Important Considerations for Overseas Physician Shadowing Opportunities


What is the Atlantis Project?

In this blog post, I’ll share my opinion based on publicly available information I have found about Atlantis and their overseas shadowing program.

Atlantis – formerly, the “Atlantis Project” – is a company that facilitates overseas shadowing opportunities for aspiring medical students. Working with hospitals and practices in a number of European and South American countries, like Italy, Spain, Poland, Greece, Croatia, and Ecuador, to name a few, this company arranges 2-8 week summer and winter physician shadowing programs for students in a number of specializations. This blog includes what I learned about Atlantis/the Atlantis Project, its cost and purpose, and some important things to consider if you’re thinking about using this service or pursuing other overseas shadowing opportunities. Gaining shadowing experience is indeed worthwhile and can help build your CV in advance of applying to medical school; however, the question remains, is it worth gaining such experience overseas, and do the financial costs justify the actual benefits in terms of enhancing your application?

Atlantis Overseas Shadowing: Fundamentals

Atlantis connects aspiring medical students and future medical professionals with shadowing opportunities in a number of overseas locations, working with doctors and hospitals in a variety of specializations. According to their website, the “typical” student in their program is an undergraduate junior or senior who already has a significant amount of clinical and/or research experience. Shadowing placements range from 2-8 weeks, with students shadowing 5 hours per day (usually in pairs), 4 days per week, rotating specializations weekly, with students seeing a variety of specialties during their stay. Though they use language like “Fellowship”, “Clinical Fellowship”, and “Internship” on their website, it’s important to note that this experience seems like a shadowing experience (or, at least, I couldn’t find anything that would indicate otherwise) that takes place overseas, rather than in the U.S. That is, as in any shadowing opportunity, students should expect to witness physicians practicing medicine, interactions between doctors and patients, and should not expect there to be a hands-on component or research component to the trip. The AAMC has recently expressed concerns about student clinical activities, particularly in international contexts, wherein students are permitted to perform medical procedures. The Atlantis website makes note of this, and emphasizes that this is only a shadowing opportunity, and that their program is “AAMC-compliant”. Atlantis overseas shadowing differs from traditional shadowing in that it takes place outside one’s home country, and thus exposes students to the opportunity for cultural exchange as part of the broader experience.

Atlantis appears to arrange for shared dormitory-style accommodations in hotels, apartments, or student residences in the host country, and states that students stay only in safe neighborhoods, almost exclusively in “highly developed” countries. They also have English-speaking Site Managers on location in the host country, in case there are any problems. They provide travel health insurance that covers most “normal” medical expenses, as well as a local non-smartphone to stay connected with the Site Manager and their peers. Additionally, transit to and from the hospital each day is covered, if it is deemed too far to walk, and they note that the commute times can range from 5 minutes to more than an hour, depending on location, traffic, etc.

In their off-time, students are able to spend their time as they choose, exploring the city, participating in tourism activities, or visiting neighboring cities/countries, so long as travel documents for any cross-border travel have been arranged.

Atlantis Overseas Shadowing: Purpose

The stated aim of the Atlantis overseas shadowing program is to allow students to shadow physicians in multiple specialties, observe the practice of medicine first-hand in a hospital setting, gain global perspective on healthcare, and network with other students and healthcare professionals. They encourage students to travel and explore during their time overseas, and welcome students to arrive prior to the start of their shadowing to spend time experiencing the city or to continue travelling after the shadowing concludes, using this as a launch point for a longer vacation (though, of course, the cost of housing isn’t covered until the shadowing begins and ends as soon as the shadowing has concluded). They highlight opportunities to practice language skills in a native-speaking environment, increase exposure to other cultures and other perspectives on healthcare, develop friendships with other pre-meds, and suggest that students are able to increase their self-confidence by participating in their shadowing program. Essentially, it is posited as a study abroad program with hospital shadowing experiences.

“Wait, Can’t I Shadow for Free in My Home Country?”

Well, the short answer is: Yes. Shadowing is traditionally done in one’s home country, working with local hospitals or physician practices, and this is completely free. Atlantis emphasizes the cultural exchange aspect of their overseas shadowing program, which may be of value, but there are some things to consider with regard to such a program, which will be discussed in more detail momentarily. Shadowing is seen as part of the larger structure of support and mentorship within the medical community, with established generations of doctors supporting the next generations by allowing them to watch them at work. Shadowing is a great way to learn more about the day-to-day practice of medicine, to learn more about possible areas of specialization, and to add to one’s med school application. Some – but not all – medical schools require a certain number of physician shadowing hours, and even if a school doesn’t require it, it’s a good thing to have on an application (you can learn more about this in our blog, “How Many Shadowing Hours Do I Need to Get into Med School?”). As is detailed more extensively below, there are undoubtedly benefits to travelling overseas, experiencing different cultures, and networking with other students and medical professionals, all of which appear to be accessible through Atlantis overseas shadowing opportunities. If you’re not sure how to secure a more traditional shadowing experience, follow this link to learn how to ask to shadow a doctor.

