Your Ultimate Guide to Medical Shadowing in Medicine-Psychiatry Residency

Understanding Medical Shadowing in Medicine-Psychiatry

Medical shadowing is often your first real window into what a career in Medicine-Psychiatry (med psych) looks like day to day. For students considering a medicine psychiatry combined residency, shadowing can clarify whether this integrated specialty fits your clinical interests, temperament, and long-term goals.

In a dual-trained discipline like Med-Psych, shadowing is even more valuable than in single-specialty paths. You’re not simply observing internal medicine or psychiatry—you’re watching how both are woven together for complex patients whose medical illnesses and psychiatric conditions are tightly intertwined.

This guide will walk you through:

• What to expect from a Medicine-Psychiatry shadowing experience
• How to find shadowing opportunities (even if you lack connections)
• How many shadowing hours are useful and how to document them
• How to turn shadowing into a strong part of your residency application
• Practical do’s and don’ts on the wards and in clinic

Whether you’re a premed, early medical student, or gearing up to apply for a med psych residency, this article will give you a roadmap to make your shadowing experiences meaningful and strategic.

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What Makes Medicine-Psychiatry Shadowing Unique?

Medicine-Psychiatry is not just “doing some medicine” and “doing some psychiatry” in parallel. When you shadow a Med-Psych physician, you see how a single clinician:

• Manages acute and chronic medical illnesses (e.g., heart failure, COPD, diabetes)
• Assesses and treats psychiatric disorders (e.g., depression, bipolar disorder, psychosis)
• Integrates both in real time, often with limited collateral information and complex social factors

Core Settings You Might Encounter

Your shadowing may span multiple environments. Each highlights different aspects of the specialty:

1. Inpatient Medicine-Psychiatry Units

   • Hybrid medical floors where most patients have active psychiatric comorbidities (e.g., severe depression with uncontrolled diabetes, psychosis in a patient with HIV).
   • You’ll see how the team stabilizes medical issues while simultaneously managing agitation, suicidal ideation, or severe anxiety.

2. Consult-Liaison (CL) Psychiatry with Internal Medicine Focus

   • Med-Psych attendings often work on CL services evaluating patients on medical/surgical floors.
   • You may observe: delirium assessments, capacity evaluations, medication interactions, and behavioral management for medically fragile patients.

3. Outpatient Integrated Clinics

   • Primary care clinics embedded in community mental health centers or dual-diagnosis clinics.
   • Here you see continuity of care: monitoring antipsychotic metabolic effects, adjusting insulin, managing hypertension, and treating mood disorders in the same visit.

4. Emergency Department (ED) and Observation Units

   • Triage of patients with both acute medical issues and psychiatric crises (e.g., intoxication plus suicidal ideation, overdose, or new-onset psychosis in someone with sepsis).

What You’ll Actually See During Shadowing

Expect to observe activities across the full biopsychosocial spectrum:

• Medical Assessment

  • Physical exams with attention to cardiopulmonary status, metabolic complications, withdrawal symptoms.
  • Interpretation of labs, imaging, and EKGs in the context of psychotropic medications or substance use.

• Psychiatric Assessment

  • Psychiatric interviews focusing on mood, psychosis, anxiety, suicidal or homicidal ideation.
  • Mental status examinations and risk assessments.
  • Collateral gathering from family or staff, especially when patients have limited insight.

• Integrated Clinical Reasoning

  • Distinguishing delirium from psychosis or severe depression from negative symptoms.
  • Considering whether a symptom is medication side effect, substance-related, primary psychiatric, or secondary to medical disease.
  • Balancing medical and psychiatric medication regimens (e.g., QT prolongation risk, metabolic syndrome, drug–drug interactions).

• Systems-Level Thinking

  • Coordination with social work, case management, outpatient providers, and community mental health systems.
  • Discharge planning that addresses shelter, follow-up, and safety—not just medical stability.

What You’ll Learn That’s Specific to Med-Psych

After shadowing, most students can articulate concrete “value adds” of med psych residency. You’ll likely notice:

• How Med-Psych clinicians reduce fragmentation of care for high-utilizing, high-need patients.
• The ability to manage complexity that might otherwise bounce between internal medicine, psychiatry, and the ED.
• A style of communication that spans medical and psychiatric teams, helping everyone stay aligned.

These observations become very powerful talking points in your personal statement and interviews.

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How to Find Medicine-Psychiatry Shadowing Opportunities

For many applicants, the hardest part is figuring out how to find shadowing in a relatively niche field. Medicine psychiatry combined programs exist at a limited number of institutions, so you have to be proactive.

