Residency Advisor
The biggest mistake students make in shadowing is treating it as passive observation instead of a launchpad for research and quality improvement.
If you are already inside the clinic or hospital as a shadower, you are standing on a goldmine of potential research and QI projects. The difference between “I followed Dr. X around for 40 hours” and “I co-designed and implemented a readmission-reduction project with Dr. X” comes down to structure, timing, and how you ask.
This roadmap will show you exactly how to convert standard shadowing into meaningful, CV-worthy research or quality improvement work—step by step.
1. Shift Your Mindset: From Observer to Problem Finder
You cannot generate a research or QI opportunity if you are only watching pathology instead of watching systems.
During shadowing, deliberately pay attention to three domains:
Workflow friction
- Repeated delays (e.g., waiting on imaging results)
- Frequent bottlenecks (e.g., discharge prescriptions)
- Handoffs that seem chaotic or rushed
Variation in practice
- Different physicians doing the same task in noticeably different ways
- Inconsistent adherence to a protocol (e.g., pre-op checklists used by some, skipped by others)
Unmet needs
- Patients frequently confused about the same issue
- Nurses or residents repeatedly complaining about the same problem
- Attending verbalizing frustrations with EMR, consults, follow-up, etc.
While shadowing, carry a small notebook (or secure digital note in line with institutional policy) and create three running lists:
- “Things that slow us down”
- “Things that cause confusion or errors”
- “Things that repeat every day that we wish were better”
You are not judging; you are cataloging. These raw observations are the seeds for:
- Quality improvement projects (PDSA cycles, process changes)
- Descriptive research (retrospective chart reviews, workflow studies)
- Intervention projects (patient education tools, checklists, templates)
A student who shows up with a specific, observed problem is far more likely to get a “Yes” from a busy attending than someone who asks, “Do you have any research?”
2. Pick the Right Environment and Attending
You can convert shadowing into research or QI almost anywhere, but some environments are far more fertile than others.
Target environments that naturally generate questions
High-yield settings for QI and clinical research:
- Emergency departments
- Door-to-doctor times, frequent flyers, sepsis protocols, triage accuracy
- Inpatient wards (medicine, surgery, pediatrics)
- Readmissions, discharge delays, medication reconciliation
- ICU
- Ventilator weaning protocols, sedation practices, early mobilization
- Outpatient primary care or specialty clinics
- Preventive care gaps, missed follow-ups, chronic disease control metrics
- Procedural areas (OR, cath lab, endoscopy)
- Turnover time, checklist adherence, complication tracking
If you can choose, prioritize:
- Academic hospitals over purely private clinics
- Sites with residency programs over those without
- Services where quality metrics are already posted or discussed (e.g., monthly QI meetings)
These are places where research and QI are expected parts of the culture.
Choose attendings strategically
You want an attending who:
- Is involved in:
- Residency or medical student education
- A committee (quality, safety, morbidity & mortality, EHR optimization)
- An academic title (Assistant/Associate Professor)
- Has an existing track record:
- PubMed-able publications
- Posters or talks at specialty conferences
- Leadership in a service line or program
Do this before you shadow:
- Look up the physician online (hospital profile, PubMed).
- Note:
- Their clinical focus
- Recent publications
- Any mention of “quality improvement,” “patient safety,” “clinical outcomes,” or “educational research.”
You want to enter day one of shadowing already knowing:
- What they care about
- Where their prior work lives
- How you might plug in
3. Shadowing with Intent: How to Collect “Project Fuel”
Stop walking behind the physician like a tourist. Start shadowing like a junior analyst.
Concrete behaviors during shadowing
Track specific, countable things that repeat
- Number of times discharge is delayed due to:
- Missing imaging
- Waiting for a bed
- Delayed consult note
- Number of patients discharged without documented follow-up scheduled
- Number of patients confused about the same instruction (diet, activity, meds)
- Number of times discharge is delayed due to:
Listen carefully in workrooms
- When residents or nurses say “This always happens” or “This is so inefficient,” write it down verbatim.
