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Residents In This Section

Resident Supervision Policy

I. Purpose of Policy

The Accreditation Council for Graduate Medical Education (ACGME) Institutional Requirement stipulate that the Graduate Medical Education Committee (GMEC) must establish guidelines regarding the levels of supervision required for all graduate medical trainees. These supervisory guidelines shall provide all residents with an educational program that is clinically and academically progressive and that complies with the requirements of the ACGME and the individual specialty boards. All accredited programs must assure that resident in their programs, as well as all supervising or attending physicians, adhere to the following standards to optimize patient care and the educational experience.

II. Policy Scope

This policy applies to all Dartmouth-Hitchcock (D-H) residency and fellowship programs, and supervising faculty.

III. Definitions

Resident: Any physician in an accredited graduate medical education program, including interns, residents, and fellows.

Progressive Authority and Responsibility: 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.

IV. Policy Statement

  • Every program must have a program-specific Supervision Policy consistent with the GME Resident Supervision Policy and RRC requirements.

  • Levels of Supervision: To ensure appropriate oversight of resident supervision, each program must use the following classification of supervision:
    • Direct Supervision – The supervising physician is physically present with the resident and patient.
    • Indirect Supervision:
      • With direct supervision immediately available – The supervising physician is physically within the confines of the site of patient care, and is immediately available to provide direct supervision.
      • With direct supervision available – The supervising physician is not physically present within the confines of the site of patient care, but is immediately available via telephonic and/or electronic modalities, and is available to provide direct supervision.
    • Oversight – The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

  • Faculty supervision assignments should be of sufficient duration to assess the knowledge and skills of each resident and delegate to them the appropriate level of patient care authority and responsibility.

  • Each program is responsible for developing descriptions of the level of responsibility accorded to each resident by rotation and Post-Graduate Year (PGY) level. These descriptions must include identification of the mechanisms by which the participant’s supervisor(s) and program director make decisions about each resident’s progressive involvement and independence in specific patient care activities. In particular:
    • The program director must evaluate each resident’s abilities based on specific criteria established by the faculty of the training program. These criteria shall be guided by national standards-based criteria when such are available;
    • Supervising faculty members will delegate patient care activities to residents based on the needs of the patient and the demonstrated abilities of the resident;
    • Senior residents or fellows should serve in a supervisory role of junior residents with appropriate patients, provided their demonstrated progress in the training program justifies this role;
    • In each training program, there will be circumstances in which all residents, regardless of level of training and experience, must verbally communicate with appropriate supervising faculty. Programs must identify and set guidelines for these circumstances and these must be available in writing for all residents. At a minimum, these circumstances will include:
      • Emergency admission;
      • Consultation for urgent condition;
      • Transfer of patient to a higher level of care;
      • Code Blue Team activation;
      • Change in DNR status;
      • Patient or family dissatisfaction;
      • Patient requesting discharge AMA, or;
      • Patient death.

  • General
    • All patient care must be supervised by qualified faculty.
    • On-call and clinical assignment schedules must be available at all clinical service locations so that residents, nursing staff and ancillary personnel can easily identify the assigned resident and their faculty supervisor.
    • PGY-1 level residents must be supervised either directly or indirectly, with direct supervision immediately available. If indirect supervision is provided, such supervision must be consistent with RRC policies, and PGY-1 residents must meet established criteria in order to be eligible for indirect supervision.

  • Faculty Responsibilities
    • Routinely review resident physician documentation in the medical record.
    • Be attentive to compliance with institutional requirements such as problem lists, medication reconciliation, and additional field defined document priorities.
    • Provide resident physicians with constructive feedback as appropriate.
    • Serve as a role model to resident physicians in the provision of patient care that demonstrates professionalism and exemplary communication skills.

  • Resident Responsibilities
    • Each resident is responsible for knowing the limits of their scope of authority and the circumstances under which they are permitted to act with conditional independence.
    • In recognition of their responsibility to the institution and commitment to adhere to the highest standards of patient care, resident physicians shall routinely notify the responsible attending physician based on the guidelines noted above, as well as any additional circumstances identified in their program-specific supervisory policy.

D-H Policy ID: 11276