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Dartmouth Medical School Dartmouth-Hitchcock Medical Center

Vital Signs

Elective is valuable, beyond a shadow of a doubt

By Rosemary Lunardini

Jessica Ash, left, is one of the nurses who's taught in the shadowing elective.

Starting when they meet their first patient at a doctor's side, medical students see physicians as their teachers. Typically, they don't see nurses in that role. But times are changing. In 2004, DMS first- and second-year students responded in impressive numbers to a new elective—one that offered them a chance to learn from nurses about their role in health care. Other schools are now inquiring about the popular Shadowing a Nurse course.

Dynamic: Before she took the course, "my thoughts of the nursing profession were incredibly naive," says Erica Holland, DMS '13. "I had never really talked with a nurse or taken the time to notice them in the hospital." She learned that a physician's attitude toward nurses makes all the difference in their working dynamic.

That's the kind of lesson that Dr. Joseph O'Donnell, senior advising dean, and Ellen Ceppetelli, director of nursing education, had in mind seven years ago. At the time, both were teaching in a fourth-year case-based course and found that students couldn't solve a problem for which the best solution was to seek information from a nurse.

This concerned Ceppetelli, as well as O'Donnell, whose daughter, Jenny, was a nursing student in Pennsylvania at the time. She had gone on rounds with medical and pharmacy students and suggested to her dad that DMS offer an elective with nurses in a teaching role and give students a chance to talk with each other afterward about their experience.

So O'Donnell and Ceppetelli set up Shadowing a Nurse. Wanda Handel, a nurse in the neuroscience special care unit, has participated in the elective for several years. "My goals are for the students to observe collaborative communication between nurses and physicians and to learn to see the patient through a nurse's holistic view," she says. "I also want them to see just how smart nurses are."

Holland was indeed surprised by how much nurses know and by the amount of record-keeping they oversee. "I was absolutely amazed by how many different tasks the nurses could juggle and still have a smile on their face," she says.

Other schools are inquiring about the popular shadowing course.

Clinton Orloski, DMS '13, who took the elective to better understand how a medical team functions, was impressed that Peter Nolette, a specialist in wound care, was able to ease a patient's anxiety by explaining and applying a different bandage.

Reflection: After two shadowing stints, students in the elective meet in three 90-minute classes to share their experiences and lessons learned. A reflection paper is also a requirement of the elective. In a 2009 article that Ceppetelli and O'Donnell wrote for Academic Physician and Scientist, they identified two themes that emerged from these papers: nurses' intimate knowledge of patients and their families and how they cultivate those relationships, and nurses' oral and written communication to maintain quality and safety for patients.

O'Donnell calls the elective "very successful" in preparing students to work in an interdisciplinary way with nurses. He'd like to see the subject brought into the mainstream for all medical students.

Profession: Handel says teaching the elective made her "very proud," as she saw students walk away with a better understanding of nursing as a profession.

From the student perspective, Holland says she'll "definitely remember" her shadowing experience. "I now understand how much of a resource the nurses can be," she says, "and, if you treat them with the respect they deserve, how productive and effective a healthy relationship [can] be for the nurse, the doctor, and especially the patient."


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