Resident Supervision

Student Handbook, Psychiatry and Behavioral Sciences: Reno

Clinical supervision is an essential part of resident education and training. Much clinical psychiatry supervision occurs during psychiatry rotations at the VA Medical Center, Renown Medical Center, Mojave Clinic, Northern Nevada Adult Mental Health Services and all outpatient settings during the four years of residency.

The primary purposes of supervision are:

  1. to provide practical assistance and advice for the resident so that the resident can provide excellent care for patients,
  2. to develop in the resident a wide variety of diagnostic and treatment skills that will be useful in future professional work as a psychiatrist and
  3. assessment of the resident's progress.

Congruent with these purposes, there are two kinds of supervision:

1. Clinical Site Supervision

At each clinical placement there is an on-site supervisor, designated by the Chief of Service or Chief of Psychiatry at that site, with the approval of the Program Director. Clinical site supervision is necessary to ensure that the resident is performing within the range of resident competence and within the policies and customary practices of that institution. Such on-site supervision may be broad-ranging and may include helping the resident gather and organize clinical material, validate diagnoses, clarify the dynamics of the case, and receive guidance in treatment for the particular case or the particular kind of case under supervision. The policy of the Residency Education Committee is that such supervision will also provide support for residents' personal and professional development. Each resident shall have at least two hours of scheduled supervision per week as required by the ACGME. At least one hour shall be one on one. This supervision shall be scheduled at regular weekly intervals and must be fulfilled even if the regular attending is unavailable due to illness, vacation or business/clinical conflicts.

2. Faculty Psychotherapy Supervision

The purpose of this supervision is resident training, growth and development in the role of psychotherapist. This supervision shall occur whenever the resident is engaged in specific psychotherapy with an identified patient. The supervisor is a full-time or clinical faculty member designated by the Psychotherapy Subcommittee of the Residency Education Committee. Selection of supervisors is covered under the Psychotherapy Supervision Program section. The Residency Education Committee encourages supervision by direct observation of residents working with patients and by reviewing audio and videotapes of residents' interactions with patients.

Additional supervision may be assigned for special projects, such as research.

On- site supervisors will forward the evaluations of resident performance to the Program Coordinator immediately upon the completion of each rotation and at three month intervals if the rotation is longer than three months. Faculty Psychotherapy supervisors will complete evaluations every three months.

When a resident is experiencing training difficulties, either the resident, the Program Director or the clinical supervisor may initiate monthly written evaluations of resident performance. If a resident is placed on formal warning or probation by the Residency Education Committee, monthly written evaluations using standard evaluation forms must be completed by all supervisors.

Residents are assigned a supervising attending/supervisor at each training site. If a resident wishes to request a different supervisor, the request will be taken under consideration on case by case basis by the site and the Program Director. The residents request should be directed to the Program Director. Every effort should be made by both residents and supervisors to work through conflicts and difficulties given the opportunities for personal and professional growth therein. When this is not possible, the persons concerned should follow the administrative hierarchy at both the site (for supervisors) and the Program office for assistance in conflict resolution.

Residents shall not be asked to cover other rotations or services at any site without written permission of the Program Director.

At all times, residents shall have an identified site supervisor. If a supervisor is unavailable due to illness, vacation or other reason, there shall be an identified designee who must fulfill all supervisory duties of the site supervisor. These duties include supervision of patient care, attending treatment teams meetings, scheduled supervision and coverage of resident site duties during resident didactics. Residents shall not be utilized to fulfill clinical or administrative responsibilities of the site supervisor under any conditions. Inadequate on-site supervision of residents for any reason may result in removal of the resident from the site until adequate supervision is demonstrated.

Interns site supervisor will be immediately available for direct supervision until the Intern has successfully passed three evaluations by a Senior Resident (PGY-3 / PGY-4) or supervisor with regard to Level of Supervision. This will occur at each psychiatric inpatient site. Evaluations are generally done during weekend training days but may be completed at anytime during the rotation by the site supervisor. A copy of the evaluation for may be found in Appendix C.

Successfully completed evaluations should be turned in to the Residency Coordinator's office to be included in the Interns file.

Once the Intern has successfully completed three Level of Supervision evaluations at that site, they may have indirect supervision, with direct supervision available.

Should any of the above obligations and restrictions concerning supervision or clinical coverage not be met, the resident shall contact the Program Director's office for directions.

The Residency Education Committee will develop procedures to monitor compliance of this policy at each site. This currently includes the Chief Resident and monthly site visits.