Residency Advisor
The biggest mistake premeds make in uncomfortable shadowing situations is believing they have to tolerate anything to “prove” they belong in medicine. That belief is wrong—and dangerous.
You can set boundaries and still be seen as professional, committed, and mature. In fact, the way you handle uncomfortable shadowing settings is often interpreted as a direct measure of your judgment and readiness for this career.
This is the playbook you should have been given on day one.
Step 1: Know Exactly What You Are Allowed to Say “No” To
You cannot set boundaries confidently if you are secretly unsure whether you are “allowed” to have them.
Think in four categories. Any time you feel discomfort, run it through this quick mental checklist.
1. Ethical and Patient-Safety Boundaries
You are expected—not just permitted—to speak up or step away when:
- You are asked to
- Touch patients, perform procedures, or handle sharps/medications when you have no training or explicit permission
- Enter rooms where the patient has not consented to observers
- Access electronic medical records (EMR) independently or look up patients on your own
- You witness
- Obvious disregard for patient privacy (discussing cases with names in public spaces, mocking patients)
- Potential safety risks (wrong patient, wrong side, wrong medication, visibly impaired clinician)
In these situations, you are protecting patients and the physician, not being “difficult.”
2. Personal Safety and Physical Boundaries
You have an absolute right to step away from:
- Environments that feel unsafe (agitated patients without appropriate security, unsecured psychiatric settings, etc.)
- Physical contact that is not clearly professional (a “too long” hand on your shoulder, invasively close proximity, blocking your way)
- Being left alone in rooms with patients when you do not feel safe or qualified to be there
If your body is signaling danger—tight chest, racing heart, nausea—that is data you must respect.
3. Emotional and Psychological Boundaries
Shadowing can expose you to:
- Traumatic events (codes, resuscitations, pediatric deaths, violent injuries)
- Disturbing content (severe burns, disfiguring trauma, graphic surgeries)
- Emotional strain (family grief, bad outcomes, end-of-life conversations)
You are allowed to say:
- “I need a moment to step out.”
- “I do not feel comfortable staying for this part.”
- “I would like to sit this one out.”
Respecting your limits early helps you build resilience safely rather than burning out before you even apply.
4. Professional and Time Boundaries
Your time and role also need boundaries:
- Staying far beyond the agreed time when you have commitments (class, work, exams)
- Being pressured into tasks outside your role (calling patients, giving instructions, writing notes in the chart)
- Being pulled into personal errands (coffee runs, paperwork unrelated to shadowing, non-educational tasks)
You are a learner, not free labor. You do not need to be available without limits to “prove” your dedication.
Step 2: Use a Simple Boundary Formula That Works Under Stress
In uncomfortable moments, your brain tends to freeze. Prepare a script framework you can plug any situation into.
Use this 3-part structure:
- Acknowledge / Align
- State boundary
- Offer alternative when possible
Think: Align → Boundary → Option
Here is how it looks in real situations.
Example 1: You Are Asked to Do Something You Are Not Trained For
Scenario: A busy resident says, “Can you go ahead and remove that patient’s IV? It’s simple.”
Response:
“I appreciate the chance to help, but I am not trained or allowed to perform procedures. I can stay and observe if that would be useful.”
- Align: “I appreciate the chance to help”
- Boundary: “I am not trained or allowed to perform procedures”
- Option: “I can stay and observe”
Example 2: You Feel Faint or Overwhelmed in the OR or Emergency Room
Scenario: During your first surgery, the room is hot, you feel dizzy, and you are afraid of causing a scene.
Response (quietly to a nurse or the surgeon):
“I am starting to feel lightheaded. I would like to step out for a moment so I do not disrupt anything.”
That line shows self-awareness and prioritizes patient safety. That is professional.
Example 3: Physician Makes Inappropriate Personal Comments
Scenario: The attending comments on your appearance or asks overly personal questions.
Response:
“I am here to focus on learning about patient care and the clinical environment. I would like to keep our conversations centered on that.”
If they persist:
“Those kinds of comments make me uncomfortable. I would like to keep things professional.”
Clear. Calm. Direct.
Example 4: You Need to Leave at the Agreed Time, but the Team Keeps Going
Scenario: You agreed to shadow from 8 a.m.–1 p.m., but at 12:55 p.m. they start a new consult.
Response:
“I have to leave by 1 p.m. for a prior commitment, as we discussed. I can stay for the initial part of this consult but then will need to head out.”
