Medical College of Wisconsin Affiliated Hospitals, Inc.
SUPERVISION OF THE HOUSESTAFF
The purpose of this policy is to outline supervision requirements for all MCWAH Programs in order to ensure (a) patients receive safe and effective care and (b) housestaff develop the skills, knowledge, and attitudes required to enter the unsupervised practice of medicine.
1. In the clinical learning environment, each patient must have an identifiable, appropriately-credentialed and privileged attending physician (or licensed independent practitioner as approved by each ACGME Review Committee) who is ultimately responsible for that patient’s care. This information should be available to housestaff, faculty members, and patients.
2. Housestaff and faculty members should inform patients of their respective roles in each patient's care.
3. The program must demonstrate that the appropriate level of supervision is in place for all housestaff who care for patients.
4. Supervision may be exercised through a variety of methods. Some activities require the physical presence of the supervising faculty member. For many aspects of patient care, the supervising physician may be a more advanced housestaff. Other portions of care provided by the housestaff can be adequately supervised by the immediate availability of the supervising faculty member or housestaff physician, either in the institution, or by means of telephonic and/or electronic modalities. In some circumstances, supervision may include post-hoc review of housestaff delivered care with feedback as to the appropriateness of that care. In ACGME accredited programs, the program must follow the appropriate Review Committee (RRC) supervisory requirements.
5. To ensure oversight of housestaff supervision and graded authority and responsibility, the program must use the following classification of supervision:
a) Direct Supervision – the supervising physician is physically present with the housestaff and patient.
b) Indirect Supervision 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.
c) Indirect Supervision 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.
d) Oversight – The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.
6. The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each housestaff must be assigned by the program director and faculty members.
a) The program director must evaluate each housestaff’s abilities based on specific criteria. When available, evaluation should be guided by specific national standards-based criteria.
b) Faculty members functioning as supervising physicians should delegate portions of care to housestaff, based on the needs of the patient and the skills of the housestaff.
c) Senior housestaff should serve in a supervisory role of junior housestaff in recognition of their progress toward independence, based on the needs of each patient and the skills of the individual housestaff.
7. Programs must set guidelines for circumstances and events in which housestaff must communicate with appropriate supervising faculty members, such as the transfer of a patient to an intensive care unit, or end-of-life decisions.
a) Each housestaff must know the limits of his/her scope of authority, and the circumstances under which he/she is permitted to act with conditional independence.
b) Housestaff should be supervised either directly or indirectly with direct supervision immediately available. Programs are required to comply with the ACGME RRC requirements under which PGY-1 housestaff may progress to be supervised indirectly, with direct supervision available.
8. Faculty supervision assignments should be of sufficient duration to assess the knowledge and skills of each housestaff and delegate to him/her the appropriate level of patient care authority and responsibility.
This revised policy was approved by the MCWAH Graduate Medical Education Council on July 18, 2011. The original policy was approved on September 17, 2007.