- Note any reference to:
- “The last time we got dinged on this metric”
- “The QI team wants us to improve X”
Ask quiet, targeted questions at natural breaks Examples:
- “I noticed we had two discharges delayed by paperwork today. Does that happen often?”
- “You mentioned we get measured on readmission rates. Are there specific conditions where that is a problem?”
- “You said the sepsis bundle is hard to follow in the ED. Has anyone tried to streamline that?”
You are not pitching a project yet. You are establishing that you are observant, interested in systems, and can notice patterns.
Build a short “Opportunity Log”
At the end of each shadowing day, convert your notes into a structured log:
- Problem: Delays in discharge prescriptions being signed.
- Where observed: Internal Medicine ward; 6-7 patients per day.
- Impact (hypothesized): Later discharge times, bed availability issues, patient frustration.
- Idea type: QI / workflow; possible EMR order-set tweak or pre-round checklist item.
Accumulate 5–10 of these over several sessions. Patterns will emerge. Those patterns become your leverage in the next step.
4. The Ask: Turning Shadowing into a Concrete Opportunity
Most students ask for research in a way that forces the attending to invent a project from scratch. Do not do that.
You will make their life easier by presenting:
- A problem you noticed
- A rough idea of how it could be studied or improved
- A specific, limited role you can perform
Step-by-step: How to ask effectively
Timing: Ask after you have:
- Shadowed several sessions
- Shown up consistently and on time
- Asked thoughtful clinical and systems questions
Ideal moments:
- End of a clinic day
- After ward rounds during a quieter period
- After you have just witnessed or discussed a recurring problem
Script structure (adapt, do not memorize word-for-word):
Appreciation + context
- “Thank you again for allowing me to shadow on service. Seeing how the team manages complex discharges has been incredibly helpful.”
Name a specific problem you observed
- “I have noticed that several discharges were delayed due to prescription issues—either waiting for signatures or clarifying instructions.”
Suggest a project frame (QI or research)
- “It made me wonder if there might be an opportunity to look at the discharge process more systematically, either as a small quality improvement project or even as a descriptive study of factors associated with late discharges.”
Offer a concrete, low-burden role
- “I would be very interested in helping with the early legwork—reviewing charts under supervision, collecting anonymized data, or drafting a process map of the discharge workflow. I am willing to commit X hours per week for the next Y months.”
Ask a direct question
- “Is this something you think could be developed into a small project under your guidance or perhaps with one of the residents?”
This structure does three things:
- Shows initiative without arrogance
- Keeps the attending’s workload low
- Signals reliability with a defined time commitment
Have multiple options prepared
From your Opportunity Log, pick two or three potential project ideas that align with:
- The attending’s known interests
- Service priorities (e.g., readmissions, length of stay, specific disease metrics)
- Feasibility for your time frame
Example set:
- Discharge delays → QI / workflow project
- Poor documented follow-up for heart failure patients → Chart review / outcomes project
- Inconsistent use of VTE prophylaxis order set → Protocol adherence QI project
When the attending shows interest in one, you double down and ask about next steps.
5. Match Project Type to What You Actually Observed
You do not need to force everything into “research.” Many shadowing-linked projects are stronger as QI, and that is still extremely valuable.
A. Quality Improvement projects
Best when you notice:
- Repeated workflow problems
- Variation in how the same task is done
- Clear mismatch between protocol and reality
Common QI frameworks:
- PDSA cycles (Plan-Do-Study-Act)
- Lean / Six Sigma tools
- Process mapping
Example conversion:
- Observation: Patients frequently leave clinic without clear instructions on how to use inhalers.
- Project: Design and test a one-page standardized inhaler teaching sheet plus a 2-minute demonstration protocol, measuring:
- % of patients correctly demonstrating technique pre- and post-implementation
Your possible roles:
- Create literature summary on existing solutions
- Draft patient handouts or checklists
- Help collect baseline and follow-up data
- Enter data into spreadsheets or REDCap
- Assist with IRB submission if required (many QI projects may be exempt, but that decision is not yours to make)
B. Retrospective clinical research
Best when:
- The problem involves outcomes or associations
- Data already exist in the EMR
- You can define a clear patient population and timeframe
Example conversion:
- Observation: Very high rate of 30-day readmissions among patients with COPD.
