Background
The purpose of this Wright State University BSOM policy is to define the appropriate levels of supervision of medical students on clinical services and sites as they progress during their education in the School of Medicine. This document also describes the expectations that are to be followed by supervising physicians to ensure that the school protects patient and student safety in accordance with our BSOM goals in the area of Patient Care (Goals 2.1, 2.2 and 2.3) and Interpersonal Skills and Communication (Goals 4.4, 4.5 and 4.6), as well as 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.”
It is also expected that supervising faculty will provide for a learning environment LCME Element 3.5.
“That is conducive to the ongoing development of explicit and appropriate professional behaviors in its medical students, faculty, and staff at all locations and is one in which all individuals are treated with respect.”
Additionally, the learning environment must be free from mistreatment, including, but not limited to, exploitation of the power differential in the faculty-student relationship; intimidation; harassment (i.e., physical, emotional, or sexual); and humiliation, as outlined in LCME Element 3.6. (See Fair Treatment of Students Policy)
Supervision Overview
Medical students participating in patient care must be supervised at all times, where the supervisor is present in the same location as the learner and is able to provide direct instructions and feedback to the learner. It is understood that the primary supervising physician will be an attending faculty physician of BSOM, practicing within the scope of his/her discipline. During instances in which a medical student is participating in a clinical setting where resident/fellow physicians or other healthcare professionals are actively involved in medical student education, it is the responsibility of the supervising faculty physician to assure all personnel are appropriately prepared for their roles for teaching and supervision of medical students within the scope of their practices.
Clinical supervision is designed to foster progressive responsibility. Supervision will be based on the medical student’s level of training, demonstrated competence, and the objectives for the clinical experience.
In the Clinical Medicine Longitudinal Module during the Foundations of Clinical Practice phase of the curriculum, students are required to meet competencies for being able to complete a history and physical; these are observed and verified by clinical preceptors. Specifically, by the end of year one of Foundations, students have been verified to be able to build a complete patient history and perform a physical exam of the following competency groups in adults: Head/Ears/Nose/Throat, Eye, Neck, Heart, Lung/Thorax, Abdomen, Peripheral Vascular, Musculoskeletal, Neurologic, and Skin.
By the end of the Doctoring Bootcamp, and just prior to entering the core clinical rotations, students are able to do the following in addition to what had been verified by the end of year 1: utilize motivational interviewing techniques; perform a physical exam on children; perform a genitourinary exam on males and females; perform an oral presentation; document findings in the SOAP note format; write a prescription; interpret a basic ECG and chest x-ray.
In addition to furthering their core history and physical building skills, developing differential diagnoses, and proposing treatment plans during the Doctoring Phase, clerkship directors provide specific guidance for each clinical experience, including the student’s level of responsibility and scope of approved activities and procedures that are permitted and/or expected during the rotation. This information is shared with all teaching faculty and residents on an annual basis.
By the time students enter Advanced Doctoring rotations, students are able to do the following: perform advanced musculoskeletal and neurological exams; utilize advanced interviewing techniques; deliver bad news; work effectively in health care teams; and apply the principles of value based care.
Expectations of Faculty and Clerkship Directors
- Model professional behavior in interactions with patients, learners, staff and all other individuals in the health care team.
- Provide opportunities for students to demonstrate responsibility and ownership for patient care responsibilities. These opportunities include, but are not limited to taking patient histories; performing complete and/or focused physical examinations; and reporting and entering findings in the patient’s medical record with the explicit approval of the patient’s supervising attending physician. The supervising physician will be responsible for reviewing student documentation and countersigning progress notes.
- Provide students with regular feedback, both positive and constructive. The clerkship or module director should be notified immediately if serious academic or professional gaps in student performance exist.
- Complete student assessments in a timely manner, with all assessments completed in time for calculation of final grades.
Expectations of Students
- 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.
- Maintain self-awareness of own competence and seek assistance/advice when clarification is needed.
- 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.
- Proactively inform the supervising physician or clerkship director concerns about levels of supervision (excessive or sub-standard).
Approved by FCC on May 24, 2017
Revised and approved by FCC on May 22, 2019