Pain 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 Pain Medicine 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

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

b. The supervising physician and/or patient is not physically present with the fellow and the supervising physician is concurrently monitoring the patient care through appropriate telecommunication technology.

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 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 fellow.

Clinical Responsibilities by PGY-Level

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: All Fellows


Clinical Activity/Procedure	Resident level (PGY)	Location	Supervision Level
Clinical Activity/Procedure Catheter and stimulator trial lead removal	Clinical Activity/Procedure PGY-5	Clinical Activity/Procedure ALL	Clinical Activity/Procedure Oversight/No supervision required
Resident level (PGY) Dressing changes	Resident level (PGY) PGY-5	Resident level (PGY) ALL	Resident level (PGY) Oversight/No supervision required
Location Placement of peripheral intravenous catheters	Location PGY-5	Location ALL	Location Oversight/No supervision required
Supervision Level Suture placement and removal	Supervision Level PGY-5	Supervision Level ALL	Supervision Level Oversight/No supervision required
Joint injections	PGY-5	ALL	Direct supervision required for first 3 months of training
Trigger point injection	PGY-5	ALL	Direct supervision required for first 3 months of training
Tendon injection	PGY-5	ALL	Direct supervision required for first 3 months of training
Peripheral nerve blocks	PGY-5	ALL	Direct supervision required for first 3 months of training
All lumbar procedures	PGY-5	ALL	Direct supervision required for first 9 months of training
All cervical procedures	PGY-5	ALL	Direct supervision
All discographies	PGY-5	ALL	Direct supervision
All RF neurotomies	PGY-5	ALL	Direct supervision
Insertion of neuroaugmentation devices	PGY-5	ALL	Direct supervision
Insertion of fully implanted neuroaxial infusion systems	PGY-5	ALL	Direct supervision
All other invasive procedures not listed	PGY-5	ALL	Direct supervision

Levels of Supervision for Common Specialty Clinical Activities and Invasive Procedures: Fellows who Completed Anesthesiology Residency


Clinical Activity/Procedure	Resident level (PGY)	Location	Supervision Level
Clinical Activity/Procedure Arterial puncture/catheterization	Clinical Activity/Procedure PGY-5	Clinical Activity/Procedure ALL	Clinical Activity/Procedure Oversight/No supervision required
Resident level (PGY) Catheterization	Resident level (PGY) PGY-5	Resident level (PGY) ALL	Resident level (PGY) Oversight/No supervision required
Location Central venous line placement by subclavian	Location PGY-5	Location ALL	Location Oversight/No supervision required
Supervision Level Dressing changes	Supervision Level PGY-5	Supervision Level ALL	Supervision Level Oversight/No supervision required
Endotracheal intubation	PGY-5	ALL	Oversight/No supervision required
Epidural catheter placement (except cervical level)	PGY-5	ALL	Oversight/No supervision required
Fiberoptic bronchoscopy	PGY-5	ALL	Oversight/No supervision required
Internal jugular and femoral approach	PGY-5	ALL	Oversight/No supervision required
Lumbar puncture	PGY-5	ALL	Oversight/No supervision required
Nasogastric intubation	PGY-5	ALL	Oversight/No supervision required
Phlebotomy	PGY-5	ALL	Oversight/No supervision required
Placement of peripheral intravenous catheters	PGY-5	ALL	Oversight/No supervision required
Pulmonary artery	PGY-5	ALL	Oversight/No supervision required
Regional anesthesia (by any technique)	PGY-5	ALL	Oversight/No supervision required
Spinal anesthesia	PGY-5	ALL	Oversight/No supervision required
Temporary pacemaker placement	PGY-5	ALL	Oversight/No supervision required
Thoracentesis	PGY-5	ALL	Oversight/No supervision required

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.