Step 1: Start with Your Own Institution

If your medical school or local teaching hospital has a Med-Psych or combined internal medicine–psychiatry program, this is your easiest entry point.

Actions you can take:

• Search your institution’s website

  • Look for “Internal Medicine-Psychiatry,” “Med-Psych,” or “Combined Medicine and Psychiatry” in department directories.
  • Identify program leadership, such as:
    • Program Director or Associate Program Director (APD) of the med psych residency
    • Core faculty with dual board certification

• Email template to request shadowing
  Subject: Medical Student Interested in Medicine-Psychiatry Shadowing

  Body (adapted for your context):

  Dear Dr. [Last Name],

  I am a [MS1/MS2/MS3/undergraduate premed] at [Institution] with a strong interest in pursuing a medicine psychiatry combined residency. I am hoping to gain first-hand exposure to the field through medical shadowing.

  Would it be possible to arrange a time to shadow you or another Med-Psych clinician in an inpatient or outpatient setting? I am happy to complete any required paperwork or training.

  Thank you very much for considering my request.

  Sincerely,
  [Full Name]
  [School, Year]
  [Contact Info]

• Contact Student Affairs and Clerkship Directors

  • Internal medicine, psychiatry, and CL psychiatry leaders often know who the Med-Psych faculty are, even if you don’t see “Med-Psych” in their title.
  • Ask about:
    • Shadowing experiences
    • Longitudinal electives
    • Summer programs or scholarly projects related to Med-Psych

Step 2: Reach Beyond Your Home Institution

If your school does not have a formal med psych residency, branch out geographically and virtually.

Strategies:

• Target institutions with established Med-Psych programs
  Look up the current list of accredited medicine psychiatry combined residencies (via NRMP or residency program directories). Visit each program’s website and identify:

  • Program Director and coordinators
  • Faculty with Med-Psych titles or clear dual training
  • Clinics or units described as “Med-Psych,” “Integrated Care,” or “Behavioral Health Primary Care”

  Email them similarly to the template above, explicitly stating that you are seeking shadowing (in-person or virtual) and understand institutional policies may limit what’s feasible.

• Leverage professional organizations and interest groups

  • Many Med-Psych programs participate in joint interest groups or listservs (e.g., within APA or ACP subspecialty sections). Ask a faculty mentor to forward an inquiry on your behalf.
  • Attend virtual panels or open houses where you can directly ask about medical shadowing or short-term observerships.

• Use alumni networks

  • Search your school’s alumni database for graduates in Med-Psych or closely aligned fields (e.g., CL psychiatry with strong medical focus).
  • Ask if they can host you, even for a short block, or connect you to Med-Psych colleagues.

Step 3: Utilize Clinical Rotations Wisely

Sometimes your most realistic option is not a labeled “Med-Psych” experience, but a composite of targeted shadowing during required rotations:

• On internal medicine, ask to follow:

  • Patients with serious mental illness (SMI) and complex medical issues.
  • The hospital’s CL psychiatry service for a session or two when appropriate.

• On psychiatry, request:

  • Exposure to units that manage medically ill psychiatric patients (e.g., geriatric psych, addiction units with heavy medical comorbidity).
  • Time shadowing psychiatry consults on medical/surgical floors.

These are valuable “Med-Psych-adjacent” experiences you can describe concretely on your application.

Step 4: Virtual Shadowing and Case-Based Learning

Some institutions or Med-Psych interest groups offer:

• Virtual shadowing: Observing telehealth visits with video off, listening to case discussions, or joining morning report/academic conferences.
• Case-based workshops and journal clubs: Even if you can’t physically shadow, attending these gives you authentic exposure to Med-Psych thinking.

While virtual experiences are not a perfect substitute, they help demonstrate interest and build relationships with faculty who may later write letters of recommendation.

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Shadowing Hours: What’s Needed and What’s Realistic?

There is no formal rule for shadowing hours needed for med psych residency. Programs focus more on the depth of your understanding and your ability to articulate why Medicine-Psychiatry fits you, rather than a specific number of hours.

General Benchmarks to Aim For

Use these ranges as planning guideposts, not rigid requirements:

• Premedical level (if applicable):

  • Total clinical shadowing: 50–100+ hours across specialties.
  • Specifically in Med-Psych or integrated settings: 10–30 hours is valuable, but even a single well-structured day can be influential.

