Radiology Resident Physician Supervision Policy
DEPT: MEDICAL EDUCATION
POLICY #: 8240.27
GOALS
1. To define responsibility for supervision and accountability of radiology residents.
2. In the clinical learning environment, each patient must have an identifiable, appropriately credentialed and privileged attending physician who is ultimately responsible for that patient’s care. This information should be available to residents, faculty members and patients. Residents and faculty members should inform patients of their respective roles in each patient’s care.
3. The program must demonstrate that the appropriate level of supervision is in place for all residents who care for patients. Supervision may be exercised through a variety of methods. Some activities require the physical presence of the supervising faculty member. For many aspects of patient care, the supervising physician may be a more advanced resident. Other portions of care provided by the resident can be adequately supervised by the immediate availability of the supervising faculty member or resident physician either in the institution or by means of telephone or electronic modality. In some circumstances, supervision may include post-hoc review of resident-delivered care with feedback as to the appropriateness of that care.
POLICY
1. Residents involved in patient care are responsible ultimately to the supervising physician with immediate supervision potentially under the auspices of a more senior radiology resident.
2. Levels of Supervision: To promote oversight of resident supervision while providing for graded authority and responsibility, the program must use the following classifications of supervision:
A) Direct Supervision:
i) The supervising physician is physically present with the resident during key portions of the patient interaction; or,
ii) The supervising physician and/or patient is not physically present with the resident and the supervising physician is concurrently monitoring the patient care through appropriate telecommunication technology.
1) The program’s clear guidelines that delineate which competencies must be demonstrated to determine when a resident can progress to indirect supervision are outlined below.
(2) The program director must ensure that clear expectations exist and are communicated to the residents, and that these expectations outline specific situations in which a resident would still require Direct Supervision.
B) Indirect supervision: The supervising physician is not providing physical or concurrent visual or audio supervision but is immediately available to the resident for guidance, and is available to provide Direct Supervision.
C) Oversight: The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.
3. The privilege of progressive authority and responsibility, conditional independence and a supervisory role in patient care delegated to each resident must be assigned by the Program Director and faculty members.
A) The Program Director must evaluate each resident’s abilities based on specific criteria, guided by the Milestones. When available, evaluation should be guided by specific national standards-based criteria.
B) Faculty members functioning as supervising physicians should delegate portions of care to residents, based on the needs of the patient and skills of the residents.
C) Senior residents should serve in a supervisory role of junior residents in recognition of their progress toward independence, based on the needs of each patient and the skills of the individual resident. Residents in their first, second and third year of radiology residency are considered to be at the intermediate level. Residents in their fourth year of radiology residency are considered to be in their final year of training.
4. There are set guidelines for circumstances and events in which residents must communicate with the appropriate supervising faculty members.
A) Each resident must know the limits of his/her scope of authority and the circumstances under which he/she is permitted to act with conditional independence.
i) A resident must immediately report to the supervising physician when the resident deems that a case or circumstance is beyond his/her scope of medical knowledge or experience.
5. Radiology resident supervision is based upon direct supervision during weekday daytime work hours of 8am to 8pm. Radiology resident independent call occurs between the hours of 8pm to 8am weeknights and on weekends with direct and indirect supervision (with direct supervision by an attending radiologist available).
A) Procedures during on-call hours are either performed by the attending radiologist solely or directly supervised by the attending radiologist. .
B) Fluoroscopic examinations that do not require a needle may be performed by residents through indirect supervision with direct supervision available.
C) All pediatric cases are performed by the attending radiologist or directly supervised..
D) In all instances, direct or indirect supervision by an attending radiologist is available 24/7 to the on-call radiology resident and referring physician by telephone and home teleradiology capabilities..
E) Radiology residents must be of a PGY-3 level or higher (radiology R2 level) before independent call is initiated. Pre-call residents undergo 12 months of extensive evaluation by faculty and an 8-hour simulated “night on-call” comprehensive test is administered (https://widi.xray.ufl.edu/overview/) prior to declaring a resident ready for independent call duties. Residents must pass all of these entrustable professional activities prior to initiation of independent call.
6. Faculty supervision assignments should be of sufficient duration to access the knowledge and skills of the resident on that rotation and delegate to him/her the appropriate level of patient authority and responsibility.
7. The radiology residency program provides a schedule which assigns qualified faculty physicians to supervise at all times and in all settings in which residents provide any type of patient care. The type of supervision to be provided is delineated in the Diagnostic Radiology Residency Curriculum.
8. The minimum amount/type of supervision required in each situation is determined by the definition of the type of supervision specified, but is tailored specifically to the demonstrated skills, knowledge and ability of the individual resident. In all cases, the faculty member functioning as supervising physician may delegate portions of the patient’s care to the resident, based on the needs of the patient and the skills of the resident.
9. Progressive authority and responsibility, conditional independence and a supervisory role in patient care is delegated to the resident by the Program Director and faculty members.
A) First year residents are supervised either directly or indirectly with immediate direct supervision available.
i) Senior residents serve in a supervisory role of junior residents in recognition of their progress toward independence.
10. Clinical Responsibilities: The clinical responsibilities for each resident must be based on PGY-level, patient safety, resident education, severity and complexity of patient illness/condition and available support services.
11. Teamwork: Residents must care for patients in an environment that maximizes effective communication. This must include the opportunity to work as a member of effective interprofessional teams that are appropriate to the delivery of care in radiology.
COTTAGE HEALTH POLICY
Original Policy Effective Date: 05/2011
Last Review Date: 1/2024
Last Revision Date: 1/2020
Owner Title: Program Director, Radiology Residency
Owner Approval Date: 1/2024
Committee Approval: Graduate Medical Education (GMEC)
Committee Approval Dates: 1/2024
VP Approval: CMO/VPMA
VP Approval Date: 1/2024
