Clinical Supervision of Medical Students
PURPOSE: The purpose of this University of Nebraska College of Medicine (UNCOM) policy and procedure is to define the expectations for supervision of medical students on clinical services in the curriculum of the College of Medicine. 

POLICY/PROCEDURE

General: Medical students should be provided with appropriate levels of supervision as they progress through their education towards a career in patient care. A supervising preceptor will ensure that medical students are provided with opportunities to learn that are progressive and commensurate with the student’s level of learning. The purpose of this policy is to describe the procedures that should be followed by supervising physicians to ensure that the school adheres to expectations that protect patient and student safety in accordance with LCME Element 9.3: 

A medical school ensures that medical students in clinical learning situations involving patient care are appropriately supervised at all times in order to ensure patient and student safety, that the level of responsibility delegated to the student is appropriate to his or her level of training, and that the activities supervised are within the scope of practice of the supervising health professional.

Scope: This policy applies to students in all courses at all training sites.

Definitions

Preceptor:

1)     Attending physician of the College of Medicine,
2)     Community teaching physician,
3)     Resident physician or fellow in a Graduate Medical Education program;
4)     Physician Assistant and/or Nurse Practitioner. 

Levels of Supervision:

1)     Direct Supervision: The supervisor is present in the same location as the learner and is able to provide direct instructions and feedback to the learner and can take over patient care duties if necessary. Alternatively, a resident physician or another health professional acting within her/his scope of practice may provide direct supervision under the indirect supervision of an attending physician.
2)     Indirect Supervision: The supervisor is on duty, immediately available, and can be called to the location of the learner if necessary 

Expectations of Supervisors/Course Directors

a)      Model professional behavior in interactions with patients, learners, staff and all other individuals in the health care team.
b)     Provide students with progressively autonomous opportunities for learning that are commensurate with the learner’s level of knowledge and technical skill and address specific learning objectives for the course.
c)      Ensure the student is appropriately supervised to ensure patient and student safety according to policies and procedures of the UNCOM and of the medical facility.
d)     Ensure call schedules permit availability of a supervising physician within a timeframe that is reasonable for the clinical setting. In situations where a supervisor may be off-site, a suitable supervising physician (including resident) must be available and be aware of this expectation.
e)     Ensure medical students are aware of expectations for their behavior and of the procedures or other tasks they are permitted to perform according to their level of competence.
f)       Ensure medical students have appropriate access to medical records and are aware of their ability to enter information into such records. Note that the specific policies and procedures of each medical facility may vary and any variations should be explained to the medical students.
g)      Ensure patients are aware of the status of medical students and that they accept that medical students may participate in their care.
h)     Review and confirm information collected by students through history taking, physical examination or other activity on a regular basis and provide feedback that enhances the student’s learning experience.
i)       Complete student assessments in a timely manner, with all assessments completed in time for calculation of final grades.

Expectations of Students

a)      Maintain professional behavior standards with the supervising physician, other members of the medical team, including resident physicians other health professionals, members of the staff, patients and any other individuals encountered in the clinical setting.
b)     Maintain self-awareness of own competence and seek assistance/advice when clarification is needed.
c)      Inform patients and/or family members of their status as a medical student and the name of the supervising physician under whom they are working.
d)     Proactively inform the supervising physician or course director concerns about levels of supervision (excessive or sub-standard). 

Reporting Concerns

a)      Any student who is concerned about the level of supervision they are receiving should address their concerns as soon as possible with the supervisor and/or course director. Any student who is dissatisfied with the outcome of such a report should report their concerns to the campus director and/or the Assistant Dean for Medical Education.
b)     Expressions of concern will be held in strict confidence if possible. However, this may not be possible in situations where student or patient safety may be compromised, illegal activities may have occurred, or other situations needing immediate contact with reporting individuals. 

Monitoring

a)      Course Directors provide annual report to the appropriate Phase Committee on how they are assuring that students are receiving the appropriate level of clinical supervision within their course
b)     Students report on end of course questionnaires whether clinical supervision was appropriate
c)      Curriculum Committee: Review questionnaire data to identify any ongoing concerns with clinical supervision and report on consistent problem identified by student reporting. Review reports of Block and Clerkship Directors on how they are assuring that students are receiving the appropriate level of clinical supervision.

Responsibilities

a)      Supervisor and/or Course Director is responsible for ensuring that this policy is followed and that all individuals who interact with the learner are appropriately trained and credentialed for the patient care interaction.
b)     Block and Clerkship Directors define the appropriate level of responsibility delegated to students for their level of training.
c)      Curriculum Committee: Development/review of this and related policies. Review and approval of recommended course specific level of responsibility delegated to students for their level of training.
d)     Medical Students: Will be aware of the details of this policy and will identify and assist in rectifying any concerns about clinical supervision.

Policy Source Review date
Clinical Supervision of Medical Students

Last revised: April 25, 2017
Approved by the Clerkship Directors: 7/11/17
Approved by the Curriculum Committee:  7/25/17 
Adapted from University of North Carolina School of Medicine policy

07/25/2017