Resident Supervision

University of Tennessee College of Medicine
Graduate Medical Education

Institutional Policy on Resident Supervision

Definitions:

Supervision is defined at three levels: General, Direct and Personal

• General supervision means that the care or procedure is conducted under the staff member's overall direction and control but the physician's presence is not required at the time of care. Access the Defined List of Procedures designated as General Supervision
• Direct supervision requires that the physician must be immediately available to furnish assistance and direction.
• Personal supervision means that the staff physician must be in attendance in the room during the procedure.

General Policy:

The program director of the resident and the chairman of the department to whom the resident is assigned is responsible for supervision of the resident. Responsibility for the specific supervision may be assigned to a staff member supervising the resident on various academic rotations. Residents are members of the medical staff as defined in the hospital by-laws. They may provide assistance in the care of patients of physicians on the service to which they are assigned.

All patients receiving care at this institution are assigned to a member of the active staff. The staff member responsible for the care of the patient will provide the appropriate level of supervision based on the nature of the patient’s condition, the likelihood of major changes in the management plan, the complexity of care, and the experience and judgment demonstrated by the residents being supervised.

As part of the training program, residents should be given progressive responsibility for the care of patients and to act in a teaching capacity and provide supervision to less experienced residents and students. It is the decision of the staff member, with advice from the program director, as to which activities the resident will be allowed to perform within the context of the assigned levels of responsibility. The overriding consideration must be the safe and effective care of the patient.

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.

Inpatient Areas: In general, patients admitted by residents to the hospital who are in
stable condition will receive General supervision. The resident should notify the
attending physician at the discretion of that attending (e.g. for every patient admitted or for selected patients). The attending physician will be expected to see the patient and/or review the management plan within 24 hours.

Outpatient Clinic: Residents seeing patients in an outpatient clinic will receive Direct supervision. Management plans for new patients or revision of management plans will be reviewed before the patients have left the clinic.

Emergency Room: Residents assigned to the emergency room service will receive Direct or Personal supervision depending on the severity of the problem and experience of the resident. Residents providing consultation or care to patients followed by their respective services receive General supervision by the staff of their service. Dispositions of these patients may be discussed by phone with the appropriate staff member and/or reviewed on return to an outpatient facility. If the patient is admitted, the treatment plan will be reviewed by the attending faculty the next day.

Operating Room or Special Procedure Facility: Residents performing diagnostic procedures that require a high level of expertise in performance or interpretation will receive General, Direct, or Personal supervision by a faculty member depending on the experience and proficiency previously demonstrated by the resident.

Emergency Care: In an emergency, defined as a situation where immediate care is necessary to preserve life or prevent serious impairment of health, residents are permitted to perform everything possible to save a patient from serious harm pending arrival of more qualified staff. The appropriate staff practitioner will be notified as soon as possible.

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