• Medical students applying for Med-Psych residency:

  • Direct Med-Psych or very closely related experiences:
    • 20–60 hours of immersive exposure (e.g., a 1–2 week elective, recurring shadow days, or a dedicated integrated care clinic experience).
  • Supplemental exposure via standard rotations:
    • Meaningful Med-Psych-relevant experiences on medicine, psychiatry, and CL psychiatry should be highlighted in your CV and personal statement.

Programs understand many schools don’t have formal Med-Psych units. They will not penalize you for lack of hours, but they will notice if your application reflects little insight into what med psych residency actually entails.

Quality Over Quantity

Instead of chasing a target number, prioritize:

• Continuity: Shadow the same Med-Psych clinician for several sessions to see different patient types and stages of care.
• Variety: Combine inpatient, outpatient, and consult experiences if possible.
• Active engagement: Ask thoughtful questions (at appropriate times), read about cases afterward, and follow up with what you’ve learned.

How to Track and Document Shadowing

Keep a simple log including:

• Date and total hours
• Setting (e.g., Med-Psych inpatient unit, CL psychiatry consults, primary care in CMHC)
• Physician’s name and role
• Brief description of patient population and what you observed (no identifiers)
• One or two key learning points or reflections

This will help when you:

• Populate the experiences section of ERAS.
• Draft your personal statement with specific examples.
• Prepare for interviews and be ready for “Tell me about a shadowing experience that shaped your interest in Med-Psych.”

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Making the Most of Your Medicine-Psychiatry Shadowing Experience

Shadowing can be passive if you let it be. Instead, aim to treat every session like a micro-rotation: you’re there to learn, integrate, and reflect.

Before You Start: Preparation

1. Clarify Expectations with Your Preceptor

   • Ask about:
     • Appropriate arrival time and dress code
     • Whether you’ll join rounds, clinics, or consults
     • Any institutional paperwork, HIPAA training, or vaccination requirements

2. Do Basic Background Reading Focus on topics often encountered in Med-Psych:

   • Delirium vs. dementia vs. primary psychosis
   • Depression in medically ill patients
   • Common psychotropic side effects: metabolic syndrome, QT prolongation, extrapyramidal symptoms
   • Substance use disorders in hospitalized patients

3. Formulate Learning Goals Examples:

   • “Understand how Med-Psych attendings differentiate medical vs. primary psychiatric etiologies of confusion.”
   • “Observe at least one capacity evaluation and learn the attending’s framework.”

During Shadowing: Professionalism and Engagement

Core principles:

• Patient privacy and consent:

  • Always ask the attending before entering a room; they may ask the patient if they’re comfortable with a student observer.
  • Never document in the official chart unless specifically instructed and supervised.

• Position and body language:

  • Stand where you’re visible to both patient and attending, but not crowding the patient.
  • Maintain an open, calm, and nonjudgmental demeanor—especially important when patients discuss stigma-laden topics (e.g., substance use, psychosis, suicidality).

• Ask questions—but at the right time:

  • During or immediately after encounters only if it doesn’t delay care.
  • Save more complex discussions for breaks or at the end of the session.
  • Examples of good questions:
    • “What clues made you suspect delirium rather than primary psychosis in that patient?”
    • “How did you weigh the risks and benefits of starting an antipsychotic given his cardiac history?”
    • “What factors influenced your decision about the patient’s capacity to refuse treatment?”

• Observe communication nuances:

  • Watch how the Med-Psych physician:
    • Explains medical risks to a patient who is very anxious or paranoid.
    • Negotiates treatment plans with patients who have limited insight.
    • Communicates with psychiatry-only or medicine-only colleagues about shared patients.

After Shadowing: Reflection and Follow-Up

1. Debrief with Your Preceptor (if possible)

   • Ask:
     • “How do you see Med-Psych physicians uniquely contributing to the care of patients we saw today?”
     • “What skills should I focus on developing if I’m considering Med-Psych residency?”

2. Personal Reflection

   • Journal briefly:
     • Cases that moved you—positively or negatively.
     • Situations where the Med-Psych lens clearly changed the treatment plan.
     • Moments that confirmed or challenged your interest in the field.

3. Maintain the Relationship

   • Send a concise thank-you email, highlighting:
     • Specific elements you learned.
     • Your ongoing interest in the medicine psychiatry combined pathway.
     • Your hope to stay in touch or work together on future projects or letters.

These steps not only deepen your learning, they create potential for mentorship, research opportunities, and strong letters of recommendation.

