Establishing the Patient Task Facilitator Program: Redefining the Shadower Role

ABSTRACT

Background

Physician shadowing offers exposure to physicians' daily responsibilities, roles, and understanding of patient interactions. Given the pressure to maintain clinical productivity, including students in Emergency Department care may be difficult. Student impact on patient care and physician workflow is understudied, and novel programs seeking to incorporate students are warranted.

Methods

We created a longitudinal educational program that combines physician mentorship and an in‐depth clinical experience by offering more direct patient‐facing activities compared with traditional volunteering or shadowing. We aimed to improve patient Emergency Department experience, incorporate students into the care team to improve the patient and family experience, and allow faculty to benefit from enhanced workflow by reducing the need for physician and nursing attention. Students served as a patient care concierge by carrying a mobile phone and providing patients with a business card with their phone number so they could be reached for questions, needs, or concerns. Students were not permitted to discuss test results, answer medical questions, or discuss care plans. The program has been modified based on feedback, which is obtained semi‐annually.

Results

The patient task facilitator program has been active since 2019. Forty‐two students and eight attending physicians have participated. Three students (7%) with engagement below expectations were removed from the program. Adaptations include ensuring consistent mentor pairing, increased phone availability, and internal promotion of the program. Faculty and student satisfaction was high; 74% of students reported plans to pursue careers in medicine, and faculty reported improved productivity, patient satisfaction, and nursing availability. Patients mentioned their patient task facilitator on Press Ganey surveys on multiple occasions as being positive and helpful, with no negative experiences noted.

Conclusion

The Patient Task Facilitator program improved both students' and faculty's satisfaction with shadowing, and additionally improved attending productivity, nursing availability, and patient satisfaction.

1. Need for Innovation

Undergraduate students' exposure to clinical practice is often limited, which may make it difficult to make an informed decision about pursuing a career in medicine and constitutes a significant shortcoming of premedical education [1]. Physician shadowing is a unique opportunity for students to get firsthand exposure to a physician's daily responsibilities and is fully supported by the Association of American Medical Colleges (AAMC). Shadowing has been demonstrated to increase students' familiarity with the physician role and increase students' understanding of physician–patient interactions.

Shadowing is a worthwhile component of an undergraduate student's premedical experience, not only allowing for opportunities to learn about medical practice, but also to build a mentoring connection with physicians [2]. Although it has been shown that including medical students and residents in clinical practice does not impact clinical productivity, the effect of undergraduate shadowing in the emergency department (ED) has not been adequately studied [3, 4]. With increasing pressure to maintain clinical productivity, including an undergraduate student in ED patient care may be increasingly difficult given their inability to help with clinical tasks or documentation.

At our institution, undergraduate shadowing experiences in the Emergency Department previously consisted of one to three shifts where students were often paired with one to two attending physicians. This was suboptimal for all parties. Students expressed frustration in their inability to aid in patient care and establish a meaningful relationship with their faculty mentor. Faculty spent much time repeating orientations and tours and felt these temporary shadowing experiences impeded workflow.

2. Background

Shadowing programs have become ubiquitous in the premedical experience, especially in the outpatient setting. Medical schools frequently look for shadowing experiences in medical school applications. Therefore, finding opportunities to observe patient‐physician interactions, procedures, and examinations is highly sought out by premedical students. Premedical students who have participated in a shadowing program are also more confident about their career choices and goals [2].

In addition to benefiting premedical students and impacting their career path, shadowing has been demonstrated to have a positive impact on the patient experience in the outpatient setting. Bing‐You et al. reported that 21.9% of patients in a family practice setting felt that student observers had a positive effect on their visit, while the remaining patients felt it had neither a positive nor negative effect on their visit. Further, 96.9% of patients stated that they would welcome a student to shadow the physician during their next visit [5].

Formal undergraduate courses that incorporate shadowing have been established. The Stanford Immersion in Medicine Series (SIMS) offers physician shadowing within the structure of an academic course and establishes patient privacy, infection control, and professionalism standards. Wang et al. found that the course provides insight into physician roles and responsibilities [1].

Many other novel pre‐medical student shadowing programs incorporating students into patient care have been described. One such program incorporates pre‐medical shadowing students into a pediatric outpatient setting. Researchers have found that students improve care by providing feedback on communication techniques and are well received by attending physicians [6].

At another institution, an Educational Shadowing Program was established where undergraduate students shadowed within the Pediatric Continuity Clinic staffed by pediatric resident physicians. Undergraduate students reported a significantly increased understanding of physician‐patient interactions from 33% before the program to 78% at its completion. Further, 72% of the residents enjoyed having the undergraduates in the clinic, and 45% felt that the undergraduates improved their clinic workflow [2].

Undergraduate student impact on ED patient care and physician workflow has not been well studied, and novel programs seeking to seamlessly incorporate undergraduate students are warranted.

2.1. Objective of Innovation

The patient task facilitator program grew from observation of our department's existing student shadowing program. The program's director noticed that as a limited shadowing experience, the program required repetitive orientations, tours, and administrative tasks with the same explanation of patient flow, Emergency Department processes, and physician, nursing, and ancillary staff roles for each rotating student. Persistent feedback from students was that they wanted to help and be involved, but limited time in the ED and unfamiliarity with physician and nursing staff precluded them from learning ED logistics and how to best assist with patient flow.

