Shadowing (Observation)

References

• United States Codes, 5 USC Sec 3111, Acceptance of Volunteer Service.
• Public Law 104-91, Health Insurance Portability and Accountability Act, 21 Aug 2006.
• OTSG/DASG-PSZ-MG Memo, Standards for Student Shadow Experiences at Army MTFs, 17 July 2013.
• MEDCOM Memo, Student Visitor and the Health Insurance Portability and Accountability Act, 22 Aug 2006.
• TAMC Regulation 40-27, Pre-Placement Medical Immunizations Requirements for Military and Civilian Students/Trainees/Observers, 25 February 2022,

Policy

• Shadowing is a time-honored recruitment tool, not only for medical professions, but for the Army in general. With the impressive resources we have here the opportunities for recruitment of future physicians, health care providers and non-allied health individuals who wish to participate.
• This policy does not apply to active duty military, DHA (Defense Health Agency), or DoD (Department of Defense) civilians wanting to shadow here at Tripler. Individuals wanting to shadow must contact the Red Cross.
• The purpose of this policy is to address the privacy and security requirements for shadowing, and to enable Tripler to ensure patient confidentiality rights are respected, patient safety is optimized, and Tripler policies and procedures are followed.
• It is part of the mission of Tripler to provide educational opportunities to the community and to members of the health care profession.
• Shadowing allows students to follow and observe a hospital staff member as they carry out their job responsibilities.
  • Students must be at least 16 years of age, and enrolled in high school or college.
  • Eligible "student" (all shadowing must be in an actual "student" status at a school or institution).
  • Does not include students participating in a contracted program of study with Tripler.
  • Student must be a U.S. citizen.
  • Short-term shadowing opportunities are intended to give the student an inside look at careers at Tripler, both in clinical and non-clinical areas, in order to aid in career decisions.
  • Tripler does not offer long-term shadowing experience.
  • Any student seeking educational credit will be excluded and redirected to the Red Cross.
  • Observation/Shadowing shall be prohibited in Behavioral Health. Exceptions may be made in Behavioral Health with written administrator approval, signed consents from patients or patients' authorized decision makers, and written explanation on the Observation Shadowing Agreement.
• Shadowing at Tripler Army Medical Center is limited to 40 hours and between the hours of 0800 to 1600 (8 A.M. to 4 P.M.), Monday through Friday. No shadowing during the evening, weekends or holidays.
• We strongly recommend that individual shadow only after exploring health care careers via other avenues and after narrowing interest to a particular career or area.

Scope

• The scope of this policy applies to individuals who meet the above description of an shadow.
• This policy does not apply to patients, family members or friends visiting or accompanying patients, or to medical staff residency rotations.
• The Graduate Medical Education (GME) Office is the proponent of shadowing program here at Tripler per U. S. Army Medical Command (MEDCOM); any exception to this policy must be coordinated with the GME Office.
• MEDCOM student visitor policy implies that we should only be hosting students who have a potential interest in the military Health Professions Scholarship Program.
• The GME Office is not responsible for obtaining a sponsoring department/service or an escort for participants.

Shadower Responsibilities

• To get a sponsor.
• Complete the Observation Shadowing Agreement.
• No-later-than fifty (50) days out from start of shadowing, provide sponsor with all required immunization documentation. 
  • Is responsible for obtaining vaccines at his/her own expense.
  • Will not be able to begin the shadowing experience without providing proof of the required immunizations.
  • No immunization exemptions of any type are allowed.
• Since immunization records are Protected Health Information (PHI), under the Health Insurance Portability and Accountability Act (HIPAA) the transmission of such will be via a secured website such as DoD SAFE (Department of Defense Safe Access File Exchange) and follow the instructions on the website for submission at https://safe.apps.mil
• Contact sponsor for official address to send immunization documentation.
• You will not contact the Occupational Health Services for any reason. If you have any questions concerning immunizations, please address your concerns with your sponsor.

Sponsor Responsibilities

• Will ensure that all shadower is registered through Patient Administration before shadowing starts.
• Will provide immunization documentation to Occupational Health Services for review per instructions contained in Tripler Army Medical Center Regulation 40-27.
• If any discrepancies in Occupational Health Services review, sponsor will notify shadower to provide necessary documentation to correct such and resubmit for review and approval of pre-clearance requirements.
• Sponsor shall agree to minimize the amount of PHI to which the shadower is exposed to. Under no condition is the observer to be provided with copies of any PHI or materials containing PHI.
• Ensure that shadower will not partake in any direct clinical care.
  • Will request permission in advance from each patient, or the patient's legal representative, an opportunity to agree or object to the presence of the shadower.
  • Consent is sought without the shadower present so that patient or the patient's legal representative is given every opportunity to refuse.
  • If patient or legal representative refuses the shadower to be present the sponsor will need to place observer with another staff member or in an area conductive for the observer to wait until the sponsor can continue the experience.
• Agreement must be documented in the patient's medical record.
  • For example, the patient' agreement to the shadower presence could be documented as "Consent obtained to have shadower participant present."
  • In situations where the patient may be unable to provide consent, observation will not occur (i.e., where the patient is unconscious, etc.)
• Provide an environment of learning.
• Assure shadower is in compliance with shadower responsibilities.
  • If not, request the termination of the shadowing experience.
  • Reason for termination should be in writing to the shadower.

Department Responsibilities

• Chiefs of department will review all requests and will have final approval for all shadowing before allowing shadower to shadow, based on the department's ability to accommodate the request. Request can be denied.
• Each department should establish procedures regarding oversight, sponsorship, availability, and how the shadower is scheduled and coordinate his/her experience.
• Be responsible for the in- and out-processing of shadower.
• Maintain a record of shadower who have participated in the shadowing experience.
• Ensure that all shadower sign-in and –out with the GME Office.
• Ensure that each shadower obtain and wear a badge identifying him/her as a shadow.
• Inform the GME Office 24-hours in advance of shadower arrival for shadowing experience.

Graduate Medical Education Office Responsibilities

• Verify shadower by two forms of picture ID.
• Verify that shadower has proof of medical insurance coverage.
• Verify that shadower has been precleared by Occupational Health Services.
• Have shadower sign Visitor (Shadow) Badge Sign-in/Sign-out Sheet.
• Issue shadower Shadow/Observe badge.
• Inform shadower that while shadowing that he/she must sign-in/-out every day with the GME office.