Clinical Supervision of Medical Students Policy

Overview/Rationale

At VP&S, we hold patient safety in highest importance. We value the role of learners as members of a team in providing excellent clinical care, and we also embrace the educational principle of graded responsibility to maximally support learners in their development of clinical expertise. This policy describes the requirements of appropriate clinical supervision to ensure both patient and student safety in the clinical setting.

Accreditation Standards

LCME Accreditation Standard:

9.2 Faculty Appointments

9.3 Clinical Supervision of Medical Students

Stakeholders

This policy applies to the medical students in the MD program at Columbia University Vagelos College of Physicians & Surgeons and their supervisors at various clinical rotations.

  1. Medical students may not provide care in an unsupervised manner.
  2. Supervisors must either hold a faculty appointment at VP&S or be supervised in their teaching and assessment roles by an individual who has a faculty appointment at VP&S. This may include physicians, house staff, fellows, and other licensed health professionals including PAs and NPs who supervise an activity within the scope of their professional practice.
  3. Students may be supervised at one of two levels as determined by the supervisor:
    1. Direct supervision: The supervisor is physically present with the medical student and patient as care is being provided.
    2. Indirect supervision: The supervisor is not physically present with the medical student and patient but is immediately available to provide guidance and direct supervision as needed.
  4. The Supervisor determines the appropriate level of supervision for the medical student, based upon the following factors:
    1. Level of training of the student
    2. Previous experience and skill of the student with the activity
    3. Familiarity of the supervisor with the student and their level of skill
    4. Acuity of activity and level of risk to patient
  5. All medical students must be under direct supervision for all medical procedures. Medical procedures are defined as any diagnostic or therapeutic activity that is physically invasive to the patient and performed in an operating room, procedure suite, or at the bedside, requiring a procedure note and informed consent of the patient.
    1. This supervision must come from a provider for whom that procedure is within the scope of practice.
    2. Medical students are expected to request and assume developmentally appropriate, graduated levels of involvement/participation in procedures during their training.
    3. The supervisor is ultimately responsible for determining the extent to which a student is competent to participate in the procedure.
    4. For each clerkship or clinical rotation, faculty leadership define the medical procedures in which medical students are permitted and/or required to participate, the prerequisite skills for participation, the appropriate clinical settings, and the expected levels of medical student participation and responsibility.
  6. Medical students, as all providers at CUIMC, must adhere to NYP/ ColumbiaDoctors policy on “ The Use of Medical Chaperones in the Provider Office.” As per the policy, medical students cannot serve as medical chaperones.
  7. Students must always be supervised in the clinical environment and seek additional supervision if they find themselves inadequately supervised because of lack of knowledge and/or insufficient experience. Students are expected to recognize when they need additional consultation and supervision in the clinical setting and seek it accordingly.
  8. Even under direct supervision, under no circumstance should a medical student perform any clinical care that is NOT part of the clinical experiences agreed upon by the leadership of the course, clerkship, or clinical rotation, nor should a medical student participate in any clinical care outside of the independent scope of practice of their supervising provider.

Procedures

  1. The supervisor reviews and independently verifies all student findings, including student documentation of patient history, physical examination, assessments/plan, and documents this review.
  2. The faculty supervisor is responsible for ensuring that non-physician supervisors who are teaching and supervising students are doing so within their scope of practice.
  3. The director of the clerkship or course is responsible for communicating policies and procedures related to supervision to faculty and students participating in their curriculum, and for monitoring compliance with the policies and procedures with a report to the relevant governance committee.
  4. The director of the clerkship or course is responsible for communicating standard procedures through which students can report concerns regarding adequate and appropriate supervision of what they may deem a violation of this policy. Procedures may include but are not limited to: reporting of learning environment/professionalism concerns; direct reporting to a clerkship or course director; and documenting concerns in course or clerkship evaluations at the end of the course or clerkship.