Supervision of Postgraduate Medical Trainees

The exchange between the Responsible Attending Physician (referred to as the "Attending Physician") and the Postgraduate Trainee (referred to as the "Trainee") is a reciprocal relationship, i.e. the Attending Physician accepts the responsibility to supervise and the Trainee accepts the responsibility of reporting information to the Attending Physician.

Each patient has a medical staff person who is ultimately responsible for his or her care, i.e. the Attending Physician. This ultimate responsibility cannot be delegated. The Trainee must clearly indicate to the patient (or responsible family member) the name of the most responsible attending physician.

There should be a mechanism to resolve disagreements between the Attending Physician and the Trainee. (See "Resolution of Resident Disagreement with Attending Physician or Supervisor".)

It is expected that the Trainee and the Attending Physician will maintain a professional relationship at all times. It is further expected that the Trainee and the Attending Physician will be cognizant of, and abide by, the standards and guidelines of the College of Physicians and Surgeons of Ontario, the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada and the by-laws and regulations of the University.

RESPONSIBLE ATTENDING PHYSICIAN ("Attending Physician")

It is the Attending Physician's responsibility to supervise the Trainee to the extent of the Trainee's experience and competence.

Evaluation
In order to determine the clinical competence and professional behaviour of the trainee, ongoing evaluation must occur and be documented. The schools should have defined evaluation procedures in place.

Validation
The Attending Physician should discuss with the Trainee, on a regular basis, the trainee's findings and their significance, the management plans for the patient, etc.

POSTGRADUATE TRAINEE ("Trainee")

It is the Trainee's responsibility to report sufficient information, in a timely fashion and appropriate to the circumstances, to his/her Attending Physician.

Notification - General Principles
The attending physician should be notified:
1. When a patient is admitted.
2. When there is significant change in the patient's condition.
3. Prior to discharge.
4. Of any relevant requests made by the patient or relatives.
5. In emergency situations.

Documentation
Documentation is an essential component of the exchange of information that takes place. Documentation is separate from notification.

Additional References

Royal College of Physicians and Surgeons of Canada
The RCPSC states that universities should have policies in place to: ensure adequate supervision, notification of the attending physician regarding decisions in patient care and regarding the presence of the attending during procedures performed by the resident.

• Patient consent regarding resident involvement in their care and a mechanism for disclosure to the patient.
• Assurance of progressive competence and responsibility of the resident for graded independent performance.

Reference:
Standard A.I – University Structure, item 3.8; Standard B.3 – Structure and Organization of the Program, items (2) and (3).

College of Family Physicians of Canada

Refer to the "Red Book", which outlines the process regarding Resident Evaluation.

Reference:
The College of Family Physicians of Canada – Standards for Accreditation of Residency Training Programs.

College of Physicians and Surgeons of Ontario (CPSO)

The CPSO's policy to clarifies the roles and responsibilities of most responsible physicians, supervisors, and trainees engaged in postgraduate medical education programs, thereby ensuring the safety and proper care of patients in situations where postgraduate clinical trainees are being educated.

Reference:
CPSO - Professional Responsibilities in Postgraduate Medical Education.

Canadian Medical Protective Association

CMPA does not have any specific guidelines or policies. CMPA has real case examples available through their Education Department.

Ontario Health Insurance Program (OHIP)

A staff physician may claim for services rendered if the following requirements are met:

• The most responsible physician must be present in the unit at the time and must be identified to the patient at the earliest possible moment.

• No fees are to be charged for services provided by a resident prior to this notification taking place.

• The most physician responsible must be personally identified to the patient. The physician's relationship to the team is defined by the CTU Director.

• The most responsible physician assumes full responsibility for the services rendered.

• Specific requirements may vary with the service and examples are cited; eg: psychotherapy – it is appropriate for the staff physician to review the record of interview.

Download COFM Supervision of Postgraduate Medical Trainees Document