- Project: Retrospective chart review of COPD discharges over 12 months examining associations between:
- Use of discharge follow-up appointment
- Written action plan
- Pulmonary rehab referral
- Readmission rate and timing
Your possible roles:
- Help define inclusion/exclusion criteria
- Apply those criteria in chart review under supervision
- Extract pre-defined variables
- Clean and code data (in Excel, SPSS, R, etc., depending on team)
- Draft background and methods for a manuscript or abstract
C. Educational or implementation projects
Best when:
- The main problem is knowledge, not just systems
- Patients, students, or staff lack standardized resources
Example:
- Observation: New interns struggle with appropriate vancomycin dosing; attendings frequently correct orders.
- Project: Develop a brief dosing pocket guide + 10-minute teaching module; evaluate:
- Confidence scores and error rates pre- and post-intervention
Shadowing exposes you to real educational gaps. Those are prime targets.
6. Formalize the Project: From Idea to Plan
Once an attending or resident says, “Yes, this is interesting,” you immediately pivot from vague idea to concrete plan.
Step 1: Clarify the question
Boil down the problem to a single, specific, answerable question.
- Avoid: “How can we improve discharges?”
- Use: “Does implementing a pre-round discharge checklist reduce discharge order time and actual discharge time by at least 1 hour compared to baseline?”
Ask the attending:
- “If we had data on this in 6 months, what would actually change in your practice or the service?”
- “What is the single most important outcome you care about here?”
Step 2: Define your role explicitly
Spell out what you will do and what you will not do.
Example commitments:
- “I can:
- Conduct chart reviews for X patients per week
- Maintain a clean, de-identified dataset
- Draft the introduction and methods for an abstract
- Attend monthly QI or team meetings as available”
Also state constraints:
- “I will be available from May through August, approximately 8–10 hours per week.”
Ask them to:
- Confirm that scope is realistic
- Identify a resident or fellow who can be your day-to-day contact
Step 3: Address logistics early
You must not handle protected health information (PHI) casually. Ask directly:
- “Will this project require IRB review or QI committee approval?”
- “What training do I need for chart access (e.g., CITI training, HIPAA modules)?”
- “How should I store any data I collect?”
Typical steps:
- CITI / research ethics training
- Institutional onboarding for research access
- IRB / QI board determination
- Some QI projects are exempt or do not require full IRB
- Data collection tool creation
- Shared, secure REDCap or institutional platform
- Or structured Excel template on secure drive
If the attending shrugs at these questions, gently suggest:
- “I am happy to draft an initial proposal or project summary that we can submit to the appropriate committee to make sure we are compliant.”
You are rescuing them from regulatory headaches. That makes you valuable.
7. Execute Like a Professional, Not Like a Pre-med
You have converted shadowing into an opportunity. Now you must not waste it.
Build a simple, reliable work routine
Set fixed work blocks each week
- Example: Tuesdays and Thursdays 4–7 pm dedicated to chart review and data entry
Track your hours and tasks
- Maintain a simple log:
- Date
- Time spent
- Tasks completed
- Any issues or questions
- Maintain a simple log:
Send short, structured updates
- Every 2–4 weeks, email your attending and primary mentor:
- “Here is where we are:
- X charts reviewed
- Y% of data variables complete
- Issues encountered: …
- Next 2–3 steps: …”
- “Here is where we are:
- Every 2–4 weeks, email your attending and primary mentor:
Use bullet points. No walls of text.
Communicate like a junior colleague
When you run into obstacles (incomplete data, confusing chart entries, delays in IRB), do not disappear.
Instead, send messages like:
- “While reviewing charts, I found that discharge times are documented inconsistently in the EMR. I see three possible approaches: [Option A, B, C]. Do you have a preference, or is there a standard way your team handles this in other projects?”
