Policy on Supervision

The following guidelines delineate the supervision policy that the University of Chicago Pediatric Residency Training Program adheres to, effective July 1, 2004:

I. The role of the Attending is:

1. To have the ultimate responsibility for all medical decisions regarding his/her patients.
2. To develop a plan for the medical management of each patient in conjunction with the house staff and consulting services.
3. To be responsible for the implementation of the plan of care and for documentation of the plan in the medical record.
4. To be responsible for providing oversight and supervision of all care provided by residents.
5. To behave in a professional manner at all times with regard to resident supervision and to encourage each resident to seek guidance from the attending at any time the resident believes it to be helpful in the care of the patient.
6. To make clear to each resident that it is only the failure to seek guidance that will be considered problematic.
7. To respond fully and respectfully to any questions or concerns expressed by the care team, including residents and fellows.
8. To communicate clearly to each resident involved in the care of the patient when the attending expects to be contacted by the resident. At a minimum, the resident must be told to notify the attending of significant changes in the patient's condition, regardless of the time of day or day of week. There are nine specific situations that automatically qualify as "significant changes" in the patient's condition and require that the resident notify the attending:



1. Admission to the hospital
2. Transfer of the patient to the intensive care unit
3. Need for intubation or ventilatory support
4. Cardiac arrest or significant changes in hemodynamic status
5. Development of significant neurological changes
6. Development of major wound complications
7. Medication errors requiring clinical intervention
8. Any significant clinical problem that will require an invasive procedure or operation
9. Any incident which compromises safety, endangers a patient or causes potential harm

If the attending physician delegates, in whole or in part, the medical management plan, the attending remains responsible for ensuring that all residents have appropriate training, experience and competence to undertake such management.

II. The senior resident's role on the ward service is:

1. To supervise the interns, subinterns, and medical students in the clinical care of patients.
2. To understand the medical plan for each child on the general pediatric team and to ensure that this plan is actively implemented.
3. To manage the team as a whole and to facilitate interactions between the general pediatric team, subspecialists, RNs, case managers, social workers, and other services.
4. To communicate clearly to the attending of record as designated in section 1h of this policy.
5. To teach the interns and medical students through:



1. Modeling appropriate interactions with patients, families and other staff
2. Demonstrating physical examination and history taking skills
3. Teaching in didactic and clinical settings whenever possible
4. Teaching procedural skills
5. Demonstrating use of evidence based medicine in the management of patients
6. Advocating on behalf of patients and facilitating processes related to their care

III. The role of the senior on call is:

1. To supervise the admission, diagnostic evaluation and treatment of newly admitted patients
2. To communicate with the attending of record as designated in section 1h of this policy
3. To oversee care of all inpatients
4. To support/supervise the interns and subinterns as they manage both newly admitted and existing inpatients
5. To be available for any urgent/emergent situation that arises on the general pediatric floor
6. To ensure that medical students are learning