Resident Supervision Guidelines

I. POLICY STATEMENT

The UCSF General Surgery residency training program requires active supervision of all residents in the program by an appropriately credentialed Medical Staff member with the supervision documented in the medical record.

Every patient must have an identifiable, appropriately-credentialed and privileged attending physician who is responsible and accountable for that patient's care. This information must be available to residents, fellows, faculty, other members of the healthcare team, and patients. Residents, fellows, and faculty must inform each patient of their respective roles in that patient's care when providing direct patient care. 

Residents must be provided with prompt and reliable systems for communication with attending physicians.

II. REASON FOR POLICY

This policy describes specific supervision policies for residents in the general surgery residency program at UCSF. Per ACGME common program requirements, the program must ensure that all resident clinical activities be appropriately supervised, and that the appropriate levels of supervision are exercised in specific clinical settings. 

These policies outline the minimum levels of supervision that are required, and the attending physician responsible for patient care must determine if a higher level of supervision is warranted on a case-by-case basis. This should be informed by an assessment of an individual resident's clinical competency and level of training.

III. DEFINITIONS

1. Direct Supervision: The supervising physician is physically present with the trainee during the key portions of the patient interaction; or, the supervising physician and/or patient is not physically present with the trainee and the supervising physician is concurrently monitoring the patient care through appropriate telecommunication technology.
2. Indirect Supervision: The supervising physician is not providing physical or concurrent visual or audio supervision but is immediately available to the resident for guidance and is available to provide appropriate direct supervision.
3. Oversight: The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.
4. Supervising physician: 1) attending physician with credentials to perform the procedure or activity at the clinical site in question, or 2) a surgical resident at the PGY2 level of higher whose supervision level is designated as "oversight."
5. Resident: This policy applies to all clinical residents in the UCSF General Surgery Residency Program, including the following:
   1. All categorical General Surgery residents PGY1-5
   2. Non-designated preliminary surgery residents PGY1-2
   3. Designated preliminary PGY1 residents in OMFS, Ophthalmology, and Interventional Radiology
6. Faculty attending physician: A physician on the medical staff, credentialed in the procedure or activity at the clinical site where the procedure or activity is occurring. 

IV. PROCEDURES

A. Principles

The attending physician is responsible for the care provided to individual patients. All residents function under the supervision of appropriately credentialed attending physicians.

Residents as individuals must be aware of their limitations. Failure to function within graduated levels of responsibility or to communicate significant patient care issues to the responsible attending physician may result in the removal of the resident from patient care activities.

PGY1 residents must initially be directly supervised until competency is obtained. This assessment will be informed by entrustable professional activity microassessments, rotation evaluations, skills lab evaluations, and direct observations by faculty, residents, and other providers. 

All procedures performed in the operating room must be directly supervised by an attending physician for the key portions of the procedure.

B. Competencies (Table of Procedures)

Below is a table of procedures indicating which procedure a surgical resident may perform, with or without supervision. In all cases the clinical situation, the experience of the specific resident, and the judgment of the more senior residents and the attending physicians, will determine if a higher level of supervision is required. 

Legend

DS = Direct Supervision
IS = Indirect Supervision
O = Oversight
DS/IS = Direct Supervision, until competency is achieved, then Indirect Supervision
I = Insertion
R = Removal