Residency Training Supervision & Accountability Policy

[Last updated: 06/20/2022]

Please reference Policies | UW Graduate Medical Education 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 to all fellows, faculty members, other members of the health care team, and patients through identification of the attending physically present on the Labor and Delivery unit.

The Obstetric Anesthesia 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, and the circumstances under which the fellow is permitted to act with conditional independence.

Supervision Definitions

To promote oversight of resident supervision while providing for 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; or

Indirect Supervision

The supervising physician is not providing physical or concurrent visual or audio supervision but is immediately available to 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 independence, 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 resident .

Clinical Responsibilities by PGY-Level

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 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.

Levels of Supervision for Common Specialty Clinical Activities and Invasive Procedures

Please list each clinical activity/procedure by PGY-level, with specific CPR Level of Supervision language:


Clinical Activity/Procedure	Resident level (PGY)	Location	Supervision Level
Clinical Activity/Procedure Pre-anesthesia consult	Clinical Activity/Procedure Fellow	Clinical Activity/Procedure UW Medical Center – Montlake	Clinical Activity/Procedure 2 (Indirect supervision)
Resident level (PGY) Initiation of labor analgesia	Resident level (PGY) Fellow	Resident level (PGY) UW Medical Center – Montlake	Resident level (PGY) 1 (Direct Supervision for first 30 procedures, or until the fellow is deemed sufficiently competent for indirect supervision [whichever occurs later])
Location Initiation of neuraxial anesthesia	Location Fellow	Location UW Medical Center – Montlake	Location 1 (Direct Supervision for first 30 procedures, or until the fellow is deemed sufficiently competent for indirect supervision [whichever occurs later])
Supervision Level Induction of general anesthesia	Supervision Level Fellow	Supervision Level UW Medical Center – Montlake	Supervision Level 1 (Direct)
Emergence from general anesthesia	Fellow	UW Medical Center – Montlake	1 (Direct)
Maintenance of all analgesia and anesthesia	Fellow	UW Medical Center – Montlake	2 (Indirect)
Insertion of invasive monitors	Fellow	UW Medical Center – Montlake	1 (Direct)
Peripheral nerve blocks	Fellow	UW Medical Center – Montlake	1 (Direct)

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

Prior to performing any invasive procedure (excluding peripheral IVs)
Prior to initiating any labor analgesic
Prior to performing any anesthetic
After completing any consult
After any adverse event
After any significant change in the status of a patient under the fellow’s care
Patient acuity becomes greater than the fellow can handle
The fellow is unable to perform their duties due to illness, fatigue, or other reason

Supervision of Consults

Fellows performing consultations on patients are expected to communicate verbally with their supervising attending at the following time intervals: after seeing the patient

Emergency Procedures

It is recognized that in the provision of medical care, 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 a single shift in duration but recur multiple times over the course of the month, and therefore are of sufficient frequency to assess the knowledge and skills of the 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 using the appropriate handoff form (OR-to-ICU, OB OR-to-PACU, etc).

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 using direct observation.