Pediatric Anesthesiology Training Supervision & Accountability Policy

[Last updated: 06/12/2025]

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 through the scheduling platform utilized at each site. The scheduling platform will be communicated to residents during their rotation orientation.

The Seattle Children’s Pediatric Anesthesiology 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 resident/fellow based on each resident/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, residents/fellows are given graded progressive responsibility according to the individual’s clinical experience, judgment, knowledge, and technical skill. Each resident/fellow must know the limits of their scope of authority, and the circumstances under which the resident/fellow is permitted to act with conditional independence.

Supervision Definitions

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

Direct Supervision

a. The supervising physician is physically present with the resident/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 resident/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 to the resident for guidance within 5 minutes and is available to provide appropriate direct supervision within 15-30 minutes.

Oversight

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

Resident Competence & Delegated Authority

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

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

Faculty members functioning as supervising physicians must delegate portions of care to residents/fellows based on the needs of the patient and the skills of each resident/fellow.

Clinical Responsibilities by PGY-Level

Intermediate Residents

Intermediate residents may be directly or indirectly supervised by an attending physician or senior resident/fellow but will provide all services under supervision. They may supervise PGY-1 residents and/or medical students; however, the attending physician is responsible for the care of the patient.

Senior Residents/Fellows

Senior residents/fellows may be directly or indirectly supervised. They may provide direct patient care, supervisory care or consultative services, with progressive graded responsibilities as merited. Senior residents or 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 senior resident/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 Central Venous Access (1)	Clinical Activity/Procedure ALL RESIDENTS until they have completed 5 directly supervised CVC*insertions FOR EACH SITE OF INSERTION (Internal Jugular (IJ), Subclavian (SC), Femoral (FEM) AND ALL CVC insertions performed by any level resident at SCH	Clinical Activity/Procedure ALL	Clinical Activity/Procedure 1 (Direct)
Resident level (PGY) Central Venous Access (2)	Resident level (PGY) ALL RESIDENTS AFTER COMPLETING 5 CVC INSERTIONS for the relevant site of insertion under direct supervision AND logged them in ACGME case logs. EXCEPTION – ALL CVC INSERTIONS AT SCH	Resident level (PGY) ALL	Resident level (PGY) 2a (Indirect)
Location Peripheral Arterial Access (1)	Location ALL RESIDENTS (until they have logged 3 directly supervised arterial line placements)	Location ALL	Location 1 (Direct)
Supervision Level Peripheral Arterial Access (2)	Supervision Level ALL CA1-3 RESIDENTS (after completed 3 under direct supervision AND logged them in ACGME case logs)	Supervision Level ALL	Supervision Level 2b (Indirect)
Peripheral Arterial Access (3)	ALL CBY RESIDENTS (after completed 3 under direct supervision AND logged them in ACGME case logs)	ALL	2a (Indirect)
Peripheral Venous Access	ALL RESIDENTS	ALL	3 (Oversight)
Tracheal Intubation	ALL RESIDENTS	ALL	1 (Direct)
Tracheal Intubation for CODES AND EMERGENT AIRWAYS AFTER HOURS ONLY*	ALL CA1-3 RESIDENTS	Seattle Children’s Hospital, VA Puget Sound Health Care System	2b (Indirect)
Lumbar Puncture (1)	ALL CBY, ALL CA1 & ALL CA2 RESIDENTS	ALL	1 (Direct)
Lumbar Puncture (2)	ALL CA3 RESIDENTS	ALL	2a (Indirect)
Epidural Puncture (1)	ALL CBY, ALL CA1 & ALL CA2 RESIDENTS	ALL	1 (Direct)
Epidural Puncture (2)	ALL CA3 RESIDENTS	ALL	2a (Indirect)
Regional Nerve Block (1)	ALL CBY, ALL CA1 & ALL CA2 RESIDENTS	ALL	1 (Direct)
Regional Nerve Block (2)	ALL CA3 RESIDENTS	ALL	2a (Indirect)
All outpatient interventional pain procedures	ALL RESIDENTS	ALL	1 (Direct)

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

Direct supervision is necessary during:

Endotracheal intubation and extubation
Laryngeal mask insertion and removal
Neuroaxial blockade – single shot and catheter placement
Peripheral Nerve blockade – single shot and catheter placement
Central venous line placement
Fiberoptic intubation and Bronchoscopy
Transesophageal echo probe insertion

Supervision is necessary during:

Neuroaxial and Peripheral nerve catheter removal
Nasogastric tube placement
Patient positioning

Supervision of Consults

Residents/fellows performing consultations on patients are expected to communicate verbally with their supervising attending, and at most within 24 hours of receiving consult.

Emergency Procedures

It is recognized that in the provision of medical care, unanticipated and life-threatening events may occur. The resident/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 of varied duration depending on the specific clinical service, but range from 8 to more than 40 hours/week and therefore are of sufficient length to assess the knowledge and skills of each resident/fellow and to delegate to the resident/fellow the appropriate level of patient care authority and responsibility.

Supervision of Handoffs

Residents/fellows conducting handoffs are expected to use structured verbal and electronic processes for patient transfers between services and locations.

Residents/fellows may be supervised directly or indirectly when conducting handoffs. PGY-1 residents should initially be directly supervised when conducting hand-offs.

Faculty must assess resident and fellow readiness to move from direct to indirect supervision when conducting handoffs and patient transfers using the following: direct supervision.