Supervision of Medical Students in Clinical Learning Situations

Effective 7/1/25

To whom this policy applies

University of Nevada, Reno School of Medicine (UNR Med) Faculty, Staff, Resident Physicians, Medical Students, Hospital Partners and Clinical Sites

Purpose/background

The University of Nevada, Reno School of Medicine (UNR Med) recognizes and supports the importance of graded and progressive responsibility in medical student education.

This policy outlines the requirements to be followed when supervising medical students and prohibits medical students from participating in or providing care to fellow students. UNR Med’s goal is to promote patient and student safety and ensure that clinical learning situations align with the student’s level of training to maximize students’ development of the skills and knowledge needed to enter the practice of medicine.

Definitions

Supervising Physician: An attending physician employed by UNR Med; a community/rural attending physician with a clinical faculty appointment at the School of Medicine; a resident or fellow physician training in a Graduate Medical Education program at or associated with UNR Med.

Direct supervision: The supervisor is present with the student and the patient

Indirect supervision: The supervisor, while not in the presence of the student and patient is immediately available and at the site of care to provide direct supervision

Level of Student Responsibility

Observe: Student observes patient history, patient care and/or a patient procedure/examination being performed.

Assist: Student assists an attendingwith providing patient care, gathering patient history, and/or performing a patient procedure/examination.

Perform: Student provides care to the patient, performs a procedure, or gathers patient history under direct supervision.

Policy

Students of UNR Med must be appropriately supervised when participating in clinical learning situations.

With the exception of residents and fellows enrolled in a Graduate Medical Education program, all persons having scheduled supervision of medical students in clinical learning situations are required to have a faculty appointment with UNR Med. This policy excludes those supervising UNR Med students participating in approved external (non-UNR Med) electives.

It is the responsibility of the director of the clinical activity (i.e. clerkship director/elective director) to work with the supervising faculty member and/or site director to communicate the requirements and expectations of this policy.

When a medical student is participating in a clinical learning activity in which allied healthcare providers are present, it is the responsibility of the supervising faculty physician/and/or site director to assure that the allied healthcare providers are appropriately credentialed and capable of medical student supervision within the scope of their practice.

At UNR Med, every student will be directly or indirectly supervised based on the Supervising Physician’s discretion. Supervising Physicians will identify those clinical learning activities for which medical student supervision may be provided by fellows, residents, and/or appropriately credentialed allied healthcare providers. Medical students, during their educational curriculum, may take patient histories and perform complete physical examinations, under the appropriate level of supervision. Medical students may only enter findings in the medical record of the patient with the approval of the Supervising Physician, based on the clinical site’s policies. The Supervising Physician will review medical student documentation and provide feedback for educational purposes. Clinical decisions and orders are never formulated or enacted by medical students without a Supervising Physician’s input and approval. All on-call experiences in which medical students participate are subject to the supervision rules described above.

A Supervising Physician is required to directly supervise all procedures including but not limited to clinical, inpatient bedside, emergency department, and/or operating room in which a medical student is involved.

The degree of medical student involvement with the procedure will depend on the complexity of the procedure, potential for adverse effects, and the demonstrated competence, maturity and responsibility of each medical student in order to prioritize the safety and comfort of the patient. This will be determined at the discretion of the Supervising Physician. The Supervising Physician must have privileges or authorization from the clinical site to perform the procedure being supervised.

Medical students may not participate in or provide care to fellow medical students.

Review

Approved by Medical Education Steering Committee, 05/16/2025