Master of Science in Bioethics and Medical Student Harvard Medical School, HKUMed - LKS Faculty of Medicine Boston, Massachusetts
Abstract: Medical shadowing is a critical component of medical education, yet the lack of a standardized shadowing process governing student involvement in Hong Kong’s (HK) public hospitals presents significant ethical and organizational challenges. HK hospitals, a prime example of integrated Chinese-Western medicine practices, adopts an opt-out informed consent model for student shadowing, in which patients often remain unaware of student observers, leading to presumed consent, potential privacy violations, and role misidentification. This lack of institutional oversight compromises patient autonomy and places students in ethically precarious situations without clear guidance on their responsibilities, eroding the integrity of medical education.
Unlike structured shadowing frameworks in other countries, HK’s public hospital system lacks uniform protocols for disclosure, consent, and supervision. This presentation uses HK’s public hospitals as a case to examine the ethical and systemic implications of a laxly implemented and enforced shadowing protocol through perspectives of patients, medical students, preceptor providers, and hospital leadership. It highlights risks including patient mistrust, legal liability, moral distress among students, and patient safety. Ultimately, it draws upon current initiatives in HK and proposes sustainable and innovative reforms, some of which can be derived from other countries' experiences and tailored to fit the unique cultural and organizational characteristics of HK’s public hospitals. These solutions include implementing a tiered consent process and leveraging digital technologies, amongst other strategies, building towards a streamlined and unambiguous consent process. These solutions offer opportunities to be expanded, adjusted, and applied in other healthcare systems globally, including hospitals in the United States.
Keywords: Medical Shadowing, Organisational Ethics, Healthcare Governance
Learning Objectives:
After participating in this conference, attendees should be able to:
Analyze the ethical, systemic and cultural challenges associated with student shadowing in Hong Kong’s public hospitals, including issues of consent, patient autonomy, and institutional oversight.
Evaluate the impact of different shadowing models in global healthcare settings and propose sustainable reforms for improving ethical governance in student involvement.
Develop institution-level policies and implementation frameworks to enhance transparency and patient consent in student shadowing, drawing insights from HK’s case study and adaptable to diverse healthcare systems.
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