PAs interact with patients, how they build patient apart and how they interact with their supervising physician.
• If there is time with before clinic or between patients, sometimes the PA will have some time to answer questions about the PA profession.

Is shadowing a PA required for Canadian PA admissions?

• No. You don’t have to. This is merely another option to research the PA profession. There are many successful PA candidates who get into Canadian PA programs without shadowing a PA.
• Note, many American PA programs require shadowing hours to submit along with their PA Program application. Canadian PA programs do not require this.

Can I shadow other Health Care Providers?

Any shadowing experience with a health care provider is valuable – especially for a couple of reasons:

• Understanding how health care providers collaborate in the Canadian health care system
• As a future PA, you will be referring to and working with different allied health providers, including rehabilitation professions services (e.g. physiotherapy, occupational therapy,, speech language pathology) and work with other health care providers (e.g. pharmacist registered nurse, social work, registered dietitian, respiratory therapist)

If you do not manage to obtain a shadowing experience with a PA, it is entirely appropriate to obtain shadowing experience with a Physician (MD) or a Nurse Practitioner (NP) as the job description, scope of practice and interactions with patients are similar if not the same as a PA (with a few differences).

How many hours should I shadow a PA?

I would recommend at minimum half a day or half a clinic. Each experience is different. I usually take on Pre-PA students for a maximum of half a day in clinic, since other days are dedicated to taking on other medical learners (1st and 2nd year PA students) who are required to complete observership/clinical hours.

Does it cost money to shadow a health care provider?

Some institutions and hospitals charge a fee for observers for administrative purposes, however not all shadowing experiences cost money to pursue.

What should I research prior to the shadowing experience?

Get your basics first before entering the practice – what is a PA? Where do PAs practice in Canada? How to become a PA in Canada? What does PA education entail? What is the job description / scope of practice?

Research the location of the clinic, and how to get there beforehand to prevent being late.

You may want to read a little bit about the specialty or clinic the PA is working in (e.g. What does a PA in Neurology usually see?). The PA may ask you why you are interested in the PA profession and a little bit about your educational background just to get to know you. You may have time for questions with the shadowing experience, but don’t waste the opportunity asking questions that could be easily googled (i.e. how many schools in Canada? What is the minimum GPA to apply?).

How long should a shadowing experience be?  

Shadowing experiences can be short term or long-term. Some students are able to secure a few hours (e.g. half day) once per week for a whole summer, other times the practice only has room for a one-time half day observership because of the number of medical learners they take on.

What should I clarify prior to starting the PA shadowing experience?

Once you have secured a PA shadowing placement, here is what you want to determine before hand:

• Location of clinic, and parking availability
• Date, as well as start and end time of the shadowing experience
• Appropriate attire to wear to clinic
• Any necessary paperwork to complete before the rotation start
• When it would be appropriate to ask the PA questions – whether its best before clinic starts, between patients, or after.

• Arrive on time.
• Dress professionally (business casual or scrubs depending on the setting requirement), It is best to first ask the PA you are shadowing how to most appropriately dress for the shadowing experiences. For clinics, I would recommend dressing business casual to be safe – especially in outpatient practices like Family Medicine, or a specialty office outside of a hospital. In some instances you may require scrubs in some clinical settings, which you can speak to the PA you will be shadowing to clarify how best to dress for the shadowing experience.

• Be attentive, enthusiastic and willing to learn. These are important characteristics of anyone looking to enter the field of medicine. Being professional, courteous, and having a positive attitude is most important.
• Introduce yourself to the PA & to the staff – with your name, and that you are someone interested in learning more about the PA profession. You can introduce yourself with staff as long as you are not distracting them if they are occupied.
• Introduce yourself to the patient (or the PA may do this for you). Patients must consent to having an observer in the room. “Hi my name is ___, I am here observing [name of PA], would this be alright with you?” If the patient prefers to speak with the PA only, don’t take it personally and just quietly exit the room and wait for the PA to complete the patient encounter.

• Be ready to LISTEN. You are an observer (read: be the wallflower), don’t be distracting or disruptive and don’t speak during the patient encounter  unless the PA or patient bring you into the conversation.
• The idea is to stand back and observe. Give the PA and patient room to do the encounter. When it comes to the physical exam it is okay to move around to slightly to get a better view.

• Take cues from the PA you are shadowing. Some are more talkative to students who are observing and others may expect you to quietly observe.

• You may have a lot of uncertainty about where to go when shadowing – the best tip would be to (1)  Look to the PA for direction on who to follow and where to go next between patients. The PA may be more hands on and explain to you where they want you to go, and when to stay in the patient room. You will get the flow of clinic as the day progresses. (2) Follow the PA everywhere – If the PA enters the room, you enter the room, if the PA leaves the room during a patient encounter – you should also leave the room. This may be best practice if the PA does not give the observer much direction (Just don’t follow the PA into the bathroom, use common sense).

