The Program Director assigns each fellow for clinical supervision by members of the teaching faculty. Neither the fellow's clinical privileges nor his/her clinical responsibilities shall exceed in scope those of his/her supervising physician. A fellow's responsibilities shall include patient care activities within the scope of his/her clinical privileges, attendance at clinical rounds and seminars, timely completion of medical records, and other responsibilities as assigned or are required of all members of the Medical Staff. The supervising Physician shall make clinical assignments to each assigned fellow consistent with the fellow's experience and demonstrated clinical competence, and strive to ensure that each fellow performs assigned duties in an appropriate manner.
A full time faculty member of the University of Tennessee will supervise all fellows. Faculty supervision of procedures performed by each fellow must occur until proficiency has been acquired and documented in evaluations and procedure logs.
Documentation of supervision will be by progress note or signature by the attending physician or reflected within the resident's progress notes at a frequency appropriate to the patient's condition.
Outpatient Clinics: Fellows seeing patients in an outpatient clinic will receive Direct supervision. Management plans for new patients or revision of management plans for existing patients will be reviewed before patients have left the clinic. Attending faculty members on-site provide direct supervision of the fellows in all outpatient clinics. Fellow clinics are held in designated areas (or the same practice area as the faculty practice) and are supported in the areas of nursing, laboratory and other services in the same manner as the faculty practice settings.
Inpatient Settings at Night and on Weekends: In general, fellows seeing in-patient consultations will receive General supervision. The fellow should notify the attending physician at the discretion of that attending (e.g., for every patient seen or for selected patients). The attending physician will be expected to see the patient and/or review the management plan within 24 hours. Management/teaching rounds are conducted seven days a week including holidays.
A faculty member is available in the Medical Center 24 hours per day (or is generally present in-house but always available by telephone at all times). A faculty member will provide direct supervision for any complex or seriously ill patient who is seen by the fellow.
Special Procedures: Fellows performing diagnostic procedures such as arthrocentesis or interpretation of synovial fluid microscopy will receive General, Direct, or Personal supervision by a faculty member depending on the experience and proficiency previously demonstrated by the fellow.
Emergency Care: In an emergency, defined as a situation where immediate care is necessary to preserve life or prevent serious impairment of health, fellows are permitted to perform everything possible to save a patient from serious harm pending arrival of more qualified staff. The appropriate attending will be notified as soon as possible.
Definitions:
Supervision is defined at three levels: General, Direct and Personal.