Supervision of Medical Students in Clinical Learning Situations

Purpose/Background

The University of Nevada, Reno School of Medicine 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. UNR Med's goal is to promote safe patient care and maximize students' development of the skills, knowledge, and attitudes needed to enter the practice of medicine.

Who Needs to Know this Policy

Faculty, Staff, Resident Physicians, Medical Students, Hospital Partners and Clinical Sites

Policy

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 further 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 assure that the specifications of this policy are followed for all medical students of the University of Nevada, Reno School of Medicine.

Level of Student Responsibility

Medical students participate in clinical activities with one of two levels of responsibilities:

• Observer: Student observes but does not interview/examine patients or actively participate in procedures
• Participant: Student actively participating by interviewing patients / obtaining parts of the history and physical or performing procedures at the level of skill determined by the supervising physician

Clinical Supervision

At UNR Med, MS 1 - 4 students will be directly supervised with the supervising physician present or with the supervising physician available based on the supervising physician's discretion. Faculty physicians will identify those patients for whom medical student supervision may be provided by fellows, residents, and/or appropriately credentialed allied healthcare providers. Medical Students, in the course of their educational curriculum, may take patient histories and perform complete physical examinations. Medical students may only enter findings in the medical record of the patient with the approval of the patient's supervising physician, based on the clinical sites 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.

Procedure Supervision

A supervising physician is required to directly supervise (physician present or available) all procedures (clinical, inpatient bedside, emergency department, and/or operating room) in which a medical student is involved.

The degree of supervision (direct supervision with supervision physician present or available) will take into account the complexity of the procedure, potential for adverse effects, and the demonstrated competence, maturity and responsibility of each student in order to ensure 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 to perform the procedure being supervised.

Allied Healthcare Providers

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

Definitions

• Supervising Physician Definition: An attending physician employed by the School of Medicine; 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 the School of Medicine.
• Supervision Levels: Direct Supervision With Supervising Physician Present: The supervising physician is physically present with the medical student and the patient and is prepared to take over the provision of patient care if/as needed.
• Direct Supervision With Supervising Physician Available: The supervising physician is on duty and is available to provide direct supervision.