From Fly on the Wall to Future Colleagues: Best Practice Recommendations for Medical Student Shadowing Programs.

Background: Physician shadowing is a common component of early medical education and frequently represents students' first exposure to clinical practice. Despite its prevalence, existing guidance primarily targets learners rather than physicians supervising shadowing experiences. This gap is especially relevant in the emergency department (ED), where high patient acuity, workflow demands, and complex clinical environments create challenges for providing safe and meaningful observational learning. We sought to develop consensus-based best practice recommendations for ED faculty supervising medical student shadowing. Methods: We conducted a modified Delphi study using an online survey platform to achieve panelist consensus. Ten emergency medicine educators with a mean of 7 years of experience in medical student advising and clerkship leadership participated. Panelists initially generated 70 proposed best practice recommendations, which were refined to 54 unique items after removal of duplicates. Four Delphi rounds were completed, during which participants iteratively selected and refined recommendations through anonymous voting and feedback. Items were progressively eliminated or merged according to consensus thresholds until a final set of recommendations was established. Results: Consensus was achieved on 10 best practice recommendations after four Delphi rounds. Key themes included establishing structured scheduling and orientation processes, clearly communicating expectations and eligibility requirements, limiting concurrent learners, assessing students' backgrounds and goals, assigning a designated preceptor, enforcing restrictions on direct patient care, integrating students into the clinical team, providing opportunities for questions and reflection, maintaining engagement during workflow lulls, and modeling professionalism. Panelists emphasized balancing educational value with patient safety and clinical efficiency. Conclusions: These consensus-driven recommendations provide practical guidance for supervising medical student shadowing in the ED. Standardizing shadowing practices may transform shadowing into a structured early clinical learning experience, improving learner engagement, supporting safe educational environments, and enhancing early exposure to emergency medicine. Future research should evaluate implementation outcomes and applicability across specialties.