Or, if they are about to walk into the next room:
“Before we go in, I wanted to let you know I need to leave at 1 p.m. for another commitment.”
Preemptive communication preserves goodwill.
Step 3: Prepare Boundary Scripts Before You Ever Step into the Clinic
You will handle discomfort better if your language is rehearsed, not improvised.
Create a small “script bank” on your phone or in a notebook. Here are ready-made phrases by category.
A. When You Want to Step Out of a Room
Use when: Emotions, faintness, traumatic procedures, or simply feeling overwhelmed.
- “I would like to step out for a moment.”
- “I am feeling a bit lightheaded. I am going to step out so I do not disrupt anything.”
- “This is intense for me as a learner, and I would like to sit this one out.”
If questioned later:
- “I am still getting used to clinical situations like that and wanted to be cautious about my reaction.”
B. When Patient Consent Seems Unclear
Use when: You are not sure the patient agreed to observers.
- Before entering:
- “Do you prefer that I step out for this visit, or is it alright that I stay?”
- To the physician (out of patient earshot):
- “For this kind of visit, would you prefer I wait outside until you confirm the patient is comfortable with an observer?”
If a patient looks uncomfortable:
- “I am just a premedical student here to observe. If you would prefer more privacy, I can step out.”
Then you leave. No debate.
C. When You Are Pushed Into Performing Tasks
Use when: Asked to call patients, give instructions, handle instruments, or work in the EMR.
- “I want to respect my role and the clinic’s policies. I am not allowed to do that as a premed, but I would like to watch how you do it.”
- “I do not have training in that. Is there another way I could help that stays within an observer role?”
D. When Conversations Turn Inappropriate or Unprofessional
Use when: Gossip, degrading comments, sexual jokes, racist/sexist remarks.
Soft redirect (if you think they will respond):
- “I am trying to learn as much as I can about clinical decision-making. Could you walk me through how you approached that case?”
Clear boundary:
- “Those comments make me uncomfortable. I would like to keep things professional.”
Documentation phrase (if you later report it):
- “On [date], during shadowing in [clinic/service], Dr. X said [quote/summary] in front of [who was present]. I felt uncomfortable and unsure how to respond.”
Write that down as soon as you get home.
E. When You Need to End the Experience or Not Return
Sometimes the right boundary is to leave and never go back.
If you need to leave early (not a safety emergency):
- “I am feeling unwell and need to head out for today. Thank you for letting me observe this morning.”
If you decide not to return:
- Email:
“Thank you again for the opportunity to shadow in your clinic. After reflecting on my schedule and needs this semester, I will not be able to continue shadowing. I appreciate the time you have already shared.”
You do not owe an abusive or inappropriate environment a detailed explanation.
Step 4: Use a Simple Internal Decision Tree in the Moment
Boundary setting becomes easier when you have a small mental algorithm.
When something feels wrong, mentally run this:
Am I or someone else in immediate danger?
- Yes → Step away or leave the room. Then seek help (nurse, charge nurse, clinic manager, trusted faculty).
- No → Go to #2.
Is this about patient safety or ethics?
- Yes → Use a neutral, safety-focused statement:
- “I may be misunderstanding, but I am concerned about [X].”
- “I am not comfortable with that as a student observer.”
- No → Go to #3.
- Yes → Use a neutral, safety-focused statement:
Is this about my personal or emotional limits?
- Yes → Use a self-focused boundary (no accusation):
- “I am feeling overwhelmed and would like to step out.”
- “I do not feel comfortable participating in this part.”
- No → Go to #4.
- Yes → Use a self-focused boundary (no accusation):
Is this a time/role overstep?
- Yes → Clarify and limit:
- “I am not allowed to do that in my role as an observer.”
- “I have to leave by [time] as we discussed.”
- Yes → Clarify and limit:
Practicing this decision tree before you shadow will make it much easier to act under pressure.
Step 5: Loop in the Right People When Boundaries Are Violated
You are not supposed to handle serious boundary violations alone. There is a structure around you; use it.
Who to Talk to First
Pick one or more of these, depending on where the shadowing took place:
- Premed advisor or health professions advisor at your college
- They have seen this before. They can help you decide if something needs to be reported and to whom.
- Pre-health committee director or faculty mentor
- Especially useful if the physician is part of your university’s affiliated hospital.
- Clinic or hospital volunteer/shadowing coordinator
- If you applied through a formal program, there is usually a coordinator whose job includes dealing with problematic situations.
- Trusted resident or nurse you met there
- They can share whether what you saw is normal for that environment (some things are harsh but standard, others are not).
