Anesthesiology Critical Care Medicine Fellowship Supervision Policy

[Last updated: 03/13/2026]

Please reference complete UW GME Institutional Supervision and Accountability Policy for additional definitions and background. This page is best viewed on desktop.

Responsibilities and Accountability

Each patient must have an identifiable and appropriately-credentialed and privileged attending physician (or licensed independent practitioner as specified by the applicable review committee) who is responsible and accountable for the patient’s care. This information will be available through direct verbal communication, published work schedules, and the electronic medical record to residents/fellows, faculty members, other members of the health care team, and patients.

The Department of Anesthesiology & Pain Medicine residents, fellows, and faculty members must 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 to the situation.

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, ant then circumstances under which the fellow is permitted to act with conditional independence.

Supervision Definitions

To promote oversight of fellow supervision while providing graded authority and responsibility, the following levels of supervision are recognized:

Direct Supervision

The supervising physician is physically present with the fellow and patient during the key portions of the patient interaction.

Indirect Supervision

The supervising physician is not providing physical or concurrent visual or audio supervision but is immediately available for the fellow for guidance and is available to provide appropriate direct supervision.

Oversight

The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

Fellow Competence & Delegated Authority

The privilege of progressive authority and responsibility, conditional independcence, and a supervisory role in patient care delegated to each fellow must be assigned by the program director and faculty members.

The program director must evaluate each fellow’s abilities based on specific criteria, guided by the milestones.

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.

Clinical Responsibilities of Fellows

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 toward 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.

Levels of Supervision for Common Specialty Clinical Activities and Invasive Procedures*


Clinical Activity/Procedure	Resident level (PGY)	Location	Supervision Level
Clinical Activity/Procedure Transesophageal Echocardiography	Clinical Activity/Procedure Fellow (>PGY4)	Clinical Activity/Procedure ALL	Clinical Activity/Procedure Direct*
Resident level (PGY) Temporary Pacemaker	Resident level (PGY) Fellow (>PGY4)	Resident level (PGY) ALL	Resident level (PGY) Direct
Location Intracranial Pressure Monitor Placement	Location Fellow (>PGY4)	Location ALL	Location Direct
Supervision Level Percutaneous Tracheostomy	Supervision Level Fellow (>PGY4)	Supervision Level ALL	Supervision Level Direct
Fiberoptic Bronchoscopy (other than for tracheal intubation)	Fellow (>PGY4)	ALL	Direct
Subclavian Central Venous Cannulation	Fellow (>PGY4)	ALL	Direct -> Indirect: Direct supervision required by a qualified member of the medical staff for at least 5 discrete events following which indirect supervision is permissible
Pulmonary Artery Catheterization	Fellow (>PGY4)	ALL	Direct -> Indirect: Direct supervision required by a qualified member of the medical staff for at least 5 discrete events following which indirect supervision is permissible
Thoracentesis	Fellow (>PGY4)	ALL	Direct -> Indirect: Direct supervision required by a qualified member of the medical staff for at least 5 discrete events following which indirect supervision is permissible
Thoracostomy Tube Placement	Fellow (>PGY4)	ALL	Direct -> Indirect: Direct supervision required by a qualified member of the medical staff for at least 5 discrete events following which indirect supervision is permissible
Central Venous Cannulation via Internal Jugular and Femoral Approaches	Fellow (>PGY4)	ALL	Indirect
Point of Care Thoracic Vascular or Abdominal Ultrasound (to include transthoracic echocardiography)	Fellow (>PGY4)	ALL	Indirect
Tracheal Intubation	Fellow (>PGY4)	ALL	Indirect, Direct*
Extubation of the Trachea in High Risk Patients	Fellow (>PGY4)	ALL	Indirect, Direct*
Elective Cardioversion	Fellow (>PGY4)	ALL	Indirect

*Supervision requirements vary depending on the primary specialty of training. For example, Anesthesiology residency graduates do not require direct supervision of tracheal intubation, whereas graduates of Emergency Medicine, Surgical or Obstetrics programs require direct supervision throughout fellowship training. Likewise, supervision requirements may be waived in certain circumstances, depending on previous training. For example, if a trainee has previously completed a Fellowship in Cardiac Anesthesiology, or has passed the competency examination for perioperative transesophageal echocardiography, supervision of this procedure by an attending physician will not be required. Likewise, trainees who have completed two or more years of training in general surgery may not require direct supervision during tube thoracostomy.

Circumstances and events in which Supervising Faculty Member(s) MUST be contacted

The fellow must communicate with appropriate supervising faculty members:

New admissions with serious, life-threatening processes
Serious, unanticipated deviations in the anticipated clinical course of a patient on the service
Any time the fellow has concern about a patient’s condition or judges there to be a need for input from the supervising faculty

Supervision of Consults

Fellows performing consultations on patients are expected to communicate verbally with their supervising attending as soon as possible after completing the consult and at most within 24 hours of receiving the consult. The majority of consults on an ICU service involve triage decisions for patients experiencing events on the acute care floor or potential transfers to a UW Medicine entity from referring facility. In general these types of consults should be discussed immediately with the supervising faculty. For APM fellows rotating on the pulmonary medicine consult service, guidance for PCCM fellow consults will be employed.

Emergency Procedures

It is recognized that in the provision of medicine, unanticipated and life-threatening events may occur. The fellow may attempt any of the procedures normally requiring supervision in a case where death or irreversible loss of function in a patient is imminent, and an appropriate supervisory physician is not immediately available, and to wait for the availability of an appropriate supervisory physician would likely result in death or significant harm. The assistance of more qualified individuals should be requested as soon as practically possible. The appropriate supervising practitioner must be contacted and apprised of the situation as soon as possible.

Faculty Supervision Assignment

Faculty supervision assignments are usually of 7 to 8 days duration and therefore are of sufficient length to assess the knowledge and skills of each fellow and to delegate to the fellow the appropriate level of patient care authority and responsibility.

Supervision of Handoffs

Fellows conducting hand-offs are expected to use structured verbal and electronic processes for patient transfers between services and locations. Fellow involvement in the hand-off process is supervised at the Indirect Supervision level. Examples of hand-offs include, but are not limited to, transfers of care from ICU to OR team, transfers care from OR team to ICU team, any transfers involving transport personnel (EMS, Airlift NW, etc), transfers of care from ICU to acute care teams and all intra-team shift sign outs.