Supervision of Medical Students on Clinical Rotations

This policy provides for the supervision of medical students on clinical rotations. Clinical supervision is fundamental to safeguarding standards, professional expertise and the delivery of quality care. The Faculty (the supervising physician and/or surgeon – , the medical student, and the attending physician and/or resident all play important roles and share responsibility in this process.

Supervising physician: a faculty-appointed physician in the College of Medicine.  Oversees the student’s clinical learning experiences and assessments.  If applicable, oversees any student engagement with other faculty or non-faculty attending physicians or other health care providers.

Attending Physician: any faculty or non-faculty physician, including residents, who may be involved in teaching a medical student but who is not immediately responsible for overseeing the student’s clinical experiences and assessments. 

This policy applies to all undergraduate students registered in the Doctor of Medicine (MD) program, and supervising and attending physicians at the University of Saskatchewan irrespective of the geographically distributed site/campus at which they are located.

This policy replaces and supersedes the Supervision of Medical Students on Clinical Rotations (2014). 

Related Policies include:  Preparation of Resident and Non-Faculty Instructors Policy

Should we also include the Conflict of Interest Policy.

1.0 Expectations of the College of Medicine

The College of Medicine will support clinical supervision of medical students as an integral part of patient care and will ensure that appropriate, experienced practitioners are identified and trained.

2.0 Expectations of the Supervising Physician

The supervising physician has a number of roles, which they are expected to perform when having a medical student with them on a clinical experience/rotation, including:

• Promote and model professional conduct at all times with medical students;
• Follow and support the Practice Standards of the College of Physicians & Surgeons of Saskatchewan.
• Identify issues relating to such matters as: conflict of interest, harassment, intimidation, and medical student safety; and be familiar with University, College and Program specific policies relating to these issues. When issues arise, provide support and direction in addressing these issues.
• Ensure that all attending physicians, residents, or other health care professionals who may be supervising medical students are oriented to supervision expectations and all other teaching responsibilities (see Preparation of Resident and Non-Faculty Instructors Policy)
• Ensure that any clinical activities supervised by a non-physician health professional are within the scope of practice of the supervising health professional, and that this supervisor has explicitly accepted delegated responsibility from the supervising physician for overseeing the medical student’s participation in those specific activities. (Note: This is not intended to imply that the many opportunities for informal interactions between medical students and other health professionals in the clinical setting necessarily comprise instances of clinical supervision by those professionals).
• Ensure that an attending physician/resident is identified and available, when not immediately present to assist the medical student;
• Ensure on-call schedules for attending physicians and residents be structured to provide medical students with continuous supervision;
• Ensure that, when urgent judgments by responsible physicians are required, attending physicians/residents are available. Under certain circumstances it may be necessary to be offsite; if so, the most responsible physician’s presence must be assured within a reasonable time in case of need.

The supervising physician is expected to provide the medical students who they are supervising with appropriate orientation to their clinical experience as well as assessment of their performance including:

• Ensuring the medical student understands their role and responsibilities in the orientation process at the beginning of each clinical rotation. The supervising physician must ensure that the medical student is informed of what to do and who to call across the spectrum of clinical assignments and rotations.
• Completing any required mid­point performance assessments and end-of-rotation performance assessments in a timely manner. When possible, initial feedback should be provided in person, followed by timely completion of the necessary written (narrative) feedback and other related documents.

 Supervising physicians, attending physicians, residents, and other health care professionals are further expected to ensure medical student and patient safety during clinical experiences/rotations. This is one of their primary responsibilities and one which ensures that the learning environment is conducive to student learning. The expectations include:

• Be aware of the medical student’s educational objectives and, in clerkship, the required clinical encounters for the period during which the medical student is working with them;
• Take into consideration the medical student’s level of training and ensure the medical student is competent in a given clinical task before delegating that task;
• Provide timely ongoing verbal and written feedback to medical students including completion of relevant clinical assessments such as entrustable professional activity (EPA) feedback forms
• Respond in a timely fashion when paged by the medical student and be available to return to the hospital in an emergency; Determine that the medical student is capable of caring for the number of delegated patients, and ensure the medical student is aware of all patients assigned to them;
• Recognize when a medical student is unable to provide safe patient care because of the number and/or complexity of patients assigned as well as because of student stress and/or fatigue, and to intervene immediately to support both the medical student and the care of the patients that have been delegated to the medical student;
• Confirm the clinical findings of the medical student and review the management plan as well as patient progress with the medical student;
• Make necessary modifications to the patient care plan managed by the medical student;
• Ensure that the patient is informed of the medical student’s status.

3.0 Expectations of the Medical Students

Medical students also have a role in ensuring appropriate supervision during clinical experiences/rotations. These expectations include:

• Maintain a professional relationship with physician/resident supervisor, and display professional conduct at all times with peers, paramedical staff, co-workers, patients and members of the public;
• Exercise caution and consider their experience when providing clinical care;
• Strive to be cognizant of the limits of their knowledge and clinical skills;
• Inform their supervising physician if they are not able to care for the delegated patients because of the number and/or complexity of the patients assigned or because of stress and/or fatigue to ensure patient safety;
• When no resident is involved in the care of a patient, the medical student is responsible for notifying the supervising physician;
• Inform patients (or responsible family member) of their status as a medical student and provide the name of the responsible supervising physician (resident or staff);
• Inform their supervisor when a patient’s condition deteriorates or when the diagnosis and/or management of the patient are in doubt;
• Complete an evaluation of their rotation at the end of a clinical rotation.

The Associate Dean, Undergraduate Medical Education, is responsible for providing oversight to the overall administration of the Supervision of Medical Students on Clinical Rotations Policy.

The Manager, Undergraduate Medical Education, with the assistance of the Undergraduate Medical Education Office, is responsible for the implementation, monitoring, maintenance, and evaluation of the Supervision of Medical Students on Clinical Rotations Policy.

Instances or concerns of non-compliance with the Supervision of Medical Students on Clinical Rotations Policy should be brought to the attention of the Vice-Dean, Education or the Associate Dean, Undergraduate Medical Education, within the College of Medicine.

The Manager, Undergraduate Medical Education, provides overall stewardship to the standard operating procedures associated with the Supervision of Medical Students on Clinical Rotations Policy.

This policy will be housed on the College of Medicine Sharepoint, in the UGME Admin common folder.  It will also be housed in SAMC Sharepoint folder.  This policy will be posted on College of Medicine website, under the Policies tab of the Students dropdown menu, as well as the policies tab of the Faculty Dropdown menu.  Any updates approved by SAMC will be distributed to the Year 3 and Year 4 Chairs and all admin coordinators/support staff responsible for Clerkship across the province, who will distribute it to all clerkship faculty leads and the Clerkship Sub-committee.   

Program Manager, UGME
Phone: 306-966-6142
Email: ugme.medicine@usask.ca