When you approach them, use a simple structure:
- What: “I want to talk about something that happened during shadowing.”
- When/where: “It was on [date] in [clinic/department] with Dr. X.”
- Concrete description: “Dr. X did/said [describe behavior], and I felt [your reaction].”
- Your question: “I am not sure if or how I should report this, but it did not feel appropriate or safe.”
You are not accusing; you are describing and seeking guidance.
When to Formalize a Complaint
Strongly consider formal reporting when:
- There is sexual harassment, physical contact, or clearly inappropriate comments
- Patient safety is compromised or laws are broken (HIPAA violations, forging notes, falsifying information)
- There is racially or sexually discriminatory behavior toward you, staff, or patients
- The physician repeatedly ignores patient consent or confidentiality
Formal routes may include:
- The hospital’s compliance office or ombudsman
- Human resources within the health system
- A clerkship or course director (if you are a medical student)
- Your pre-health office, which might contact the site on your behalf
If you fear retaliation (letters of recommendation withheld, etc.), say that clearly when you report. Many institutions have specific protections for students in those situations.
Step 6: Design Preventive Boundaries Before You Start Shadowing
You can prevent many uncomfortable situations by establishing expectations up front.
Before the First Day
In your initial email or conversation:
Clarify your role and limitations
- “As a premedical student, I understand I am here to observe only and will not interact with patients independently or access the EMR.”
Clarify time boundaries
- “I am available on [days/times]. On those days, I need to leave by [time] to make it to class/work.”
Ask about sensitive settings
- “Will there be any settings you recommend I prepare for in advance (for example, trauma, OB/GYN, end-of-life care)?”
This signals maturity and may prompt the physician to be more thoughtful about what they expose you to.
On the First Day in Clinic
Have a 2-minute expectations check:
- “I appreciate the chance to be here. I want to make sure I respect your space and the patients. Are there particular situations where you would prefer I step out, or where I should definitely stay?”
- “If I ever feel faint or overwhelmed, is it alright if I quietly step out and wait in the hall?”
Most attendings will respect that and remember it later.
Create Your Own Internal Rules
Decide in advance:
- What you will do if you see:
- A patient getting undressed with no explicit acknowledgment of your presence
- A procedure that you know you cannot tolerate yet (e.g., severe trauma)
- A physician asking you to do something in the EMR
- How long you will stay per day (e.g., maximum 4–6 hours initially so you do not get exhausted and lose judgment)
Pre-commitment strengthens your boundaries when you are tired or intimidated.
Step 7: Protect Your Future While Protecting Yourself
Many premeds fear: “If I speak up or leave, I will lose a letter of recommendation.”
Two key points.
1. You Do Not Want a Letter from Someone Who Violates Boundaries
A physician who:
- Ignores patient consent
- Harasses staff or students
- Puts you in unsafe roles
is not someone you want representing your character to admissions committees.
A shorter but honest shadowing history is better than a long one built on silence in a toxic environment.
2. Admissions Committees Value Professional Judgment
If you later describe a boundary decision in an application or interview (carefully, without defaming anyone):
- “During shadowing, I realized I had to prioritize patient privacy and my role as a learner. In one situation, I chose to step out when I felt my presence might not be fully consented to.”
That signals:
- Respect for ethics and consent
- Self-awareness about your limitations
- Courage to make uncomfortable but correct choices
Handled thoughtfully, your boundary-setting can become a strength in your narrative, not a liability.
Step 8: Run Post-Shadowing Debriefs with Yourself
Every uncomfortable experience should teach you something about your boundaries.
After each shadowing day, ask yourself:
- Did I feel unsafe or deeply uncomfortable at any point?
- Did I override my own discomfort to “avoid being rude”?
- Was there a moment I wish I had spoken up or stepped out?
- Which script would I use next time in that situation?
- Do I feel okay returning to this site or physician?
If the same red flags show up repeatedly, that is data. Either reinforce your boundaries or exit that environment.
Write down:
- Date
- Setting
- What happened
- How you responded
- What you would do differently next time
Over months, you will see yourself becoming more confident and clearer about what you stand for.
You do not prove your fitness for medicine by silently enduring discomfort or misconduct. You prove it by protecting patients, respecting yourself, and exercising sound judgment under pressure.
Your next step is concrete:
Open your calendar and pick your next (or first) shadowing date. Then write down three exact sentences you will use if you need to step out, refuse a task, or redirect an inappropriate comment. Memorize them before you walk into the clinic.
