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Supervision of Residents (43.19)

Supervision of Residents (43.19) - Policies, Administrative, UWHC, Department Specific, Graduate Medical Education (GME)

43.19



Graduate Medical Education Departmental Policy

Policy Title: Supervision of Residents
Policy Number: 43.19
Effective Date: November 18, 2015
Version: Revision
I. PURPOSE

To establish an institutional supervision policy to ensure all residency and fellowship training programs
provide increasing amounts of responsibility with appropriate supervision of residents.
II. PERSONS AFFECTED

This policy applies to all Graduate Medical Education (GME) programs and residents sponsored by the
University of Wisconsin Hospitals and Clinics (UWHC).

III. DEFINITIONS

A. Resident is intended to include all residents and fellows in ACGME accredited training programs
sponsored by the University of Wisconsin Hospitals and Clinics.
B. Program(s) will refer to ACGME-accredited program(s).

IV. POLICY

A. Program Policies: All UWHC GME training programs must create a program-specific
supervision policy that aligns with ACGME program requirements, this policy, the Bylaws, Rules
and Regulations of the Medical Staff of the University of Wisconsin Hospital and Clinics, the
Joint Commission, law and other hospital policies. In the case of inconsistent requirements, the
most restrictive must be followed.
B. Supervision of Residents: In the clinical learning environment, each patient must have an
identifiable, appropriately-credentialed and privileged attending physician (or licensed
independent practitioner as approved by each Review Committee) who is ultimately responsible
for that patient’s care.
1. This information should be available to residents, faculty members, patients and other
hospital staff.
2. Residents and faculty members should inform patients of their respective roles in each
patient’s care.
3. In all resident care cases, the ultimate responsibility rests with the attending physician, who
determines the level of supervision required for appropriate training and to assure quality of
patient care.
C. Levels of Supervision
1. Direct Supervision – the supervising physician is physically present with the resident and
patient.
2. Indirect Supervision:


a. With direct supervision immediately available – the supervising physician is physically
within the hospital or other site of patient care, and is immediately available to provide
direct supervision.
b. With direct supervision available – the supervising physician is not physically present
within the hospital or other site of patient care, but is immediately available by means of
telephonic and/or electronic modalities, and is available to provide direct supervision.
3. Oversight – The supervising physician is available to provide review of
procedures/encounters with feedback provided after care is delivered.
D. Progressive Authority and Responsibility
1. The privilege of progressive authority and responsibility, conditional independence, and a
supervisory role in patient care delegated to each resident must be assigned by the program
director and faculty members.
2. Each resident’s abilities should be evaluated based on specific criteria. When available,
evaluation should be guided by specific national standards-based criteria.
3. Faculty members functioning as supervising physicians should delegate portions of care to
residents, based on the needs of the patient and the skills of the residents.
4. Senior residents or fellows should serve in a supervisory role of junior residents in
recognition of their progress toward independence, based on the needs of each patient and the
skills of the individual resident or fellow.
5. Programs must set guidelines for circumstances and events in which residents must
communicate with appropriate supervising faculty members, such as the transfer of a patient
to an intensive care unit, or end-of-life decisions.
6. Each resident must know the limits of his/her scope of authority, and the circumstances under
which he/she is permitted to act with conditional independence.
7. Faculty supervision assignments should be of sufficient duration to assess the knowledge and
skills of each resident and delegate to him/her the appropriate level of patient care authority
and responsibility.
E. On-call schedules and rotation schedules are developed to provide residents with a variety of
patient experiences. Supervision is available at all times through more senior residents and faculty
attending physicians.

V. PROCEDURE

A. Each GME program must establish and review annually a program level policy and procedures
associated with supervision of residents that incorporates the standards set forth in this policy.
B. GME programs are responsible for educating their residents and faculty regarding appropriate
supervision for patient care activities.
C. Policy must include circumstances in which clinical trainees must communicate with the
supervising physician including but not limited to end of life decisions, discharge against
medical advice and transfer to an intensive care unit.
D. Policy must assure supervising physicians and clinical trainees receive and understand the
lines and levels of supervision for each graduate level and rotation (when appropriate).
E. Each program will post their supervision policy on MedHub in the trainee job description area, to
be available to hospital staff. UWHC leadership as needed may set additional procedure
documentation requirements.
F. Occasionally the need arises for nursing unit staff or other UWHC clinical staff to reach a
supervisory physician. Reasons for this include inability to reach the physician (usually a
resident) on call, or the need to resolve a concern that has not been resolved after discussion with
the physician on call. We have encouraged moving up the chain of command when clinical issues
require resolution. UWHC Paging has used the chain of command concept for years. The
proposed change will make our front line clinical staff aware of the chain of command. Some


have indicated to us they are unsure of who to call if the intern on call does not answer a page—
the chain of command may vary by department. In general, the Message Center (UWHC Paging)
will follow this algorithm:
Intern or junior resident

Senior resident

Fellow (if applicable)

Staff physician on call

Division Head (if relevant)

Vice Chair for Clinical Affairs

Department Chair

Chief Medical Officer

If an individual does not respond, UWHC Paging will move to the next line of the algorithm. The change
will be making front line staff aware of the chain of command option. The goal is to provide timely high
quality care to all of our patients.

I. MODIFICATIONS
This Policy creates no rights, contractual or otherwise. Statements of policy obtained herein are not made
for the purpose of inducing any person to become or remain an employee of UWHC, and should not be
considered "promises" or as granting "property" rights. UWHC may add to, subtract from and/or modify
this Policy at any time. Nothing contained in this Policy impairs the right of a non-represented employee
or UWHC to terminate the employment relationship at-will.
II. REFERENCES

ACGME Institutional Requirements (www.acgme.org)
ACGME Policies and Procedures Manual (www.acgme.org)
ACGME Common Program Requirements (www.acgme.org)
Bylaws, Rules and Regulations of the Medical Staff of the University of Wisconsin Hospital and Clinics

III. COORDINATION

Sr. Management Sponsor: Susan L. Goelzer, M.D., Designated Institutional Official
Author: Director, Graduate Medical Education and Medical Staff Administration
Review/Approval Committee: Graduate Medical Education Committee 11-18-15

SIGNED BY






Susan L. Goelzer, M.D., M.S.
Professor of Anesthesiology, Internal Medicine and Population Health Sciences
Senior Medical Director for GME/Designated Institutional Official
Associate Dean for Graduate Medical Education

Revision Details:

Previous Revision Date: 8/31/2013
Next Revision Due: 10/21/2018 (3 years after effective date)