(Approved GMEC November 2022)

III.D.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; 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 Supervision: the supervising physician is 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: 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 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 supervision through feedback from House Officers and monitoring by Chief Residents and Program Directors.In the learning and working environment, each patient must have an identifiable, appropriately credentialed and privileged attending physician who is responsible and accountable for that patient’s care.  This information must be available to House Officers, faculty members, all members of the health care team, as well as the patient.  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. The following persons and/or factors determine a House Officer’s degree of progressive responsibility:

Observations of House Officer performance by GME faculty on each service

Assessment of the House Officer’s level of competence through frequent observation and semi-annual review by the Program Director and Chief Resident(s)

Achievement of specific milestones (where applicable)

Evaluation of performance in simulation labs and OSCEs (where applicable) prior to the House Officer performing specific procedures on patients

The expected components of supervision include:

Defining educational objectives

Faculty assessment of House Officer skill level through direct observation

Defining the course of progressive responsibility allowed beginning with close supervision and advancing to independence as the skill is mastered

Documentation of supervision by supervising faculty must be customized to the settings based on guidelines for best practice and regulations from the ACGME, JCAHO, and other regulatory bodies and 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 informal feedback and are required to give formal summative written feedback that is competency based and includes evaluation of both professionalism and effectiveness of transitions.

Several of the essential elements of supervision are contained in the Policy of Professionalism.

Programs must specify level- and service type-specific criteria using the grids below.

Inpatient Services

Intensive Care Units

Ambulatory Settings

Consult Services

Operating Rooms:

Procedure Rotations

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

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