Given this observation and feedback, the patient task facilitator program was established. The goal of the program was to offer a longitudinal, educational shadowing program offering physician mentorship and an in‐depth clinical experience. We strived to offer more direct patient‐facing activities compared with hospital volunteer work or isolated shadowing experiences, incorporate students into the care team, improve the patient and family ED experience, and allow faculty to benefit from an enhanced workflow.

2.2. Development Process

Medical student educators, community engagement specialists, and emergency department administrative leadership iteratively codesigned the patient task facilitator program. Author S.G. leads departmental community engagement and is heavily involved in undergraduate medical education at our institution. She initially designed the program with the previously mentioned goals in mind. This proposal was then reviewed by departmental educational leadership (M.L.D.) to optimize learning and mentorship opportunities and was revised based on feedback. It was then reviewed by departmental administration to ensure that the students could be seamlessly incorporated into the departmental workflow.

After revision, the initial version of the Patient Task Facilitator program was established. Students were paired on shift with an attending physician mentor and were expected to be present for at least 20 shifts per semester. Students served as a patient care concierge by carrying a mobile phone and providing patients with a business card with their phone number so they could be reached for questions, needs, or concerns during the patient's ED course. Students were not permitted to discuss test results, answer medical questions, or discuss care plans with patients or family members. They conveyed these questions to the attending physician to facilitate physician and patient/family communication.

2.3. The Implementation Phase

At its inception, we anticipated the largest obstacle to be physician recruitment and engagement. Given this, we elicited and received overall departmental buy‐in during faculty meetings with an opt‐out option offered to all faculty. No faculty opted out of the program. Students self‐scheduled to work a variety of 4‐h shifts throughout the day with no more than 1 student working at any given time. Attendings were informed that students (patient task facilitators) would be working and were encouraged to ask them to perform patient‐centered tasks (i.e., providing blankets, food and water as allowed, providing nurse with discharge paperwork, checking in with patients for response to treatment, etc.) while also incorporating them into medical student and resident physician education. After a period of 6 months, student feedback was elicited both directly and anonymously to further develop the program. Multiple students reported that their experience was variable and dependent upon the faculty member with whom they worked. Variable experiences led to student dissatisfaction and faculty disengagement. Students requested more direct mentoring and direction by being paired with engaged faculty members with whom they could work throughout the program.

Based on this feedback, program recruitment of faculty shifted. Students were matched with a group of physician hosts, so students worked only when an engaged faculty member who was willing to guide them was present. Seven students self‐scheduled around a team of 8 physician hosts. After an additional 6 months, student feedback was elicited in a similar manner. Participants reported improved, but similar problems. Despite a smaller number of engaged physicians, they had difficulty learning each of the 8 physicians' workflows. Students also competed to work with certain physicians who were felt to provide a better mentoring experience.

Given feedback regarding the desire for dedicated mentorship and consistency, the program was revised once more to one‐on‐one student faculty pairing. In this model, each patient task facilitator would schedule their shifts around their faculty member's clinical shifts. Faculty expectations, including mentorship and education, were emphasized during recruitment. Possible student responsibilities were also reviewed to ensure that students were adequately and appropriately utilized and incorporated into the patient care team. In addition to the previously mentioned tasks, physicians were encouraged to allow patient task facilitators to contact families and skilled nursing facilities, gather procedural supplies, and review and summarize outside medical records at their discretion.

2.4. Outcomes

The task facilitator program began in September 2018 and the final iteration has been active since 2019. Forty‐two students and eight attending physicians have participated. Three students (7%) with engagement below expectations were removed from the program. The program continues to be modified based upon feedback, which is obtained semi‐annually. Adaptations include ensuring consistent mentor pairing, increasing phone availability, and internal promotion of the program. Student satisfaction was high, with 74% of students reporting plans to pursue careers in medicine after their participation. Press Ganey is a United States healthcare company that administers patient satisfaction surveys after hospital visits, outpatient appointments, or procedures. Patients specifically noted their patient task facilitator on Press Ganey patient satisfaction surveys on multiple occasions, reporting their experience to be positive and helpful with no negative experiences noted.

Participating faculty were asked to answer 2 survey items about the program and its impact on patient care and workflow and complete an evaluation form for open‐ended feedback. Two 9‐point Likert scale survey items asked participants to (1) rate their satisfaction with the patient task facilitator program (1—completely unsatisfied, will not participate again to 9—completely satisfied, I will be participating again) and (2) whether a patient task facilitator helps clinical productivity (1—strongly disagree to 9—strongly agree). All 8 faculty completed the survey items. Faculty were very satisfied with the program (mean 7.4, standard deviation 1.9) and felt that patient task facilitators improve clinical productivity (mean 6.6, standard deviation 1.8).

