GME Policy on Supervision of Residents

I. PURPOSE

Graduate medical and dental education (GME) is the essential step of professional development between professional school and autonomous clinical practice. It is in this phase of the continuum of medical and dental education that residents (where "residents" refers to both residents and fellows) learn to provide optimal patient care under the supervision of faculty members who not only instruct, but serve as role models of excellence, compassion, professionalism, and scholarship. GME programs have a responsibility to facilitate graduated levels of responsibility throughout the course of training, such that the care of patients is undertaken with appropriate program faculty supervision and conditional independence, allowing residents to attain the competencies and professional attitudes required for autonomous practice. 

Each patient has the right to be cared for by residents who are appropriately supervised and possess the requisite knowledge, judgment, skills, and abilities; understand the limits of their knowledge and experience; and seek assistance as required to provide optimal patient care.  Patients and their families (as applicable) should be informed of the roles of each team member participating in their care.

This policy establishes supervision guidance for all residents participating in Accreditation Council for Graduate Medical Education (ACGME)-accredited and Commission on Dental Accreditation (CODA)-accredited programs sponsored by New York Medical College (NYMC) and provides recommendations for NYMC-affiliated GME programs.

 II. POLICY

Residents must have an assigned supervising attending clinician for all aspects of patient care.  This attending clinician must be appropriately licensed, credentialed, and privileged for the scope of care in which the resident is engaged.  While all members of the team are responsible for patient safety and quality, the attending clinician has the ultimate responsibility for patient care provided by their learners.

III. SCOPE

All residents and fellows enrolled in an ACGME or CODA-accredited program sponsored by New York Medical College. 

IV. DEFINITIONS 

Resident refers to any person enrolled in a residency program accredited by the ACGME or CODA and sponsored by New York Medical College

Fellow refers to any person enrolled in a fellowship program accredited by the ACGME and sponsored by New York Medical College 

ACGME is the Accreditation Council for Graduate Medical Education

CODA is the Commission on Dental Accreditation

V. PROCEDURES

A. The attending clinician has the ultimate responsibility for patient care provided by their learners.

1. The assigned attending clinician must also meet any specialty-specific requirements of the applicable accrediting body.  
2. A schedule of attending clinician coverage must be available to residents and pertinent program faculty, nursing, and other staff.
3. When residents are assigned to home call or in-house call without an on-site supervising attending (if permitted by specialty-specific accrediting body requirements), there must be an assigned attending clinician available remotely and able to provide direct on-site supervision as required.  When residents are in-house without an on-site supervising attending, there must be procedures in place for urgent/emergent on-site assistance from an appropriate attending clinician (such as from emergency medicine or anesthesiology).
4. Residents must know who to contact if the supervising attending clinician is not available in a timely manner.
5. Program faculty supervision assignments must be of sufficient duration to assess the competencies of each resident and to delegate to the resident the appropriate level of patient care authority and responsibility in the context of patient volume and acuity.

B. All programs must have a program-specific supervision policy consistent with NYMC and primary clinical site/employing hospital policies.  The policy must:

1. Define levels of supervision consistent with current ACGME or CODA definitions.  As of February 2024, these ACGME definitions include:

a. Direct Supervision: 

i. The supervising physician is physically present with the resident during the key portions of the patient interaction; or, 
ii. 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 (consistent with applicable ACGME or other accrediting body specialty-specific requirements).
iii. PGY-1 residents must initially be supervised directly with the supervising physician physically present with the resident during the key portions of the patient interaction until such time as the resident is granted permission to perform specific aspects of patient care without direct supervision, based on defined criteria. 

b. Indirect Supervision: 

i. 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.
ii. 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.

c. Oversight - The supervising physician provides review of  procedures/encounters with feedback provided after care is delivered.

2. Specify the process by which the program determines how residents are deemed qualified to perform specific aspects of patient care at levels of supervision less than direct supervision.  The supervision level for specific patient care tasks must be based on the evaluation and competency assessment of the individual residents. If the level of supervision for specific patient care tasks is based on PGY-level of training, the program must document and follow promotion criteria inclusive of relevant competencies.

3. Specify the process by which the program documents levels of supervision required for specific residents to perform specific aspects of patient care.  

a. This documentation must be accessible to residents, program faculty, nursing, and other pertinent support staff.
b. Residents, program faculty, nursing, and other pertinent support staff must be educated on how to access supervision requirements and on how to contact a member of the program’s leadership for any clarifications, as needed.
c. Indicate the circumstances under which residents may supervise more junior learners in specific aspects of patient care. 
d. Senior residents and fellows should have opportunities to serve in a supervisory role to more junior residents/fellows in recognition of their progress toward independence, in a manner appropriate to the needs of individual patients, and the competencies of individual residents.

4. Specify guidelines for circumstances and events in which residents must communicate with the supervising faculty member(s) in a timely fashion.  At a minimum, these circumstances include:

a. Admission of or consultation for an unstable or critical patient
b. Indication to transfer patient to a higher level of care (such as to a step-down unit or ICU)
c. Code or rapid response team activation
d. Change in resuscitation status
e. Request of a patient, patient’s family member, or member of the healthcare team to speak to the supervising attending 
f. Patient discharge/request to be discharged against medical advice
g. Patient death
h. Resident identification of need for increased supervision or assistance

5. Indicate that in emergency situations a resident may perform any aspects of patient care for which they are capable to avoid patient morbidity or mortality that could result from delays in care, until such time that appropriate supervision or assistance becomes available.

6. Be regularly reviewed with residents, program faculty, and relevant nursing and other staff, and distributed and/or available electronically to such individuals.

7. Be reviewed at least every 24 months by the program’s leadership and clearly indicate updates. 

VI. EFFECTIVE DATE

This policy is effective immediately.

VII. POLICY MANAGEMENT

Executive Stakeholder: Dean of the School of Medicine
Oversight Office: Office of Graduate Medical Education