In the learning and working environment, each patient must have an identifiable and appropriately credentialed and privileged attending physician who is responsible and accountable for the patient's care. This information must be available to House Officers, faculty members, other members of the health care team, and patients. House Officers and faculty members must inform each patient of their respective roles in that patient's care.
The specific policies for supervision are as follows.
Faculty Responsibilities for Supervision and Graded Responsibility:
House Officers must be supervised in such a way that they assume progressive responsibility as they progress in their educational Program. Progressive responsibility is determined in a number of ways including:

• GME faculty on each service determine what level of autonomy each House Officer may have that ensures growth of the House Officer and patient safety.
• The Program Director and Chief Residents assess each House Officer's level of competence in frequent personal observation and semi-annual review of each House Officer.
• Where applicable, progressive responsibility is based on specific milestones.
• Use of simulation labs and OSCEs where applicable before allowing the House Officers to perform procedures on patients.

The expected components of supervision include:

• Defining educational objectives.
• The faculty assessing the skill level of the House Officers by direct observation.
• The faculty defines the course of progressive responsibility allowed starting with close supervision and progressing to independence as the skill is mastered.
• Documentation of supervision by the involved supervising faculty must be customized to the settings based on guidelines for best practice and regulations from the ACGME, JCAHO, and other regulatory bodies. Documentation should generally include but not be limited to:
• progress notes in the chart written by or signed by the faculty.
• addendum to House Officer's notes where needed.
• counter-signature of notes by faculty.
• a medical record entry indicating the name of the supervisory faculty.

In addition to close observation, faculty are encouraged to give frequent formative feedback and required to give formal summative written feedback that is competency based and includes evaluation of both professionalism and effectiveness of transitions.

The levels of supervision are defined as follows:

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X.A.1 Levels of Supervision

To promote appropriate resident supervision while providing for graded authority and responsibility, the program must use the following classification of supervision[1]:

Direct Supervision: the supervising physician is physically present with the resident during the key portions of the patient interaction

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; or, PGY-1 residents must initially be supervised directly, only as described:

A supervising physician must be immediately available to be physically present for PGY-1 residents on inpatient rotations who have demonstrated the skills sufficient to progress to indirect supervision.

The supervising physician and/or patient is not physically present with the resident and the supervising physician is concurrently monitoring the patient care through appropriate telecommunication technology.

Indirect

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Supervision: the supervising physician is

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Indirect with Direct Supervision IMMEDIATELY Available – Resident – the Senior Resident is physically present within the hospital or other site of patient care and is immediately available to provide direct supervision.

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not providing physical or concurrent visual or audio supervision but is immediately available to the resident for guidance and is available to provide appropriate direct supervision.

Oversight

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: the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

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.

PGY 1 residents must be supervised by either faculty or more senior residents in the hospital setting.

The Sponsoring Institution will monitor implementation of these policies through Annual Review of Programs Program Evaluations and Special Focus Reviews. Furthermore, the Sponsoring Institution monitors supervision through a series of questions in the Annual Resident Survey. The Program will monitor this supervision through feedback from House Officers and monitoring by Chief Residents and Program Directors.  House Officers can report, free of reprisal, any inadequate supervision and accountability to the Program Director, DIO, or the LSU GME Ombudsman.  House Officers can report any inadequate supervision or accountability to the program administration or the LSU GME Ombudsperson.

[1] ACGME Common Program Requirements (Residency),  ACGME-approved focused revision: June 13, 2021; effective July 1, 2022