Open‐ended, qualitative data obtained was evaluated by the study investigators (AJ, MD) who met to discuss broad themes that emerged from responses. To evaluate for face validity, these themes were shared and reviewed with experts in medical education and administration who found the themes to be credible and interpretations accurate. Data was obtained from 3 participating faculty members and 4 major themes were identified. These are presented in Table 1.

TABLE 1.

Themes from interviews with participating faculty.

Theme	Examples
Incorporating the patient task facilitator	Introduce student to patient as someone to make them more comfortable and provide updates Introduce student to nurse, patient care technicians, and secretary as a contact person Ensure student knows department layout, where to find supplies, food/drink, blankets, etc Have student join for initial patient evaluation
Faculty tasks	Tell student if patient can eat/drink before leaving patient room Discuss activities and thoughts out loud and encourage students to ask questions Start shift by identifying expectations—tasks that student can complete and with which they should be proactive
Patient task facilitator tasks	Take ambulatory patients to bathroom for urine Call social work/case manager for patient transportation needs Find nursing home/assisted living contact details Gather equipment—i.e. ultrasound, suture cart, IV supplies, etc. Restock simple things like otoscope tips, tongue depressors, etc. Manage visitor ambushes (visitor walks up and asks for directions, etc.) Find family/visitors in waiting room Hourly check in rounds with the patients—provide care process updates Comfort rounds—provide pillows/blankets, food/drink—and bring questions back to care team Discharge paperwork delivery (nurse, folder, etc.) Patient clarifications—preferred pharmacy, patient phone number, etc.
Patient task facilitator factors for success	Proactive and motivated student improves workflow and allows faculty to focus on seeing patients and documenting Student should be comfortable interacting with patients, visitors, and emergency department staff Eager and motivated students are more innovative and offer to do tasks not thought of previously Students who are comfortable in the ED environment or have prior shadowing experience thrive in this role Student performance improves with time

2.5. Limitations

Our program has limitations that may affect its generalizability. It required motivated faculty and departmental support for implementation. Further, to gather student participants, it required a strong relationship with our undergraduate university. The major limitation we faced in assessing its effectiveness was obtaining open‐ended feedback from faculty regarding the program. While students were given feedback surveys as part of the program, only 3 of 8 faculty provided open‐ended data. This introduces an element of bias. Moving forward, we aim to develop a better system to obtain high‐yield feedback from all parties to optimize the program's success.

3. Reflective Discussion

Our Patient Task Facilitator Program has grown into a successful novel educational and mentorship experience. We believe that it can be easily implemented at other institutions. Other programs estimate new students require 2–3 h of preparation, including attending an orientation covering professionalism, clinic etiquette, and Health Insurance Portability and Accountability Act regulations [3, 5, 6]. We found this to be an accurate estimate. Participating students need to obtain hospital clearance, complete code of conduct forms, and receive a hospital photo ID badge. Additionally, they must complete immunizations and other health requirements. Our institution has onboarding services that we were able to utilize for our program.

The patient task facilitator program was assigned to one administrator who could field all questions, gather all necessary paperwork, address any deficiencies, and coordinate scheduling. This was vital in the program's continued success given the administrative burden that would be otherwise placed on the program's physician leader.

Student feedback has been an important part of the program's ongoing growth and development. Since its inception, the PTF program has morphed into a meaningful and worthwhile student experience—offering vital opportunities for exposure to the medical system and mentorship, while incorporating the students into patient care and the physician working environment. Shadowing programs' positive impact on student participants has been previously demonstrated, and our program had similar reviews. The program also aided participants' final decision to pursue a career in medicine. Some students, after getting real‐world exposure to the physician role, the working environment, and the physician‐patient interactions, decided they no longer wanted to pursue a career in medicine. Students reported that the program highlighted the realities of a patient care, and while this was met with enthusiasm and interest for most, it provided important insight regardless of subsequent career path.

Although limited, faculty feedback was essential. Four themes emerged that are key to success and improved workflow—incorporating patient task facilitators, patient task facilitator tasks, faculty tasks, and patient task facilitator factors for success. It is essential to discuss expectations before starting patient care and to evaluate whether students are meeting these expectations. If the student is not meeting these expectations consistently, they can become a burden to patient care and workflow and thus may be removed from the program.

Moving forward, we intend to better define and address obstacles for faculty recruitment, retention, and feedback. Additionally, we plan to gather objective data on clinical productivity to compare patient throughput and physician efficiency with and without patient task facilitators, as well as elicit more granular qualitative data on physician shift experience with task facilitators. We hope to then leverage these data to continue to recruit and maintain a strong cohort of faculty mentors.

Author Contributions

A.J. drafted the manuscript, conducted faculty interviews, and reviewed interviews for themes. S.G. created and currently runs the Patient Task Facilitator Program, and provided critical revisions of the manuscript. M.L.D. reviewed interviews for themes, provided critical revisions of the manuscript for intellectual content.

Conflicts of Interest

The authors declare no conflicts of interest.

Janicki A., Gonzalez S., and Dorfsman M. L., “Establishing the Patient Task Facilitator Program: Redefining the Shadower Role,” AEM Education and Training 9, no. 5 (2025): e70084, 10.1002/aet2.70084.

Data Availability Statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.