Medical Student Supervision and Teaching Policy

I. PURPOSE

The purpose of this policy is to ensure that the New York Medical College School of Medicine (NYMC SOM) provides medical student education aimed at producing the highest quality physicians while ensuring patient safety.  This policy outlines the expectation for the supervision of medical students in the clinical environment (LCME 9.3)

II. POLICY

It is the policy of the NYMC SOM that medical students be incorporated into, and accepted as, integral parts of the healthcare team, permitted to participate in team care of the patient, and expected to demonstrate individual ownership of patient care and responsibilities under supervision.  Such supervision is based on a student’s demonstrated ability, level of training, the objectives of the clinical experience, and is designed to foster progressive responsibility.  Supervision of all students is to be provided by NYMC SOM faculty or residents/fellows of NYMC or preceptors employed by an affiliated medical facility at all times that a student is in the clinical environment.  Medical students may not participate in patient care or perform procedures without appropriate supervision.

III. SCOPE

This policy applies to medical students, course/clerkship directors, residents/fellows and faculty.

IV. DEFINITIONS

Supervising Physician – a physician with an NYMC SOM faculty appointment
Direct Supervision – the Supervising Physician or their designee is physically present with the student and the patient
Indirect Supervision ­­– the Supervising Physician or their designee is not physically present with the student and the patient but is immediately available to provide Direct Supervision.

V. PROCEDURES

A. The appropriate level of supervision as determined by the assigned NYMC SOM faculty member is based on the following factors:

1. Level of training of the student;
2. Previous experience and skill of the student;
3. Familiarity of the supervisor with the student’s abilities; and
4. Risk to the patient.

B. Students are expected to:

1. Take patient histories, perform complete and/or focused physical examinations and enter findings into the medical record of the patient with the approval of the Supervising Physician.
2. Write patient encounter notes and coordinate care in a fashion commensurate with their training level.
3. Sign all entries in the medical record, along with the designation that they are medical students.
4. Supervising Physicians are to review student notes and all other entries.
5. Write orders for education purposes even if the orders will not be entered as the official patient order.

C. Students may be assigned and directed to provide additional patient care services, and perform specific procedures or activities as outlined in the syllabus under the appropriate level of supervision by the Supervising Physician. Documentation of supervision is required and, in all such patient care contacts, the patient care contacts, the patient shall be made aware that the individual providing care and/or performing the procedure is a student.

D. If a student has concerns about the adequacy and availability of supervision in the clinical environment, they should contact the following:

1. Site Director
2. Course/Clerkship Director
3. Assistant Dean for Clinical Sciences
4. Student Liaison Representative
5. Dean of Student Affairs or Dean of Undergraduate Medical Education

E. Supervising Physicians are expected to:

1. Review and independently verify all student findings; assessments and plans; and document this review.
2. Provide students with regular feedback, both positive and constructive.
3. Review student notes and all other entries.

F. If a Supervising Physician or resident/fellow or preceptor has concerns about a student’s academic or professional performance, they should discuss this feedback with the student, as well as notify the clerkship/course director immediately.

G. Course/Clerkship Director Responsibilities:

1. Communicate policies and procedures related to supervision to faculty, residents, and students and monitor compliance with these policies and procedures.
2. Meet and follow up with students when concerns about their clinical or professional performance are brought to their attention.
3. Communicate lapses in supervision with the Assistant Dean for Clinical Sciences.

H. If it is determined that there is inadequate supervision at a clinical site, the Assistant Dean for Clinical Sciences will meet with the Course/Clerkship Director as well as the Site Director to address the issue.

VI. EFFECTIVE DATE

This policy is effective immediately.

VII. POLICY MANAGEMENT

Executive Stakeholder: Dean, School of Medicine
Oversight Office: Office of Undergraduate Medical Education

VIII. REFERENCES

LCME 9.3 – Clinical Supervision of Medical Students:  A medical school ensures that medical students in clinical learning situations involving patient care are appropriately supervised at all times in order to ensure patient and student safety, that the level of responsibility delegated to the student is appropriate to his or her level of training, and that the activities supervised are within the scope of practice of the supervising health professional.