Supervision of Medical Students on Clinical Rotations

This policy applies to all undergraduate students registered in the Doctor of Medicine (MD) program, and supervising physicians, residents and non-physician health care providers entrusted with medical student supervision at the University of Saskatchewan at all campuses/ learning sites.  

Related Policies and Procedures include: 

• Preparation of Resident and Non-Faculty Instructors Policy
• Conflict of Interest During Assessment of Student Performance Policy
• Non-Involvement of Providers of Student Health Services in Student Assessment Policy
• Order and Prescription Writing Policy
• Procedures for Addressing Instances of Student Mistreatment, Harassment and Discrimination
• Procedures for Concerns with Medical Student Professional Behaviour
• Clerkship Work Hours and Call Policy
• Medical Faculty Policy and Procedures

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. Supervisors and medical students all play important roles and share responsibility in this process.

Supervisors should recognize and mitigate systemic barriers that may affect medical students’ learning experiences. Supervisors should actively model culturally safe and inclusive behaviors, and ensure all students have equitable access to meaningful clinical experiences and feedback.

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 MD faculty, residents or other health care providers.

Supervisor: any individual, including a supervising physician, another MD faculty, resident, or non-physician health care provider who may be involved in teaching and supervising a medical student during a given clinical learning experience.  

Medical students: a student in the MD program of the University of Saskatchewan or a visiting student from another institution engaged in clinical learning experiences as part of their medical education.

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

The Academic Director and the Director, Faculty and Learning Environment are jointly responsible for the implementation, monitoring, maintenance, and evaluation of the Supervision of Medical Students on Clinical Rotations Policy, in collaboration with UGME educational leaders and administrative staff.

A. Expectations of the College of Medicine

The College of Medicine (CoM) will support clinical supervision of medical students as an integral part of patient care and will ensure that appropriate, experienced supervisors  are identified and trained. The CoM will support development and dissemination of policies and offer professional development to support safe and effective clinical learning experiences.  The CoM will work with clinical departments and clinical affiliates as needed to both promote safe and effective clinical supervision and promptly address any identified instances when appropriate supervision was not provided. The supervisors m2.0 Expectations of the Supervising Physician

B. 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 and culturally safe, inclusive behaviour at all times with medical students;
• Follow and support the Practice Standards of the College of Physicians & Surgeons of Saskatchewan;
• Maintain a faculty appointment with the College of Medicine, University of Saskatchewan;
• Identify issues relating to such matters as: conflict of interest, mistreatment, discrimination or harassment, , 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 individuals who may be supervising medical students are oriented to supervision expectations and other teaching responsibilities; 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 appropriate supervision coverage (on-site or on-call) that supports student learning and patient safety;
• Ensure on-call schedules for physicians and residents be structured to provide medical students with continuous supervision;
• Ensure that, when urgent judgments by responsible physicians are required, supervisors are available. Under certain circumstances it may be necessary to be offsite; if so, the supervisor’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:

• Ensure 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;
• If a conflict of interest with a supervisor is identified, promptly inform relevant UGME team members to adjust supervision as required;
• If a conflict of interest with a medical student is identified, avoid assessing that student and promptly inform relevant UGME team members to adjust supervision as required;
• Provide timely ongoing verbal and written feedback to medical students including completion of relevant clinical assessments such as entrustable professional activity (EPA) feedback forms;

Complete 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, and all other supervisors 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 equitable access to clinical learning opportunities, mentorship, and feedback;
• Contribute to a supportive learning environment through engaging all team members, including medical students, in a respectful and inclusive manner;
• Promptly address or report concerns in the learning environment including any concerns of mistreatment, discrimination or harassment;
• Respond in a timely fashion when paged by the medical student and be available to return to the hospital in an emergency; 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 intervene immediately to support both the medical student and the care of the patients that have been delegated to the medical student;
• Adhere to policy regarding works hours and call;
• Confirm student clinical findings, review management plans, and co-sign or provide verbal confirmation to nursing staff of all orders written by a 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.

C. Expectations of the Medical Students

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

• Maintain a respectful relationship with their supervisor, and display professional conduct at all times with peers, non-physician health care providers, staff, co-workers, patients and members of the public;
• Exercise caution and recognize limits of their knowledge and skills and seek support to ensure safe provision of patient care;
• Inform their supervisor 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;
• Review in a timely manner clinical findings, presumptive diagnoses and proposed care plans with their supervisor;
• Promptly inform their supervisor when a patient’s condition deteriorates or when the diagnosis and/or management of the patient are in doubt;
• In the event of being unable to reach the supervisor for timely guidance on urgent patient care needs, seek support from an alternative physician until the supervisor can be contacted;
• If a conflict of interest with a supervisor is identified, promptly inform relevant UGME team members to allow adjustment of supervision as required;
• Inform patients (or responsible family member) of their status as a medical student and provide the name of the responsible supervisor, complete an evaluation at the end of a clinical rotation or clinical learning experience, provide feedback in a constructive manner.

This policy is housed on the College of Medicine Sharepoint, in the UGME Admin common folder.

This policy is posted on the College of Medicine website, under the Policies tab of the Students 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 clerkship faculty leads via the Clerkship Sub-committee.

Faculty are informed via annual policy updates distributed by the Director Faculty and Learning Environment.

Students, faculty, or staff can report non-compliance with the Supervision of Medical Students on Clinical Rotations Policy, including mistreatment, discrimination, harassment, or unsafe supervision to the OSA, Year Chair, or Associate Dean, UGME or Vice-Dean, Education. Reports may be confidential and are protected from retaliation.

The UGME office will assess the concern, and, if needed, initiate a confidential investigation . Interim measures may be taken to ensure student safety.

Director of Faculty and Learning Environment UGME and Academic Director UGME
Phone: 306-966-6142
Email: ugme.medicine@usask.ca