The clinical learning environment has become increasingly complex. In addition to physician faculty, a program’s training environment may include advanced practice (AP) care providers and a variety of other learners such residents or fellows from other SIU programs, allopathic or osteopathic medical students, or AP students.    


The presence of multi-disciplinary advanced practice providers and learners can enrich the delivery of clinical care and the learning environment. From a workforce and recruitment standpoint, it is advantageous for SIU School of Medicine to be able to provide excellent clinical experiences to advanced practice learners. Programs have a responsibility to monitor the learning environment to ensure that residents’ education is enriched and not compromised by the presence of other providers and/or learners. The guidelines below do not contradict or supersede the SIU Employee Guidelines for Advanced Practice Providers, SIU School of Medicine Guidelines for Internships, or any APP Collaborative Care Agreements.

Advanced Practice Care Providers

If an APP is providing clinical service in any division or department with residents, the roles and responsibilities between the advanced care provider and residents must be clearly delineated regarding:

  • Their respective roles in the patient care team - for example:
    • Resident involvement in providing coverage for APP patients ( or vice versa)
    • Operative case assignments
    • Call scheduling and responsibilities
    • Administrative responsibilities (including scheduling)
  • Any teaching, assessment or supervisory role (as permitted by RRC)
    • The program must ensure that any APP who has a role in the education, supervision or assessment of residents must participate in the appropriate professional development for these skills.

Advanced Practice Learners

  • Each department must have an organized process for the acceptance and supervisor assignment of AP learners. For any clinical assignments in a residents’ learning environment:
    • If the AP learner is to be precepted by an APP, the program director should be notified in advance.
    • If the AP learner is to be precepted by an SIU physician faculty member, the assignment should be approved by the program director.

If residents’ education is compromised by the presence of other providers or learners, the program director should report this to the DIO and Graduate Medical Education Committee (GMEC).

 Last Approval Date: September 21, 2018

 Effective Date: September 21, 2018