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GME IM Program Supervision

South Georgia Health System Policies And Procedures

Title: GME IM Program Supervision

Facilities: System Policy
Number: 8.005

  • [x] SGMC
  • [ ] SGMC Berrien Campus
  • [ ] SGMC Lanier Campus
  • [ ] SGMC Lakeland Villa

Approvals:
Function Approval:

  • Program Director
  • Designated Institutional Officer
  • Chief Medical Officer

Function:

  • [x] 9.000 GME
  • [x] 1.000 Administrative/Operations
  • [ ] 2.000 Clinical Services
  • [ ] 3.000 Compliance
  • [ ] 4.000 Environment of Care
  • [ ] 5.000 HIPAA
  • [ ] 6.000 Finance
  • [ ] 7.000 Human Resources
  • [ ] 8.000 Long-Term Care

Purpose

The purpose of this policy is to define processes to ensure that the care of patients is undertaken with appropriate faculty supervision and conditional independence and to ensure that there is a mechanism for effective communication between the Graduate Medical Education Committee, the residency programs, and supervising physicians.

Overview

South Georgia Medical Center Graduate Medical Education Program endorses and adheres to the Supervision Policy of the Graduate Medical Education Committee (GMEC) at South Georgia Medical Center and the Accreditation Council for Graduate Medical Education (ACGME) Internal Medicine Common Program Requirements, section VI.A.2.

Application

This Policy is applicable to SGMC GME Program and participating sites.

Definitions

Resident: Any physician in an ACGME-accredited graduate medical education program.

Policy

All clinical services provided by resident physicians must be supervised appropriately to maintain high standards of care, safeguard patient safety, and ensure high quality education, based on patient acuity and a resident's graduated level of responsibility. Four levels of supervision are recognized and must be used by each program in defining supervision of each clinical experience as outlined in Procedures below:

  1. Level 1: Direct supervision: The supervising physician is physically present with the resident during the key portions of the patient interaction. PGY-1 residents must initially have direct supervision.

  2. Level 2: Indirect supervision with direct supervision immediately available: 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. Level 3: Oversight: The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

Procedures

Availability of Supervising Physicians

Faculty call schedules are structured to assure that support and supervision are readily available to residents on duty. Residents will be able to identify which faculty member is on call and how to reach this individual. Backup will be available at all times through more senior residents and appropriately credentialed faculty physicians.

Progressive Resident Responsibility

As they advance in their training program, residents will be given progressive responsibility for care of patients. Resident graded responsibilities for each level of training are described in the individual goals and objectives for each clinical rotation. The determination of a resident's ability to provide care to patients independently, or to act in a teaching capacity is based on the resident's clinical experience, judgment, knowledge, and technical skill. It is the decision of the supervising physician as to which activities the resident will be allowed to perform within the context of the assigned levels of responsibility.

Roles And Responsibilities

Program Director

The program director is responsible to:

  1. Develop written guidelines governing supervision of residents and establish categories of all resident activities according to graduated levels of responsibility, and appropriate levels of supervision. These guidelines will vary according to specialty, intensity of patient care responsibilities on a given rotation, level of experience, and educational requirements in accordance with ACGME guidelines.

  2. Define the levels of responsibilities for each year of training by preparing a description of the types of clinical activities residents may perform and assures that these levels of responsibilities are communicated to residents, supervising physicians, the medical staff and all members of the health care team.

  3. Establish schedules which assign qualified faculty physicians or senior residents to supervise at all times and in all settings in which residents provide patient care, and informs all members of the health care team of faculty members and residents currently responsible for each patient's care.

  4. Establish guidelines for circumstances and events in which a resident must communicate with appropriate supervising faculty members, such as the transfer of a patient to an intensive care unit, or end-of-life decisions.

  5. Evaluate each resident's abilities based on specific criteria, guided by the ACGME Milestones.

Supervising Physician

All patients are the direct responsibility of an attending physician. The attending physician of record is responsible for the quality of all of the clinical care services provided to his or her patients. Accordingly, when the attending staff physician accepts a resident on the service, the attending staff physician becomes the supervising physician responsible for the supervision of the resident's patient care.

Supervising physicians will direct the care of the patient and provide the appropriate level of supervision based on the complexity of care and the experience, judgment, and level of training of the resident being supervised. This responsibility is exercised by observation, consultation, and direction. Fulfillment of such responsibility requires personal involvement with each patient and each resident who is providing care as part of the training experience, with sufficient duration for the supervising physician to individually delegate authority. Supervising physicians may use their discretion in allowing or disallowing residents to perform certain procedures independently, even though a resident may be credentialed to do so. The supervising physician is expected to provide the resident with timely instruction, advice, support, and feedback. The supervising physician agrees to provide a comprehensive, written evaluation at the end of the rotation.

Supervising physicians are also responsible for determining when a resident is unable to function at a level required to provide safe, high quality care to assigned patients and must notify the Program Director of any deficiencies in medical knowledge, patient care, interpersonal communications, systems-based practice, practice-based learning, or professionalism consistent with their level of training. In addition, the supervising physician must have the authority to adjust duty hours as necessary to ensure that patients are not placed at risk by resident physicians who are overly fatigued, impaired, or otherwise not fit for duty.

Residents

Each resident is responsible for communicating significant patient care issues to the supervising medical physician and such communication must be documented in the medical record. Individual residents must be aware of their limitations and not attempt to provide clinical services or do procedures for which they are not trained. They must know the graduated level of responsibility described for their level of training and not practice outside of that scope of services. Failure to function within graduated levels of responsibility, communicate significant patient care issues to the supervising physician, or appropriately document the level of supervising physician oversight may result in corrective action, including the removal of the resident from patient care activities. Residents must inform the program director when appropriate attending physician supervision is not readily available.

Monitoring

The quality of resident supervision is monitored through periodic department reviews such as annual program review, the residents' evaluations of their faculty and rotations, and faculty evaluation of the program. The GMEC shall provide oversight by monitoring resident survey responses, annual program review, and reports of concerns. For any significant concerns regarding resident supervision, the program director shall submit a plan for its remediation to the GMEC for approval, and the program director may be required to submit progress notes to the GMEC until the issue is resolved.

Responsibility

PROGRAM DIRECTOR, GMEC & DESIGNATED INSTITUTION OFFICIAL

Policy History

Original Adoption Date: 07/2020

Last update: April 22, 2026