PURPOSE
To outline processes that ensure the safety of patients and learners and create a supportive environment of graded and progressive responsibility with appropriate supervision in the clinical environment.

AUDIENCE
All medical students

LCME STANDARD
9.2 Faculty Appointments   
9.3 Clinical Supervision of Medical Students

POLICY
Students of the School of Medicine must be appropriately supervised when participating in required or elective clinical activities.

  1. Medical students may not provide care in an unsupervised fashion.
  2. Supervisors must either hold a faculty appointment or be supervised in their teaching and assessment role by an individual who holds a faculty appointment. Supervisors may include physicians, residents, fellows, and other licensed health professionals supervising an activity within their scope of expertise or practice.
  3. Students may be supervised at one of three levels, as determined by the supervisor:
    1. Direct Supervision: the supervisor is present with the student and the patient
    2. Indirect Supervision with Immediate Availability: the supervisor, while not in the presence of the student and/or patient, is immediately available to the student and/or at the site of care to provide direct supervision
    3. Indirect Supervision with Remote Availability: the supervisor, while not in the presence of the student and/or patient, is immediately available to the student by means of telephonic and/or electronic modalities to provide direct supervision
  4. Determination of appropriate level of supervision is made by the supervisor, based on many factors, including:
    1. Level of training of the student
    2. Previous experience and skill of the student with the clinical activity and setting
    3. Familiarity of the supervisor with the abilities of the student
    4. Acuity of activity and level of risk to patient
  5. Students may not perform procedures without appropriate supervision

PROCEDURE

  1. The supervisor must review and independently verify all student findings, assessments, and care plans, and document this review.
  2. The supervisor must ensure that any non-physicians who are supervising any student are acting within their scope of practice.
  3. The clerkship/course IOR must communicate policies and procedures related to supervision to faculty, residents, and students participating in their curriculum, and monitor compliance with the policies and procedures with a report to the relevant governance committee upon request.
  4. Students should report concerns regarding adequate and appropriate supervision through mistreatment reporting, direct reporting to a clerkship/course IOR or coordinator and may also document concerns in clerkship/course evaluations at the end of the clerkship/course.

RESPONSIBILITY
Course/Clerkship Directors

REFERENCES
Liaison Committee on Medical Education, Structure and Function of a Medical School – Standards for Accreditation of Medical Education Programs Leading to the MD Degree

RELATED POLICY/POLICIES
Pre-Clerkship Attendance, Participation and Absence Policy
Clerkship Attendance, Participation and Absence Policy

POLICY OWNER
Committee on Education Policy

REVIEWED BY
Committee on Educational Policy*
Curriculum Managers

REVIEWED DATE and REVIEW CYCLE
January 2021; 3-year cycle