Colorectal Surgery Resident Manual

POLICY FOR SUPERVISION OF RESIDENT PHYSICIANS AND FELLOWS FOR ST. JOHN’S HOSPITAL

PURPOSE
To establish an institutional policy regarding supervision for all graduate medical education trainees programs within the institution for St. John’s Hospital.

POLICY
The medical staff monitors and supervises postgraduate trainees assigned patient care responsibilities as part of an approved medical training program including the following:

1 . Residents and fellows are supervised by the attending physicians or dentists who have responsibility for the care of the patients, and who have received or applied for educational credentials as clinical faculty of the SIU School of Medicine.

2. Supervision shall be provided by physicians who are board certified or board eligible in their respective specialties, and who are licensed independent practitioners who hold clinical privileges at St. John’s Hospital through the medical staff process. There shall be a sufficient number of these physicians to supervise the postgraduate trainees in their specific training program to meet reasonable and expected demand, and residents may provide service within the scope of privileges granted the attending physician.

3. There is continuous monitoring of patient care services provided by trainees to assure provision of quality patient care services within the scope of the privileges of the attending physician.

4. Supervision by attending physicians of the care provided to surgery patients by postgraduate trainees must include as a minimum:

1. a) personal supervision of all surgical procedures requiring general anesthesia or an operating room procedure;
2. b) preoperative examination and assessment by the attending physician, and
3. c) postoperative examination and assessment no less frequently than daily by the attending physician;

5. Disciplinary action and other corrective measures may be taken against the individual providing service and/or the attending/supervising physician when services provided exceed the scope of privileges granted to the attending physician.

RULES AND REGULATIONS

Orders for Treatment
All orders for treatment shall be in writing, by medical staff or house staff. Documentation of house staff supervision, including the writing of orders, must be in the medical record. All orders for treatment must be in accordance with standard formats and ordering practices set by hospital administration and the medical staff. An order shall be considered to be in writing if dictated to a registered nurse, a licensed practical nurse, a physician assistant, or a nurse practitioner, but such an order must be countersigned by the resident physician or fellow promptly. The attending physician may countermand or nullify an order by a resident or fellow at any time

Progress Notes
Pertinent progress notes shall be recorded at the time of observation, sufficient to permit continuity of care and transferability. Each of the patient's clinical problems shall be clearly identified in the progress notes and correlated with specific orders and results of tests and treatment. Progress notes shall be written at least daily by the responsible resident physician. The countersignature of the trainee's progress notes by the attending physician indicates that significant changes in the patient's condition or changes in management were discussed with the trainee or that management is proceeding as planned.

Documentation of Supervision
The medical record must contain evidence of supervision of the residents and fellows by the attending physicians. This requirement can be fulfilled by including phrases such as "case discussed with attending" and "notes and orders reviewed" in the entries. Countersignature of notes and orders by the attending physician is also acceptable. Such documentation should appear at the time of admission of a patient, daily thereafter and when there is a significant change in the condition of the patient or the plan of treatment.

Supervision of House Staff
Each patient's identified attending physician shall participate in or supervise treatment provided by residents and fellows to assure that all aspects of patient care meet proper quality levels; and shall assure that there is a meaningful learning experience for any house officer or student who interacts with the attending faculty member in the care of the patient. Recognized clinically significant changes in the patient's status will be promptly reported to and reviewed by the attending in a timely manner.

Supervision of Procedures
Invasive procedures actually performed by the trainee will be approved by the trainee's attending physician in advance. Such advance approval may be obtained on a case-by-case basis or such other basis as the approving physician deems necessary (such as publication of a general authorization for the house staff).

Evaluation and Advancement
The evaluation and advancement of residents and fellows is the responsibility of the program director. Such evaluation and advancement is conducted in accordance with the policies and procedures of the residency program. Attending supervising physicians may make decisions regarding progressive involvement and independence of trainees in specific patient care activities based upon direct observation of the trainee's level of expertise and competence.

Approved by
Graduate Medical Education Committee at SIU School of Medicine December 21, 2001
Medical Staff Executive Committee at St. John’s Hospital _______(date)_______________
Governing Board at St. John’s Hospital _______(date)_______________

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