When a resident requires supervision, this may be provided by a qualified member of the medical staff or by a trainee who is qualified to perform the procedure independently. In all cases, the attending physician is ultimately responsible for the provision of care by trainees.
Supervision as defined in this policy means that the qualified Medical Staff member has been notified of a procedure and has deemed the resident qualified to perform the procedure without direct supervision. Direct supervision is defined as the presence of a qualified Medical Staff member or qualified trainee at the bedside.
No supervision required:
Dressing changes, suture placement and removal, central venous catheter removal, breast exam, pelvic exam, and endocervical cultures.
Supervision required until competency achieved:
The following procedures require direct supervision by a qualified individual until the trainee has achieved the training level or number of procedures performed with competency specified; thereafter, direct supervision is not required.
* are procedures required by RC-FM for all residents
The residency program will maintain documentation of the procedures performed and entered by residents.
For any procedure planned by a resident, the resident will supply access to the documentation of their competency to perform the procedure when requested by any member of the medical team. If the trainee cannot provide documentation when requested, the procedure should be delayed, except in emergency situations, until competency is verified with the residency program office or attending physician.
In some cases, the residency program may determine that a resident is competent to perform some or all of the procedures described above without direct supervision. In those cases the resident will be identified by the language 'Deemed competent to perform this procedure' in the documentation program.
Direct supervision by a qualified member of the medical staff always required:
Vaginal delivery, including repair of vaginal lacerations or episiotomy, repair of cervical laceration, uterine exploration
D&C or D&E, uterine
Exercise treadmill test
Flexible or rigid sigmoidoscopy
Sedation for procedures
All other invasive procedures not listed.
Emergency procedures:
It is recognized that in the provision of medical care, unanticipated and life-threatening events may occur. The trainee may attempt any of the procedures normally requiring supervision in a case where the death or irreversible loss of function in a patient is imminent, and an appropriate supervisory physician is not immediately available. The assistance of more qualified individuals should be requested as soon as practically possible.
Resident review and promotion process:
The residency program uses a multifaceted assessment process to determine a resident's progressive involvement and independence in providing patient care. Residents are observed directly by the attending staff and their performance discussed regularly. Formal assessments are generally obtained on a monthly basis from supervising physicians, students and colleagues. These assessments include evaluation of the resident's clinical judgment, medical knowledge, technical skills, professional attitudes, behavior, and overall ability to manage the care of a patient. Annually, the program director and residency review committee determine if the trainee possess sufficient training and the qualifications necessary to be promoted to the next level.
Trainees are evaluated continuously by the attending staff. If, at any time, their performance is judged to be below expectations, the program director (or designee) will meet with the trainee to develop a remediation plan. If the trainee fails to follow that plan, or the intervention is not successful, the trainee may be dismissed from the program. If a trainee's clinical activities are restricted (e.g., they require a supervisors presence during a procedure, when one would not normally be required for that level of training) that information will be made available to the Medical Director, appropriate medical and hospital staff.