Process of Supervision of resident physicians in programs of
professional graduate education.

Purpose:

To ensure quality patient care and patient safety when
residents interact with patients, the following describes
the process of supervision of resident physicians.

Organization:

The various residency training programs operate under the
authority and control of St. Barnabas Hospital.  The
Institutional Graduate Medical Education Committee of St.
Barnabas Hospital (IGMEC) is  standing committee of the
Executive Committee of the Medical Board responsible for the
oversight of all residency training programs.  Members of the
IGMEC include the Medical Director, residency program
directors, resident representatives, administrators, and
other members of the faculty.  The IGMEC meets at least
quarterly and it establishes and implements policies that
affect all residency training programs.

The IGMEC establishes liason with program directors and
ensures that residents have an opportunity to participate in
safe, effective, and compassionate patient care, under
supervision, commensurate with the resident's level of
advancement and responsibility.  The IGMEC establishes
policies regarding the Chain of Command as it applies to
residents at various levels of training and attending
physicians, including the roles, resposibilites, and patient
care activites of the residents, and what degree of
independence residents are given about medical care decisions
and rendering patient care.  The IGMEC also assures that
program directors, attending staff, and residents are aware
of hospital policies that pertain to performance of
procedures, appropriate use of chaparones, informed consent,
indications for the use of restraints, pain control, patient
confidentiality, and DNR status.

The Chairman of the IGMEC communicates regularly with the
Medical Staff and Governing Board about such policies, the
performance of its residents, patient safety issues, quality
of patient care, and other matters of graduate medical
education.

Policy:

Attendings-

All care rendered by resident physicians is under the general
supervision of the attending physicians for that patient.
The supervising attending decides as to the degree of
independcence resident physicians are given about medical
care decisions and rendering patient care.

The attending physican (or a covering attending) must be
readily available to provide guidance for patient care
decisions.

The attending physician must evaluate the patient in person,
confirm the findings of the resident physician, and
review all orders.

Orders for DNR must be signed by the attending physician.

The attending physician must communicate to the resident the
findings, plan of patient care management, and the degree of
independence the resident will be given for this patient's
care.

As the level of skill and knowledge of individual residents
increases, the supervising attending physicians will delegate
increasing levels of responsibility and allow increasing
levelof participation in patient care.

At the time of discharge, the supervising attending may
delegate some of the discharge planning to the resident.  The
attending physician will review any discharge documents
produced by the resident and sign any required attestation
statements.

While the principal documents of a hospital stay may be
prepared by the residents, the comleteness of the documents
will be reviewed and countersigned by the supervising
attending for completeness.

Resident Physicians-

Resident physicians must promptly notify the supervising
attending of all admissions, transfers to other services,
transfers to other facilitites, discharges, or any
significant change in a patient's clinical status.

In urgent or emergency situations, if the supervising
attending is not immediately available, the resident will
discuss the patient care with an on-site Intensive Care Unit
attending.

Residents may perform a history and physical examination
(while adhering to policies regarding chaparones).

Residents may develop an assessment and plan.

Residents may perform rounds and record progress notes.

Residents may write orders under the general supervision of
the attending.

Residents may perform procedures under direct, inperson,
supervision, if they have not yet been given written
privileges to perform the procedure on their own, if the
procedure is indicated, appropriate consent has been
obtained, and they are being supervised by an individual who
has been credentialed to supervise the procedure.

Residents may perform procedures on their own, under the
general supervision of the attending, if the procedure is
indicated, appropriate consent has been obtained, and the
resident has been granted written credentialing to perform
the procedure on their own.

Residents may provide patient education.

Residents may assist at surgery.

Competencies:

The residency programs maintain files on each of their
residents that include each resident's approved competencies.

delegated to the IGMEC, a standing committee of the Executive
Committee of the Medical Board.  On a periodic basis, the
chair of the IGMEC shall communicate to the Medical Board and
the Board of Trustrees on matters relatd to graduate medical
education.