"Walking a Day in My Shoes": A Clinical Shadowing Program to Enhance Medical Students' Understanding of Chronic Disease Management Beyond Clinical Settings.

Abstract

Aims/background: Medical education is largely clinical and biomedical with little emphasis being put upon the social determinants of health (SDH) and patient-centredness. A programme entitled "Walking a Day in My Shoes" was devised as a pilot cohort study with the view of evaluating the impact of a clinical shadowing experience upon the empathy, SDH awareness, and patient-centredness of medical students.

Methods: A prospective cohort study, involving 28 final-year London-area medical students, employing a three-phase teaching programme comprising preparation, observation, and reflection was carried out. Students' confidence in the management of non-medical barriers, SDH awareness, and empathy before and after shadowing were measured using pre- and post-shadowing questionnaires. Qualitative analysis of patient feedback and journals also occurred.

Results: Statistically significant improvements were observed in students' empathy (mean score increase from 6.8 to 8.9, p < 0.001), understanding of SDH (advanced comprehension rose from 35% to 93%), confidence in addressing non-clinical barriers (from 39% to 86%), and awareness of logistical challenges (from 31% to 81%). Qualitative analysis highlighted key themes, including systemic barriers (transportation, polypharmacy, and social isolation) and students' increased awareness of the emotional toll of chronic illness. Patients expressed high satisfaction, with 97% agreeing that the programme improved students' understanding of chronic disease management. These findings suggest the programme's practicality and scalability in medical education.

Conclusions: This pilot cohort study demonstrated the significant enhancement of the students' empathy, perception of SDH, and patient-centredness preparation through immersive shadowing. The findings support the use of experiential learning programmes as curricular interventions.