Resident Supervision Policy
1. All resident patient care activity must be supervised by an attending physician with the
appropriate clinical privileges at Oakwood. All operative and major invasive procedures
require the presence of an attending physician in the operating room or interventional/cath
lab with the resident, except during wound closures. The management of each patient’s care
is ultimately the responsibility of the attending physician.
2. Residents and faculty members should inform patients of their respective roles in each
patient’s care.
3. Residents’ service responsibilities must be limited to patients for whom the teaching service
has diagnostic and therapeutic responsibility, except in rare circumstances such as Code Blue
or other emergency situations. (Teaching Service is defined as those patients for whom
residents routinely provide care)
4. Residents must write all orders for patients under their care, with appropriate supervision by
the attending physician. In those unusual circumstances when an attending physician or
subspecialty resident writes an order on a resident’s patient, the attending or subspecialty
resident must communicate his or her action to the resident in a timely manner.
5. Each physician of record has the responsibility to make management rounds on his or her
patients and to communicate effectively with the residents participating in the care of these
patients at a frequency appropriate to the changing care needs of the patients.
6. Residents or other appropriate supervisory physicians (e.g., subspecialty residents, fellows,
or attendings) with documented experience appropriate to the acuity, complexity, and
severity of patient illness must be available at all times on site to supervise first-year
residents.
7. 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.
a) The program director must evaluate each resident’s abilities based on specific criteria.
When available, evaluation should be guided by specific national standards-based
criteria.
b) 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.
Revised 06/2011
c) 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.
8. To ensure oversight of resident supervision and graded authority and responsibility, the
program must use the following classification of supervision:
a) Direct Supervision – the supervising physician is physically present with the resident
and patient.
b) Indirect Supervision 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.
c) Indirect Supervision 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.
d) Oversight – The supervising physician is available to provide review of
procedures/encounters with feedback provided after care is delivered.
9. GME programs must provide for progressive development and responsibility for their
residents while ensuring safe and appropriate care for patients. Programs must demonstrate
that the appropriate level of supervision is in place for all residents who care for patients. A
policy will be provided by each GME program describing the process faculty and program
directors use to make decisions regarding residents’ readiness to assume progressive
responsibility. In conjunction with this policy, each residency program will provide written
descriptions of the role, responsibilities, and patient care activities for each postgraduate year
level resident. These will include specific reference to who may write orders, what chart
entries must be co-signed by the attending physician, what procedures may performed, and
the mechanisms used for resident supervision. Programs must post residents credentials for
performing procedures without direct supervision on OakNet.
10. Programs must set guidelines for circumstances and events in which residents must
communicate with appropriate supervising faculty members, such as admissions, the transfer
of a patient to an intensive care unit, discharge or end-of-life decisions.
11. The department’s QA Committee will regularly submit to program directors reports on the
residency program’s clinical quality issues. Program Director’s will submit to the Medical
Education Committee annually a review of the residency program’s clinical quality issues to
include:
a) a summary of random chart audits conducted to ensure the above policies and
procedures are being followed
b) a review of any substantive quality of care issues involving the program identified
during that period and the resulting action plans and follow-up
c) specific patient safety initiatives that have been undertaken, and
d) any actions taken in regards to resident performance in their program.
12. The ACGME Institutional Requirements, and the Common Program Requirements, specify
that resident supervision must be assured at all times. Programs must ensure the availability
Revised 06/2011
of schedules that inform all members of the health care team of attending physicians and
residents currently responsible for each patient’s care:
Program Directors or their designees should always be available by page to the residents
for supervision in the case that they are unable to contact faculty or medical staff for
supervision. They must notify the page operator and the Medical Education office of the
designated “back-up” physician supervisor for the residents in their absence. The
Director of Medical Education or their designee is available at all times through the page
operator as a final back-up, in case faculty, program director or designee cannot be
contacted for some reason.
These procedures will ensure that there is always a physician available to the residents for
consultation and supervision of their patient’s clinical care. Program Director should
communicate with all of faculty and house staff outlining the procedures that will ensure
24 hours a day, 7 days a week, availability of supervision to residents for their clinical
care activities. They should immediately notify the page operator of their availability
status, or the designated emergency back-up physician for their program.
Finally, an e-mail or memorandum should be sent to the Medical Education office and
the page operator, when the program director or their designee is delegating
responsibility to another physician in case of vacation or leave.
13. Faculty and residents will be provided annual education on resident supervision policies.
14. Compliance with resident supervision policies will be monitored by the GMEC. This will
include the regular review of resident supervision compliance through:
a) Review of posted program policies, job descriptions and credentialing at least
annually
b) Annual resident survey data (both internal and ACGME resident surveys)
c) Internal reviews of residency programs.
Revised 06/2011