"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.

Keywords: empathy; experiential learning; medical education; patient-centred care; social determinants of health.

Figure 1

Flow diagram of participant recruitment and inclusion.

Figure 2

The pre- and post-programme outcomes across eight learning domains. Each bar represents the percentage of students reporting agreement, awareness, or advanced understanding in the specified domain before and after participating in the shadowing programme.

Figure 3

Systemic barrier map with intervention points. This figure illustrates the interconnected relationships between social determinants of health, systemic barriers, and health outcomes. It highlights critical intervention points, such as addressing transportation and polypharmacy, that can improve patient-centred care. The visualisation underscores the importance of integrating non-clinical factors into healthcare decision-making.