“How Many Shadowing Hours Do I Need to Get into Med School?” Check out our response to this common question:

Atlantis Overseas Shadowing: Things to Consider

Cost

At the time of writing this, it appears that the prices they list for 2-8 week programs range from $2399-$7800, plus a non-refundable $900 enrollment fee. Student must also cover the cost of flight/train/bus to and from the host country, travel documents like visas, and some meals. As noted above, the cost of housing in shared hotel- or apartment-style rooms or student residences is covered by the program fees (they do note a likely lack of air conditioning in many accommodations, as this isn’t always a common amenity in overseas locations), but they note that a single room can be requested for an additional $25 per night. There are light daily breakfasts provided, as well as three group lunches or dinners each week and cultural excursions during the trip. Students cover the cost of other meals, excursions, and activities, as well as general incidentals. If there are any required medical tests or vaccinations required by the host country or hospital (e.g., Hepatitis B vaccination), these must be completed prior to departure.

Atlantis does seem to offer some financial assistance options, in the form of merit-based scholarships, need-based financial aid, and multiple payment plan options. Students must already be enrolled in the program to be eligible for financial assistance (i.e., it doesn’t appear possible to secure financial assistance and then decide to enroll if such assistance is awarded). They state that merit-based scholarships are offered for students who have excelled academically; financial aid for students with limited resources requires a separate application and is awarded on a case-by-case basis. According to their website, only around 1% of students will receive financial assistance, and most financial aid or awards will cover up to 15% of the student’s program fees.

Language barrier

While Atlantis ensures that their Site Managers on location all speak English, they state that they cannot make such guarantees with regard to the physicians students will shadow (and certainly not with regard to the locals/patients for whom the doctors are caring); even if the physician knows some English, they will be communicating with patients in their native language. On the one hand, if you have been learning another language, this is a great way to practice and test your fluency. As well, if the physician and patient do not speak English, you would be able to take note of non-verbal aspects of communication, which are indeed important and part of the larger patient-physician relationship. On the other hand, behavioral communication is certainly present when all are fluent speakers of the same language, and it is only possible to learn so much from a doctor who doesn’t speak the same language you do. Obviously, the physician cannot explain to you what they are doing or why, nor share their ideas on meaningful aspects of their work with you, if you do not speak the same language. This can be a barrier to learning, for some, so knowing your own learning needs here is very important. Shadowing is about more than just watching what a doctor does; at its very best, it’s also about that doctor communicating with the student about the realities of their day-to-day practice of medicine. This cannot happen if the language barrier is absolute.

5 hours/day

On average, students in Atlantis physician shadowing programs spend 5 hours per day, 4 days per week, shadowing physicians. They note that sometimes, due to the schedule of the hospital or doctor, this may fluctuate – say, shadowing for 7 hours one day, and only 3 hours the next day. Often, in more traditional shadowing, the day can be much longer – a full, 8-9-hour shift/shadow session is not uncommon. The reason for this is that few doctors work shifts shorter than this, and shadowing usually begins when the doctor enters their practice for the day and concludes as they leave for the day. So, one benefit is that a shorter day would give students in the overseas shadowing program more time to explore, take part in tourist activities, have meals with their group, and so on; but, it doesn’t give a full, accurate picture of what the day-to-day practice of medicine looks like in the U.S. That full picture is precisely the point of shadowing, in the traditional sense – the idea of what the practice of medicine is often differs considerably from the on-the-ground realities. If you’re looking into a specialty that would regularly have you putting in 10+ hour shifts, you’re not going to fully grasp that reality (and your own ability or desire to live that reality day-in and day-out as your career) from a series of 5-hour shadowing days.

Specializations

As students rotate specializations weekly, the number of weeks in your program largely determines the number of specializations you can see (i.e., ideally, if you sign up for a 3-week program, you’ll see 3 specialties, if you sign up for a 6-week program, you’ll see 6 specialties, etc.). Their website does note that, because hospital and doctor schedules vary, this may not always be the case, and some students may see more specialties/departments, some fewer. As well, while they make an effort to match students with their preferred department(s), they cannot guarantee the ability to shadow in one’s desired area(s) of specialization. Again, this is comparable to home country shadowing – you may not always be able to secure the area or areas of medical practice that you’re most interested in exploring. This isn’t necessarily a negative thing. As with the practice of medicine as a whole, things often look quite a bit different from the inside than we assume the will from the outside. Shadowing of any kind is a useful experience and being exposed to specialties you’re less familiar with – or even those you hadn’t considered at all – might offer an occasion for you to gain new insights into the field. If you have your heart set on a particular specialty, though, it appears that you aren’t guaranteed to see it, even with all the cost associated with an overseas experience.

