Applies to: Trainees in the WSU Critical Care Medicine Fellowship–Everett program.
Date: January 21, 2025
1.0 Policy Statement:
It is the WSU College of Medicine Critical Care Medicine Fellowship–Everett policy to establish and maintain the effective supervision of all fellows in the Critical Care Medicine Fellowship–Everett program.
2.0 Definitions
Accreditation Council for Graduate Medical Education (ACGME)
Accredits Sponsoring Institutions and residency and fellowship programs, confers recognition on additional program formats or components, and dedicates resources to initiatives addressing areas of importance in graduate medical education.
Attending Physician
An identifiable, appropriately credentialed, and privileged primary physician (or licensed independent practitioner as approved by the ACGME Resident Review Committee) who is responsible and accountable for that patient’s care. The attending physician is responsible for assuring the quality of care provided and for addressing any problems that occur in the care of patients and thus must be available to provide direct supervision when appropriate for optimal care of the patient and/or as indicated by individual program policy.
Direct Supervision
The supervising physician is physically present with the Trainee 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.
- 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.
Oversight
The supervising physician is available to provide review of procedures/ encounters with feedback provided after care is delivered.
Progressive Responsibility
Graded and progressive responsibility provided to a Trainee according to the individual Trainee’s clinical experience, judgment, knowledge, and technical skill.
Supervision
In the setting of graduate medical education provides safe and effective care to patients; ensures each resident’s development of the skills, knowledge, and attitudes required to enter the unsupervised practice of medicine; and establishes a foundation for continued professional growth.
3.0 Responsibilities
Program Director
4.0 Procedures
The Critical Care Medicine Fellowship–Everett program recognizes and supports Supervision in the setting of graduate medical education provides safe and effective care to patients; ensure development of the skills, knowledge, and attitudes required to enter the unsupervised practice of medicine; and establishes a foundation for continued professional growth. This policy outlines the requirements to be followed when supervising fellows.
The goal of this policy is to promote assurance of safe patient care, and the fellow’s maximum development of the skills, knowledge, and attitudes needed to enter the unsupervised practice of medicine. The responsibility for the supervision of fellows within the program ultimately resides with the program director at all sites, while in collaboration with the associate program director, and faculty. The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care, consequently, is delegated by the program director and faculty members to each fellow.
To promote oversight of resident supervision while providing for graded authority and responsibility, the program uses classification of supervision of:
- Direct Supervision: The supervising physician is physically present with the resident 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.
- Indirect Supervision 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. according to the individual Trainee’s clinical experience, judgment, knowledge, and technical skill.
- Oversight: The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.
Each patient must have an identifiable, appropriately credentialed, and privileged attending physician (or licensed independent practitioner as specified by the applicable ACGME Review Committee) who is responsible and accountable for the patient’s care with this information available to fellows, faculty members, other members of the health care team.
Fellows and faculty members inform each patient of their respective roles in that patient’s care when providing direct patient care.
The program will provide the appropriate level of supervision for each fellow based on each fellow’s level of training and ability, as well as patient complexity and acuity. Supervision may be exercised through a variety of methods, as appropriate.
As part of their education program, fellows are given graded progressive responsibility according to the individual’s clinical experience, judgment, knowledge, and technical skill. Each fellow must know the limits of their scope of authority, and the circumstances under which the fellow is permitted to act with conditional independence.
Faculty members functioning as supervising physicians must delegate portions of care to fellows based on the needs of the patient and the skills of each fellow.
Fellows may be directly or indirectly supervised. They may provide direct patient care, supervisory care or consultative services, with progressive graded responsibilities as merited. Fellows should serve in a supervisory role to medical students, junior and intermediate residents in recognition of their progress towards independence, as appropriate to the needs of each patient and the skills of the fellow; however, the attending physician is responsible for the care of the patient.
Procedures performed by Fellows are initially directly supervised. Once competency and proficiency is achieved, procedures may be indirectly supervised with an appropriate classification of supervision.
Fellows should communicate with the appropriate supervising faculty member regarding all anticipated and unanticipated deaths and unexpected changes in clinical condition.
Fellows conducting hand-offs are expected to use structured verbal and electronic processes for patient transfers between services and locations. Fellows may be supervised directly or indirectly when conducting hand-offs. Faculty must assess fellow readiness to move from direct to indirect supervision when conducting hand-offs and patient transfers.
Attending physicians are available for guidance 24 hours a day. The fellow should call with any discomfort, uncertainty, or disagreement regarding a patient’s status or the need for guidance with management issues of both new and established patients.
5.0 Related Policies
GME Supervision and Accountability Policy
6.0 Revision History
GMEC Approval: January 21, 2025
Revision/Review Date(s):
Responsible Office: WSU Critical Care Medicine Fellowship–Everett