• Time your questions appropriately without taking away from patient care. Keep in mind that whenever a clinic takes on a clinical learner or observer, it may (or may not) slow down the clinic.
  • If the clinic is relatively slow, the PA may take some time explain aspects of their work between patients.
  • However if the clinic is very busy the PA may not be able to speak with you between patients. Be respectful and perhaps wait closer to the end or if there is a slower lull between patients. You don’t want to be the reason for slowing the clinic down or causing other health care providers in the practice to be frustrated.

• Respect PHIPA and patient confidentiality. Don’t share names or any identifying information with friends, family or social media of the patients you observed that day – that’s a big no no in the medical world. You can “vaguely” refer to cases, “middle aged male presented with history of cough x 10 days, etc) or “we saw many shoulder cases today”. No taking pictures of patient x-rays and posting them on social media.

How can I make the most of the PA shadowing experience?

Outside of following the tips above, I would recommend:

• Bring a notebook and pen and jot down anything memorable to you about the PA/patient encounter. You are NOT jotting notes about the patient’s condition, treatment options, etc.  You are observing the patient encounter and jotting down anything memorable about communication, professionalism, bedside manner, etc.

• Write a thank you email to the PA after the experiences (whether same or day or within the same week) to acknowledge the time they’ve taken out of their busy clinic to take you on.

• Write down a summary about the PA shadowing experience and use the material for the supplementary application. I would recommend doing this exercise on the SAME DAY you have your PA shadowing experience, take out a piece of paper (or a blank Google Doc or Microsoft Word Doc, or start a private blog (i.e. blogspot.com or wordpress.com)) and reflect on your experience.

Shadowing Dont’s:

• Don’t bring other work or be on your phone during downtime between patients. It comes across as disrespectful, especially when you are in a shadowing experience to learn about the PA profession.
• You’re not here to “clock” hours (nor is this a requirement for any PA school in Canada). Use the opportunity to speak with the PA or to observe and learn as much as you can.
• Don’t take it personally if patients ask to not have an observer in the room. This has happened a few times when I have taken on students, and I always reassure students that often they would prefer to just see the provider.
• Be self aware of your body language – don’t look tired or uninterested. Your experience may influence whether the PA you are shadowing decides to take you on for more hours, or recommend their PA colleagues to you to shadow. Be professional!

Whether you obtain a shadowing experience or have an opportunity to chat with a PA in person, over the phone or Zoom, it is best to avoid asking questions that can be easily googled. You should be asking questions that are specific to the PA – why did they pursue the PA profession? How did they find the experience of PA school and what challenges did they run into?

I outline a few methods and resources you can use in “How to Shadow a PA in Canada” to find an experience.

How to increase your chances of obtaining PA shadowing

• Start a conversation with a few questions via email, linkedin messaging, etc.. Realize that asking a PA to shadow is like “cold calling”. Some may respond, others have not. Once you’ve had an email exchange with a PA, ask the PA if they’d be willing to take you on for half a day of shadowing. I find that if the students take time to engage with me, prior to requesting a shadowing experiences, I may make an extra effort to try to find a time that will work (even if its many weeks/months in advance). Other times, it’s not possible. If the PA declines after the request, be courteous and thank them for their time. At the very least you were able to speak to a PA about their experience!.
• Be willing to travel outside of your neighbourhood to have unique PA shadowing experiences. Many requests for PA shadowing are requests for major city centres. PAs in these centres receive MANY requests because of their location. However, there are many PAs that work outside large municipalities (rural, suburban) that are happy to take on Pre-PA students for shadowing. If you can, make arrangements to commute to the location for just one half day – whether it’s by car, bus or bike. It’s well worth the trip.

What if I can’t find a PA to shadow in Canada despite my best efforts? If you have looked into shadowing a PA, and have already considered

• Like I mentioned previously, it is not a requirement to shadow a PA in Canada for admissions. Many successful PA candidates have not shadowed a PA (myself included). You can also learn about what it’s like to practice as a PA by speaking with a PA, whether over phone, skype call, or a quick coffee meetup. During these conversations you can ask about the PA’s day to day, what they enjoy, what they dislike, and more.
• Volunteer in a clinic that has a PA. Whether that’s a medical clinic, physician’s office or hospital. Just by being in the vicinity you get to exposed to many health care providers and perhaps even some experience interacting with patients.
• Have relatives or friends in the States? Maybe they know a PA. One of my classmates was able to shadow PA in the US (Nephrology unit) through connections.
• Because there are so few PAs in Canada compared to other health care professionals – PAs can receive MANY requests for Pre-PA shadowing, especially if they are closer to larger urban centres. It is more common here for Pre-PAs to do a one-time half day observership with one (or a few) PAs. Be flexible and willing to travel to shadow.