Supervision Policy, GME The Institution Manual
This document summarizes the University of Minnesota Department of Surgery (DOS) policies and procedures regarding resident supervision. These policies are designed to be 100% compliant with the 2014 ACGME Program Requirements. It is mandatory that all residents and faculty understand and uphold these policies at all times.
Levels of Supervision
Principles of Supervision of All Residents (PGY-1 to PGY-5)
All residents are supervised by an identifiable, credentialed, and privileged attending surgeon faculty who is ultimately responsible for that patient's care. This information is readily available to residents, faculty members, and other health care professionals at each hospital. Additionally, every patient is apprised of who this attending is upon admission to the hospital. Typically, this information is available to the patient with complete information about the care team at the facility (resident, fellow, faculty, nurse, etc.) This also clarifies the roles of each member of the care team for the patient. Attending call schedules are available through the hospital operators. Additionally, most sites have attending call schedules available on line. Direct Supervision is provided in the operating room for all residents when performing cases at our training institutions.
Guidelines for Specific Circumstances and Events
The University of Minnesota Physicians faculty practice has established guidelines for when attending physicians are to be notified about patient care issues. While not all-inclusive, residents are also expected to contact attending staff for other issues as needed. Each resident is provided a card listing the guidelines to attach to his/her identification badge as a reminder. Additionally, the UMMC SICU rotation has a similar card as noted below. Residents are required to notify attending staff specifically for the following indications. University of Minnesota Physicians Surgery Attending Physician Notification Guidelines
UMMC SICU Rotation “When to Call the Attending” Card
We recognize that starting this academic year, particular levels of residents require more strict attention and accountability for activities within our hospital systems, especially as this pertains to procedural skills. We are keenly aware of this and in fact, in a proactive way, have been functionally utilizing our SimPORTAL curriculum with this exact paradigm in mind for several years. This year, we have formally introduced a supervision policy as it relates to the new requirements in this area.
PGY-1: Indirect Supervision
PGY-1 residents may be indirectly supervised for the following. Supervision will be by senior members of the resident teams, fellows, or attending faculty. Direct supervision may be appropriate depending on the resident's level of proficiency. The basic competencies that are addressed below are introduced in a structured way as part of our PGY-1 bootcamp experience. Taken together, supervision occurs during daily rounds and other reporting structures currently in place:
1. Patient Management Competencies
a. evaluation and management of a patient admitted to hospital, including initial history and physical examination, formulation of a plan of therapy, and necessary orders for therapy and tests
b. pre-operative evaluation and management, including history and physical examination, formulation of a plan of therapy, and specification of necessary tests
c. evaluation and management of post-operative patients, including the conduct of monitoring, and orders for medications, testing, and other treatments
d. transfer of patients between hospital units or hospitals
e. discharge of patients from the hospital
f. interpretation of laboratory results
2. Procedural Competencies
a. performance of basic venous access procedures, including establishing intravenous access
b. placement and removal of nasogastric tubes and Foley catheters
c. arterial puncture for blood gases
PGY-1: Direct Supervision
Until competency is demonstrated, PGY-1 residents require direct supervision for the following. In each situation below, PGY- 1 residents know to alert more senior residents (or attendings) who are expected to supervise patient care and who’s role on the care teams is to provide care in these situation. For example, patients with hypotension, oliguria, cardiac arrhythmias, etc. are cared for in the intensive care units. The ICU teams are led by PGY-2 residents or above.
1. Patient Management Competencies
a. initial evaluation and management of patients in the urgent or emergent situation, including urgent consultations, trauma, and emergency department consultations (ATLS required)
b. evaluation and management of post-operative complications, including hypotension, hypertension, oliguria, anuria, cardiac arrhythmias, hypoxemia, change in respiratory rate, change in neurologic status, and compartment syndromes
c. evaluation and management of critcially-ill patients, either immediately post- operatively or in the intensive care unit, including the conduct of monitoring, and orders for medications, testing, and other treatments
d. management of patients in cardiac or respiratory arrest (ACLS required)
2. Procedural Competencies
a. carry-out of advanced vascular access procedures, including central venous catheterization, temporary dialysis access, and arterial cannulation
b. repair of surgical incisions of the skin and soft tissues
c. repair of skin and soft tissue lacerations
d. excision of lesions of the skin and subcutaneous tissues
e. tube thoracostomy
f. paracentesis
g. endotracheal intubation
h. bedside debridement
Methods for Determining Progression from Direct to Indirect Supervision
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