Resident House Staff Supervision

Supervision of resident physicians is the responsibility of faculty members and staff physicians holding appointments/affiliations or serving as preceptors. Faculty supervision assignments should be designed to allow for sufficient assessment of individual knowledge and skills resulting in delegation of the appropriate level of patient care authority and responsibility.

A variety of supervision methods may be exercised as long as an appropriate level of supervision is in place for all resident physicians. Specific resident capabilities are determined and documented by the respective programs using detailed performance assessment systems described in departmental manuals.

Guidelines for circumstances and events in which resident physicians must communicate with appropriate supervising faculty members, such as, the transfer of a patient to an intensive care unit, or end-of-life decisions, are also outlined.


Levels of Supervision

To ensure oversight of resident supervision and graded authority and responsibility, the programs must use the following classifications of supervision:

Direct Supervision

The supervising physician is physically present with the resident physician and patient.

Indirect Supervision

There are two types of indirect supervision:

  • Direct supervision is immediately available (within 30 minutes) as the supervising physician is physically within the hospital or other nearby sites of patient care.
  • Direct supervision is available by means of telephonic and/electronic modalities (within 30 minutes) as the supervising physician is not physically present within the hospital or other nearby sites of patient care.
Oversight

The supervising physician is available to provide a review of procedures/encounters with feedback provided aftercare is delivered (e.g., post-hoc review of resident delivered care with open dialogue regarding the appropriateness of that care).

Note: First year resident physicians should be supervised either directly or indirectly with direct supervision immediately available.