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Supervision Policy


RUHS assumes full responsibility for the supervision of resident physicians in the Family Medicine Residency Program. This responsibility is delegated to the individual departments and fulfilled by the Attending Physician (Medical Staff) in various clinical departments.

 

Level of Supervision:

1. Direct Supervision - The supervising physician is physically present with the resident and patient.
2. In-Direct 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.

 

Supervision in the Family Medicine Department:

1. Inpatient

The Family Medicine attending physician on the service must see and examine every patient on the service daily, and supervise residents by reviewing orders and plan of care. The Family Medicine attending physician provides on-site and in-person supervision for all procedures.

 

a. PGY-1 residents are supervised at all times by a senior resident or an attending during admissions.

b. PGY-1's are given increased responsibility of care of patients as their knowledge and skill set increases, and faculty make this determination based on feedback and evaluations from the senior residents who have worked with the junior residents

c. PGY-1 residents care for the critically ill patients in the ICU under the supervision of the intensivist and/or the Internal Medicine Team.

d. Senior call is usually done by PGY-3 residents, and in some cases PGY2 residents

e. PGY-2 and PGY-3 residents are encouraged to contact the faculty on call with any question they have and are required to call the attending on call based on the "Attending Notification Policy"

f. All transfers of patient care are supervised by an attending physician.

g. Hand-Off communication is directly and indirectly (over the phone) supervised by an attending physician, depending on when the hand-off occurs.

 

The following requires automatic Attending Notification:

The senior resident on call or senior ward resident MUST inform the appropriate attending ASAP in the event of:

  • Admission of all obstetrical patients, elderly patients ≥ 75 years of age, and patients less than 18 years of age.
  • Transfers to PCU, ICU or NICU not discussed previously
  • ER discharges.
  • Direct patient transfers.
  • Death or any significant change in hemodynamic, respiratory and neurological status
    • new or persistent hypotension
    • new or persistent tachycardia
    • new or persistent respiratory distress
    • new or persistent altered mentation
  • Medication errors requiring clinical intervention.
  • Code Blue or Rapid Response Call
  • Family expressing dissatisfaction
  • A clinical problem requiring invasive procedure or operation not anticipated or addressed earlier by the attending.
  • For any question or concern at any time of the day
  • Any need for end-of-life decision
     
    2. Obstetrical Deliveries
     
    The Family Medicine and/or OB attending physician provides on-site and in-person supervision for continuity OB patients in active labor through delivery.
     
    3. Family Medicine Center
     
    During each clinic session in the continuity clinic sites, a ratio of no less than 1:4 Attending: Resident will be used for precepting and supervision of residents.
     

PGY-1 Resident: In the first 6 months, all PGY-1 residents will be directly observed for 100% of their clinic visits, at which time they will be expected to have 4 patient visits per clinic session.

• This process of supervision will occur until the resident is evaluated by the Clinical Competency Committee after 6 months of training and cleared for active precepting.

• In the second 6 months, the number of clinic visits increases to 6 visits per clinic session.

• All PGY-1 residents will be directly supervised for all procedures.

• All PGY-1 residents advance to the next level of training if they achieve the criteria of the Promotion Policy.


PGY-2 Resident: All PGY-2 residents will participate in "active precepting" for 100% of their clinic visits, at which time they will be expected to have 7 patient visits per clinic session. 

• In the second 6 months, the number of required clinic visits increases to 8 patients' visits per clinic session.

• All PGY-2 residents will be directly supervised for all procedures.

• All PGY-2 residents advance to the next level of training if the achieve the criteria of the Promotion Policy.


PGY-3 Resident: All PGY-3 residents will participate in "active precepting" for 100% of their clinic visits, at which time they will be expected to have 9 patient visits per clinic session. 

• In the second 6 months, the number of clinic visits increases to 10 patients' visits per clinic session.

• All PGY-3 residents will be directly supervised for all procedures.

• All PGY-3 residents advance to the next level of training based on their meeting the criteria in the Promotion Policy.

4. Nursing Home and Home Visit 

  1. PGY-2 and PGY-3 residents do care for their continuity patients in alternative sites (home visits and nursing homes)
  2. Residents are permitted to see their NH patient(s) alone and may call the faculty to discuss the case. Indirect supervision of their progress notes or admission notes occur by an Attending physician.
    • All residents must call within 24 hours for routine visits and routine admissions
    • All residents must discuss changes in status or urgent issues with the faculty assigned to that particular patient or the on-call faculty if it occurs after hours.
  3. All home visits are performed with a multi-disciplinary care team and are supervised by an attending physician on site. 


Supervision in Non-Family Medicine Departments

1. Inpatient
The level of supervision must be commensurate with the resident's level of training and his / her individual level of clinical skills. All PGY1 residents must have on-site / in-person supervision by a senior resident or attending physician for all clinical duties, including ED admissions and ward patients. On call schedules for faculty assures that supervision and / or consultation is readily available at all times to residents on assigned clinical duties.
For inpatient and ED procedures, all residents must be supervised on-site and in-person by an attending physician.

2. Outpatient Clinics
During all three (3) years of residency, all patients visits and progress notes must be reviewed and
co-signed by an attending physician at the time of the visit.
All procedures performed by residents in the clinic must be supervised on-site and in-person by an attending physician.