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Using Shadowing to Strengthen Your Med-Psych Residency Application

Residency programs want evidence that you know what you’re signing up for. Thoughtful shadowing becomes powerful when you translate it into a coherent application narrative.

Personal Statement: From Observation to Motivation

Use concrete shadowing experiences to answer:

• “Why Medicine-Psychiatry, specifically?”
  Instead of generic “I like both medicine and psychiatry,” reference:

  • A case where you saw how Med-Psych training prevented unnecessary transfers or readmissions.
  • A patient with SMI and chronic medical illness where integrated care improved engagement or outcomes.

• “What do you understand about the day-to-day of Med-Psych?”
  Show that you grasp:

  • The workload and complexity of caring for medically and psychiatrically ill patients.
  • The cognitive demands of constantly switching between medical and psychiatric frameworks.

ERAS Experiences: Highlight Med-Psych-Relevant Activities

In your ERAS application, don’t just list “medical shadowing.” Be specific:

• “Medical shadowing (Medicine-Psychiatry, integrated inpatient unit): Observed 25+ hours of Med-Psych rounds, contributed to literature reviews on antipsychotic-induced metabolic syndrome, and discussed diagnostic reasoning in complex delirium vs. psychosis cases.”

• Label experiences clearly:

  • “Outpatient primary care in community mental health setting”
  • “CL psychiatry exposure during medicine rotation”

This paints a picture of consistent, focused interest in integrated care.

Interview Preparation: Using Shadowing Stories

Expect questions like:

• “Tell me about a clinical experience that solidified your interest in Med-Psych.”
• “What do you see as the role of a Med-Psych trained physician in the current healthcare system?”
• “Describe a time you observed a conflict between medical and psychiatric treatment priorities.”

Prepare 2–3 shadowing-based stories that:

• Demonstrate your understanding of integrated care
• Showcase your empathy, insight, and professionalism
• Highlight lessons learned rather than just dramatic details

When you can translate your shadowing hours into clear insights and mature reflections, programs will feel more confident that you’re ready for a five-year medicine psychiatry combined residency.

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FAQs About Medical Shadowing in Medicine-Psychiatry

1. Do I need formal Med-Psych shadowing to match into a med psych residency?

No. Many successful applicants train at schools without Med-Psych programs. Programs look for:

• Genuine, well-informed interest in integrated care
• Strong performance and letters from internal medicine and psychiatry
• Evidence that you sought out relevant experiences (e.g., CL psychiatry, integrated primary care, SMI-focused clinics)

Formal med psych residency shadowing is ideal but not mandatory. Med-Psych-adjacent experiences, if thoughtfully described, can be just as convincing.

2. How many shadowing hours do I need specifically in Med-Psych?

There is no official requirement for shadowing hours needed. A reasonable target for a serious applicant might be:

• 20–60 hours of clearly integrated or Med-Psych-like experiences, spread across:
  • Med-Psych attendings (if available)
  • CL psychiatry with medically complex patients
  • Primary care in mental health settings or addiction medicine

Programs care far more about how you talk about what you learned than whether you hit a particular number.

3. Can premed students shadow in Medicine-Psychiatry, or is it only for medical students?

Premed students can absolutely benefit from shadowing in Med-Psych, especially if they’re deciding between medicine, psychiatry, or another field. However:

• Access may be more limited due to hospital policies and liability concerns.
• You may find it easier to shadow in general internal medicine or psychiatry initially, then seek Med-Psych as you gain more experience.

If you can’t access formal Med-Psych as a premed, focus on:

• General medical shadowing
• Psychiatry clinics or inpatient units
• Any integrated care or collaborative care clinics near you

These will still position you well for future med psych interests.

4. How can I find shadowing if my school has no Med-Psych faculty?

Consider a layered strategy:

1. Maximize what’s locally available:

   • CL psychiatry
   • Addiction medicine
   • Primary care clinics for high-risk or SMI populations
   • Rotations on wards that care for medically complex psychiatric patients

2. Reach out externally:

   • Email Med-Psych programs about virtual shadowing, case conferences, or short observerships.
   • Attend open houses and ask specifically about opportunities to observe their integrated units or clinics.

3. Frame your experiences thoughtfully:

   • Emphasize how your local experiences mirror Med-Psych practice (e.g., managing delirium, SMI with chronic medical disease, integrated addiction care).

With intentional planning and reflection, you can build a strong Medicine-Psychiatry narrative, even without a formal Med-Psych department at your home institution.