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:  

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.