“Extensive clinical/research experience”

As noted above, Atlantis identifies a typical student in the program as one who already has a wealth of experience with research and/or in a clinical setting. It’s great (though not necessary) to have such experience prior to going into a shadowing position, as this will enhance your understanding of what you’re witnessing. However, for those schools that don’t require shadowing, having such “extensive” experience can be equally impactful on your application – and sometimes even more so, depending on what that experience entails. If you’ve done medical volunteer work, worked in a position where you served others, gone on an international medical mission, researched and published in the field, these are often more impressive to admissions committees than shadowing alone. Again, if a school requires shadowing for an application, then you must have this. But shadowing is rarely the make-or-break aspect of your application, and such clinical or volunteer experiences often carry more weight.

Fundraising advice

For some students, several thousands of dollars for an overseas shadowing experience is not financially feasible, particularly when shadowing opportunities can usually be secured for free at home. While getting into medical school and studying medicine requires considerable monetary investment, such an investment is not always easy to secure, and many students need to be careful with how they make such investments, and/or how they allocate the debt they are taking on. The Atlantis website has a fundraising guide brochure, which they will not allow to be copied or distributed without express permission, so we will not recreate it here (it can be found by going to their website, clicking “Learn More”, and then selecting “Financing and Aid”, scroll down to find the link to download the Fundraising Guide, along with a link to their GoFundMe page, which students can use as part of their own fundraising campaign for financing their overseas shadowing trip). Without reproducing their materials, I’ll just say that if you have the time, logistical information, and resources to organize a marathon to raise funds, go for it, but you don’t need to do that to secure a shadowing opportunity. Likewise, there are many who would advise against sending funding request letters to the home addresses of doctors you don’t know personally, and that might be advice to consider. Feel free to review the suggestions in their brochure and implement them if you desire.

Perception

Because a shadowing program like this is may be financially inaccessible for some, and because shadowing is generally a free activity that is considered part of the generational mentorship at the heart of teaching and learning medicine, some have suggested that a program like this may not have the desired effect on one’s application. While one cannot put a price on the value of cultural exchange, and while international travel is largely considered beneficial for one’s own growth (as an aspiring physician and as a person), some might think that this looks more like medical tourism for those who can afford it – particularly if applying to a medical program that prioritizes care for underserved, impoverished, or marginalized communities. Pursuing shadowing opportunities is great for expanding your own knowledge and demonstrating your commitment to the field of medicine, but be sure to take into consideration the program to which you’re applying and how an experience like this might be perceived by the admissions committee. It may even be worth directly contacting the admissions department of the school(s) to which you’re applying and asking them whether such overseas physician shadowing programs are considered a positive addition to a candidate’s application – there is some suspicion out there, as evidence by AAMC’s statement of concern about some international clinical experiences (though, again, Atlantis states that they go to lengths to ensure their programs are AAMC-compliant). There isn’t one single, universal interpretation of such programs, and getting a feel for the priorities of the schools to which you are applying will benefit you in many ways, including – but far from limited to – the case of overseas shadowing programs.

Atlantis Overseas Shadowing: Is it Worth it?

This is a rather complicated question. Undoubtedly, international travel and opportunities for cultural exchange are invaluable, regardless of the context or reasons behind it. As well, networking with fellow pre-med students and aspiring medical professionals, while also possibly building relationships with physicians in other parts of the world (assuming they speak the same language as you), is always beneficial. Having a great time in a different country, making friends, and doing some learning while you’re there is lovely – and the opportunity for such a big trip may not present itself again for quite some time (since you’ll be busy with medical school!). If you’re going to do something like this while you’re young, now might be the time to do it.

Additionally, overseas shadowing cannot replace shadowing in the United States. You’ll still have to shadow in your home country, even if you’re participating in an overseas shadowing program. As well, understanding the practice of medicine in a global context is indeed important, but volunteering in areas where medical care is needed, or in rural, impoverished, or medically underserved areas, would give such perspective while also providing opportunities to learn about global health disparities and the practice of medicine in less-than-ideal circumstances, even if you’re “only” shadowing. Shadowing in international locations with a shared standard of care doesn’t necessarily allow for the same kinds of reflections that an experience like volunteering in impoverished or rural communities can – it allows you to see how the same medical procedures are done in relatively similar ways, just in different locations. If you’re considering participating in a program like this because you want it to stand out on your application, just ensure that you’ve looked into the impact of other kinds of overseas medical work and observation before making a final decision.

Ultimately, if you’re interested in this kind of program specifically because it is overseas, and you can either afford it or are willing and able to do the fundraising work necessary to afford it, that’s great! Do so for your own desires; do so because you want to do it and can access it.

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To your success,

Your friends at BeMo

BeMo Academic Consulting

Disclaimer: The following represents the opinion of the author and students are encouraged to make their own decisions. BeMo Academic Consulting Inc. does not endorse or affiliate with Atlantis and vice versa. To learn more about Atlantis, contact them directly. 

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