14 - Clinical Supervision Policy for Medical Students

Purpose

To cultivate an environment that maximizes the safety of patients and students and encourages the development and mastery of clinical skills necessary in the care of patients.

Overview

In order to fulfill our dual duties to patient care and safety, and to the education of medical students in the practice of medicine, and to align with accreditation requirements (as outlined by the LCME standards 9.2 Faculty Appointments, and 9.3 Clinical Supervision of Medical Students), this policy delineates the requirements to meet the standard for supervision in the clinical environment across all years of undergraduate medical education.

Policy

All medical students at DGSOM must be appropriately supervised when participating in patient care in required or elective clinical activities at all clinical training sites.

1. Medical students should not provide clinical care to patients without supervision.
2. Supervisors must either hold a faculty appointment at the David Geffen School of Medicine, or be supervised in their teaching role by a physician with a faculty appointment at the David Geffen School of Medicine. Based on this requirement, appropriate supervisors may include physicians, residents, fellows, and other licensed health professional faculty overseeing activities within their scope of practice.
3. Medical student supervision may be categorized as:
   1. Direct supervision, in which the supervisor is physically present with the student in the performance of clinical care.
   2. Indirect supervision with immediate availability, in which the supervisor is not physically present with the student, but is available immediately if needed.
4. The determination of the appropriate level of supervision is the responsibility of the supervisors, and should be based on multiple factors, including but not limited to:
   1. The level of training of the student
   2. Familiarity of the supervisor with the clinical abilities of the student
   3. The acuity of the patient and the level of risk to the patient
   4. The complexity of the clinical activity
5. Students should not perform any invasive procedures or sensitive examinations, including breast, pelvic and rectal exams, without direct supervision from a supervisor who is qualified to independently perform the given procedure.

Procedures

1. The supervisor reviews and independently verifies all student findings, assessments, and care plans, and documents this review.
2. It is the faculty supervisor’s role to ensure that any non-physicians and physician trainees who are engaged in clinical teaching or the supervision of medical students are acting within their scope of practice and skill level.
3. The Dean’s Office – in partnership with the Clerkship Chairs, Clerkship Site Directors, Chairs for Longitudinal Preceptorship courses in Years 1, 2 and 3, as well as all Year 4 Course Chairs – is responsible for communicating and disseminating policies and procedures related to supervision to faculty, residents, fellows and students who participate in the clinical curriculum, and for monitoring compliance.
4. Students should report concerns regarding inappropriate supervision, and any violations of this policy. The multiple forums for reporting include direct reporting to a course chair, clerkship site director or clerkship chair; direct reporting to the Assistant Dean for Clinical Education; documenting concerns in course or clerkship evaluations at the end of the course or clerkship, or by established reporting mechanisms monitoring the learning environment. 

Approved by MEC May 2019