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UNDER EMBARGO UNTIL SATURDAY, MARCH 29, 2025, AT 7:30 A.M. ET

Newswise — Bethesda, MD – March 29, 2025 – A new study from the Uniformed Services University (USU), "Rethinking Shadowing for Aspiring Physicians," just published in the New England Journal of Medicine, challenges the traditional emphasis on physician shadowing as a key criterion for medical school admission, highlighting its financial and accessibility barriers for many aspiring doctors. The study, authored by Army Col. (Dr.) Danielle B. Holt and Dr. Eric A. Elster, calls for a reevaluation of shadowing practices and suggests alternative pathways for professional identity formation in premedical students.

Medical school admission in the United States remains highly competitive, with prospective students submitting an average of 18 applications each in 2024, according to the Association of American Medical Colleges (AAMC). Shadowing a physician is widely regarded as an essential experience for applicants, with 95% of students in the AAMC’s 2024 Matriculating Student Questionnaire reporting they had participated in physician shadowing. However, the study finds that shadowing—often requiring 100 to 150 hours of observation—can disproportionately favor students from higher-income backgrounds and create unnecessary financial burdens.

“Premedical students are spending hundreds of hours shadowing, often taking gap years to gain experience, which delays their entry into the workforce and increases financial strain,” said  Holt, who is the Associate Dean for Recruitment and Admissions for USU’s Hebert School of Medicine. “Our research found that students who shadowed more than 50 hours were more likely to be admitted to medical school and that higher family income was correlated with greater access to shadowing opportunities.”

The study, which analyzed 17,157 USU applications from 2019 to 2024, found that only 59% of applicants reported shadowing a physician. Among those accepted, the average number of shadowing hours was 130, compared to 119 for non-accepted applicants. The data also revealed that students from higher-income backgrounds were more likely to accumulate extensive shadowing hours, further widening the opportunity gap.

Beyond accessibility concerns, the study also raises questions about the educational value of unstructured shadowing experiences. Most shadowing opportunities lack defined learning objectives, structured assessment, or time for reflection. The presence of observers in clinical settings can also place strain on medical teams and patients if roles and expectations are unclear.

To address these issues, the study suggests expanding access to structured clinical experiences, such as preceptorships in undergraduate and postbaccalaureate programs. It highlights the Stanford Immersion in Medicine Series, which integrates shadowing into a structured academic course, as a model for improving the quality of clinical exposure while maintaining accessibility. Data from the Stanford program indicate that students need far fewer shadowing hours—often just 11 to 20—to determine whether medicine is the right career path for them.

Elster, Dean of USU’s Hebert School of Medicine, emphasized the need for a broader definition of clinical experience. “Many alternative experiences, such as working as a paramedic, emergency dispatcher, or certified nursing assistant, provide meaningful hands-on involvement and professional growth that shadowing alone cannot offer. Medical schools should prioritize these diverse experiences over passive observation.”

At USU, the admissions process prioritizes service, leadership, and adaptability—qualities essential for military medicine and beyond. The study advocates for medical schools nationwide to adopt a more holistic review of applicants, valuing a wider range of experiences that cultivate critical competencies outlined by the AAMC.

“If we redefine what constitutes a valuable premedical experience,” Holt said, “we can make medical education more accessible and foster a well-prepared physician workforce driven by genuine pursuits.”

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About the Uniformed Services University

The Uniformed Services University of the Health Sciences (USU) is the nation’s only federal health sciences university. USU educates and trains health professionals, scientists, and leaders to support the readiness and health of the military and public. With a focus on service, leadership, and excellence in research, USU prepares students to meet the unique challenges of military medicine and beyond. For more information, visit.