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EAA055 Medical Student Supervision During Required Clinical Activities Policy

Policy Number: EAA055
Policy Title: Medical Student Supervision During Required Clinical Activities Policy

A. Purpose

The purpose of a supervision policy is to ensure that learners are appropriately supervised for patient safety, quality of care, and increasing autonomy. Students gain skills at varying times and will always be supervised. This process, however, should prepare students to be entrusted with professional activities once graduated.

B. Persons affected.

The policy will cover all students participating in the UTRGV SOM curriculum.

C. Definitions

The following definitions are used throughout the document:

Student - a learner enrolled in an accredited School of Medicine.

Resident - a professional post-graduate trainee in a specific specialty or subspecialty.

Licensed Independent Practitioner (LIP) - a licensed physician, dentist, podiatrist, or optometrist who is qualified usually by board certification or eligibility to practice their specialty or subspecialty independently.

Medical Staff - an LIP who has been credentialed to provide care in their specialty or subspecialty by a hospital.

UTRGV Supervising Physician- the immediate supervisor of a student who is credentialed in their hospital for specific procedures in their specialty and subspecialty that they are supervising. The supervising physician will also be a credentialed faculty member of the School of Medicine.

Levels of Student Supervision

• Direct Supervision - the supervising physician is physically present with the student and patient.
• Indirect Supervision: - 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.
• Student assignments to residents as supervisors may be determined by program director and clerkship director discussion.

D. Policy

Supervision may be exercised through a variety of methods. Most activities require the physical presence of the supervising faculty member. For many aspects of patient care, the supervising physician may be a more advanced resident or fellow. Other portions of care provided by the student can be adequately supervised by the immediate availability of the supervising faculty member or resident physician, within the same area. The goal is to ensure that both patients and students have adequate safe supervision throughout their medical education. This policy defines the following goals:

1. To define the role, responsibilities, and patient care activities of students
2. To define the process for supervision of physicians by supervising UTRGV Faculty
3. To define the developmental responsibility of supervision based on defined levels of competency.
4. To define the role of supervision by upper-level resident physicians.
5. To define the role of supervision in both the inpatient and outpatient settings of health care.
6. To define the role of supervision in chart writing.

The privilege of progressive authority, responsibility, and conditional independence in patient care delegated to each student must be assigned by the clerkship director and faculty members. The Clerkship director must evaluate each student's abilities based on specific criteria. When available, evaluation should be guided by specific national standards-based criteria.

Faculty supervising students must be aware of the medical student's level of training, the objectives of the clerkship, and the Teacher-Learner /Student Mistreatment policy.

Individuals having a close family or personal relationship to the student must not be involved in the academic assessment and promotion of the student. Questions about the appropriateness of a student assignment to a faculty member will be resolved by the clerkship director, in consultation with the Assistant Dean - Clerkships, or their designees.

Individuals who provide psychiatric/psychological care or other health services to a medical student must have no involvement in the academic assessment and promotion of that student.

The School of Medicine will request assurance that students participating in electives or sub-internships at other LCME- accredited institutions will be provided faculty supervision as outlined in this policy.

Faculty members functioning as supervising physicians should delegate portions of care to students, based on the needs of the patient and the skills of the student. Residents or fellows should serve in a supervisory role of students based on the needs of each patient and the skills of the individual resident or fellow. In general, if a resident/fellow is approved to perform a procedure or process without direct supervision, they may supervise and evaluate a student for that same procedure/process.

Each student must know the limits of their scope of authority, and the circumstances under which they are permitted to act. In particular, students will always be supervised by a UTRGV Faculty either directly or indirectly with direct supervision immediately available.

It is recognized that students learn at different rates and their education and capabilities are developmental. Supervision by upper-level residents and faculty is imperative in student education. As students gain skills and competency in the 6 ACGME competencies, direct supervision is developmentally changed to more indirect supervision. For example, students can take an independent history and physical exam, but it must be corroborated by a faculty.

E. PROCEDURES

Supervising Physician
In all instances the supervising physician will be a UTRGV Faculty. However, any member of medical staff with appropriate clinical privileges may act as supervising physician for a student under the primary supervision of the UTRGV FACULTY.

It is the responsibility of the supervising physician to:

1. Maintain primary responsibility for patient care.
2. Provide education, instruction and expertise to the student in accordance with supervision and clinical responsibility guidelines outlined in this document.

By exception, supervision of students may be performed by qualified and credentialed practitioners with particular expertise in certain diagnostic or therapeutic procedures, if so designated by the clerkship director.

NOTE: The supervision and clinical responsibility guidelines contained herein are those that are minimally acceptable. It remains the responsibility of the supervising physician to assess the competency level of an individual student and to provide a higher level of supervision/limitation of clinical responsibilities as determined appropriate. 

All UTRGV clinical faculty are vetted and credentialed through the UTRGV SOM faculty appointment process and are expected not to practice outside their level of credentialing. Affiliate faculty and UTRGV faculty credentialed at affiliate hospitals are expected not to practice outside their level of credentialing. It is the responsibility of the Medical Executive Committee at the School of Medicine and the Chief of Staff at the affiliate faculty to ascertain that faculty are not practicing beyond their level of credentialing.

Physicians not credentialed by an affiliate hospital are required to be credentialed as UTRGV Faculty. It is the responsibility of the Medical Executive Committee to ensure that all faculty are practicing within their scope of capacity. Clerkship directors, academic coordinators, and student evaluations as well as the anonymous student portal are measures to ensure that faculty are not practicing outside their level of competency.

General Guidelines Regarding Entries Made in the Medical Record

Student entry of information into the medical record will be determined by the policies of the clinical facility in which the student is working. Entries made in the medical record by students require countersignature by the supervising physician. Students are not allowed to give verbal orders.

Outpatient Training: Position Descriptions by Year of Training, and Progression of Skills/independence at Outpatient Sites

• The supervising physician will co-sign all charts for the students.
• The supervising physician will be responsible for "live" coding of all visits. Students may provide coding recommendation as component of their training however faculty are responsible for submission of the final codes.

During the course of training, students are expected to participate in the performance of a variety of procedures. The Required Conditions and Procedures delineate the required procedures performed and outlines the necessary degree of supervision required, as well as the location. As the students progress through the program, they are expected to demonstrate competence at each level before proceeding to the next. All students will be supervised for all procedures.