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Definitions

  • Postgraduate medical trainees: a medical trainee with MD (or equivalent) certification who is undertaking training in family medicine or a specialty or subspecialty; referred to as ‘resident’ in this document. Residents will be under the supervision of the Most Responsible Physician (MRP) or a consultant physician in their interaction with a patient or group of patients.

  • Housestaff team: includes all learners involved in the care of a group of patients including senior and junior residents and medical students.

  • Re-entry trainees: residents who have previously held (or are eligible to hold) a license to practice medicine in a particular discipline but have returned to training in a new field or a subspecialty of their original discipline.

  • Supervising physician: the licensed physician who is ultimately responsible for the supervision of a resident or group of residents in a particular practice or service. Supervising physicians may be:

    • Most responsible physician: the medical staff member deemed most responsible for a given patient’s (or group of patients’) care: referred to as attending physician in this document.

    • Consultant physician: a physician involved in the care of a patient on a consultation basis.

    • The on call physician for a particular practice or specialty

Guiding principles

  • Postgraduate medical trainees (residents) are not independent practitioners.

    • Residents are pursuing further training in a particular discipline and must acquire the sufficient experience, knowledge and skills to undertake such practice in an independent and unsupervised manner following completion of their training program. The training program must provide an environment in which experience and competencies are acquired in a manner that is responsive to the need for supervision and hands-on practice and decision making.

    • As a general rule, the level of direct supervision lessens a residents progress through the years of the training program. However, residents acquire skills and knowledge at different paces and where necessary / appropriate usual supervision levels must be adjusted to the needs of the particular resident / situation.

    • Disclosure of the role of residents and the teaching environment must be provided to patients.

  • Patient safety and well-being must be the primary concern in determining the degree of supervision required.

    • Supervising physicians must be available at all times to residents under their supervision, in keeping with the policies of the health region. Whether this availability requires on site presence by supervising physicians will be governed by the situation and regional and program specific policies and procedures.

  • The educational environment must facilitate safe patient care and effective learning.

    • Attending physicians should strive to create an atmosphere in which residents feel comfortable seeking assistance and disclosing lack of sufficient experience, skills or knowledge to deal with a particular situation. Open and supportive communication along with prompt responses to requests for help are essential in encouraging residents to express concerns or need for assistance.

    • Attending physicians should provide sufficient direct observation to form a robust assessment of the trainee’s strengths, weaknesses and skill level including the trainee’s self assessment skills.

    • Delegated responsibility: the training process requires residents to assume responsibility for more junior learners. It is both appropriate and necessary for more senior residents to be delegated responsibility for supervision of other learners. This must be done with due care and attention to the experience, knowledge and skill level of the more senior resident, the needs of the more junior learners and the clinical context.

  • Re-entry trainees often bring into their training programs extensive experience and skills. However, they must be prepared to assume the role of trainee with responsibility to attending physicians and other delegated supervisors and must work within the parameters of the training program and level.

  • Ethical practice and appropriate professionalism: both supervising physicians and residents must collaborate in patient care within appropriate ethical and professional boundaries. Particularly where there are differences of opinion with respect to conscientious refusal to provide certain services, there must be a respectful approach between residents and supervising physicians that allows such choices to be exercised appropriately and without inappropriately involving the patient, family or other staff members / trainees.

Responsibilities of the supervising physician

  • Ensure that residents under their supervision are aware of their responsibilities and expectations about performance and communication.

  • Be available at all times by phone or pager and when necessary, in person. Health region guidelines for maximum response times must be followed.

  • Review in a timely manner all new patient consults / admissions / cases with the resident / housestaff team involved, including both clinical and educational aspects of the case / procedure. Regularly review patients under their care with the assigned resident and housestaff team.

  • If unavailable, ensure that an appropriate alternative supervising physician is available and has agreed to provide supervision for residents. This information must be communicated to all appropriate individuals / groups in a timely fashion. Supervising physician status may only be delegated to another fully licensed practitioner in the specialty.

  • When delegating supervisory responsibility, ensure that the individual to whom supervision is delegated has appropriate knowledge, skills and experience.

  • Intervene in situations of dispute (where appropriate, assist the resident in identifying strategies for appropriate dispute resolution and in pursuing resolution).

Responsibilities of the resident

  • Residents must inform each patient under their care of their status as trainees, the training environment and the name of the attending physician who is supervising the resident in their role with the patient.

  • Residents must perform their designated clinical responsibilities to the best of their abilities under the guidance and instruction of their supervising physician.

  • Document notification of the attending physician and the information exchanged. Documentation is an essential component of the exchange of information between resident and supervising physician (or delegate). Documentation is separate from notification.

  • Inform their supervising physician if for any reason they are unable to carry out assigned duties.

  • Develop awareness of their limitations and seek assistance appropriately.

Responsibilities of the training program

  • Ensure appropriate communication occurs about the role of residents in provision of clinical care to patients.

  • Ensure that residents are aware of and comply with policies around disclosure of their trainee status to patients.

  • Identify expectations as to when residents should / must notify supervising physicians.

  • Ensure that there are appropriate mechanisms and clear expectations around appropriate communication of patient information for call and post call coverage and sign over.

  • The program must ensure that both residents and supervisors are aware of the College of Physician and Surgeons of Saskatchewan Principles and Guidelines: Supervision of postgraduate clinical trainees.

June 17, 2009 – Approved by Full PGME Committee