You are not just reporting a problem; you are proposing options.
Aim for a tangible product
From the first week of the project, ask:
- “What is the realistic endpoint of this work?”
- Internal QI presentation?
- Poster at our hospital’s research day?
- Submission to a specialty conference?
- Manuscript for a journal?
- “What is the timeline?”
- Data done by Month X
- Abstract by Month Y
- Presentation in Month Z
Build backwards from that.
Your goal: By the time you apply to medical school or residency, this project appears on your CV as:
- “Quality Improvement Project: Implemented pre-discharge checklist on Internal Medicine service, contributing to a 45-minute reduction in median discharge order time. Presented at [X] conference.”
8. If the First Attending Says No: Salvage and Redirect
Many students stop after the first “No.” That is a mistake.
You can still convert your shadowing experience into something more:
Ask for redirection
If an attending declines, respond with:
- “Thank you for considering it. Is there someone on your team or in your department who is particularly involved in QI or clinical research that you would recommend I contact?”
- “Does your division have ongoing projects that could use help with data collection or literature review?”
Often the right person is:
- A chief resident
- A quality officer
- A research coordinator
- A more junior faculty member hungry for help
Use your observations as a calling card
When you approach the next person, do not say “I want research.” Say:
- “While shadowing on the Internal Medicine service, I noticed repeated delays in discharge related to medication reconciliation. I drafted a short list of potential project ideas and would be very interested in helping with data collection or a small QI initiative in this area.”
You are now presenting yourself as someone already embedded in the environment, not a total outsider.
9. Translate the Experience into Application Power
Even if the project never becomes a publication, the story is gold for interviews and personal statements.
When writing or speaking about it:
Start with the clinical reality you observed
- “During shadowing on a busy internal medicine service, I noticed that several patients remained in hospital beds for hours after they were medically ready for discharge.”
Describe the question you asked
- “I wondered whether this was a rare occurrence or a pattern with measurable consequences.”
Explain how you acted
- “I approached my supervising attending with a proposal to systematically track and analyze discharge times and their causes. Under her guidance, I helped design a small quality improvement project focused on implementing a pre-round discharge checklist.”
State the outcome concretely
- “Over three months, we collected data on 120 discharges and saw a reduction in median discharge time by 50 minutes. The project was presented at our institution’s QI day, and elements of the checklist were incorporated into daily rounds.”
Reflect on what you learned about medicine
- Focus on:
- Systems thinking
- Interdisciplinary collaboration
- The gap between protocol and practice
- How small changes can yield real patient-level impact
- Focus on:
This shows maturity far beyond “I observed procedures and confirmed my interest in medicine.”
10. A Simple Roadmap You Can Implement This Month
To make this truly actionable, here is a condensed, 10-step sequence you can follow:
Choose your shadowing site and attending strategically
- Academic, QI-oriented environment if possible.
Shadow with a systems lens
- Track bottlenecks, variation, and repeated frustrations.
Maintain an Opportunity Log
- Summarize concrete, recurring problems you see.
Research your attending’s interests
- Read 1–3 of their recent publications.
Identify 2–3 potential project angles
- QI, retrospective research, or educational intervention.
Ask for a meeting or use a natural end-of-day moment
- Present one focused problem + a simple project frame + your proposed role.
Co-define a clear question and outcome
- Tighten scope; avoid trying to solve everything.
Address approvals and logistics immediately
- IRB/QI review, access, data tools, mentorship chain.
Execute with professionalism and reliability
- Regular hours, clean data, concise updates, problem-solving mindset.
Package the experience for your CV and interviews
- Emphasize observation → question → action → measurable impact.
Key Takeaways
- Shadowing should not be passive; treat it as structured fieldwork to identify fixable problems in real clinical systems.
- The best way to get a research or QI opportunity is to walk in with a specific, observed problem and a small, clearly defined role you can reliably perform.
- Professional execution—clear communication, respect for logistics, and a focus on tangible outcomes—turns a simple shadowing experience into a powerful academic and personal narrative.
