Please reference complete UW GME Institutional Supervision and Accountability Policy for additional definitions and background.

UW Sleep Medicine Fellowship
Harborview Medical Center
University of Washington Medical Center
Veterans Administration Puget Sound Healthcare System
Seattle Childrens Hospital
Virginia Mason Medical Center

Responsibilities and Accountability

Each patient must have an identifiable and appropriately-credentialed and privileged attending physician (or licensed independent practitioner as specified by the applicable Review Committee) who is responsible and accountable for the patient’s care. This information will be available through annual rotation schedule, rotation descriptions, monthly consult schedules and clinic templates to fellows, faculty members, other members of the health care team, and patients.

The UW Sleep Medicine fellows, and faculty members must inform each patient of their respective roles in that patient’s care when providing direct patient care.

The program will provide the appropriate level of supervision for each fellow based on each fellow’s level of training and ability, as well as patient complexity and acuity. Supervision may be exercised through a variety of methods, as appropriate to the situation.

As part of their education program, fellows are given graded progressive responsibility according to the individual’s clinical experience, judgment, knowledge, and technical skill. Each fellow must know the limits of their scope of authority, and the circumstances under which the fellow is permitted to act with conditional independence.

Supervision Definitions

To promote oversight of <resident/fellow> supervision while providing for graded authority and responsibility, the following levels of supervision are recognized:

1. Direct Supervision

a. the supervising physician is physically present with the fellow and patient during the key portions of the patient interaction; or,

b. 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.

2. 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 appropriate direct supervision.

3. Oversight:  the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

Resident Competence & Delegated Authority

The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each fellow must be assigned by the program director and faculty members.

The program director must evaluate each fellow’s abilities based on specific criteria, guided by the Milestones.

Faculty members functioning as supervising physicians must delegate portions of care to fellows based on the needs of the patient and the skills of each fellow.

Clinical Responsibilities by PGY-Level

Fellows

Fellows may be directly or indirectly supervised. They may provide direct patient care, supervisory care or consultative services, with progressive graded responsibilities as merited.  Senior residents or fellows should serve in a supervisory role to medical students, junior and intermediate residents in recognition of their progress towards independence, as appropriate to the needs of each patient and the skills of the fellow; however, the attending physician is responsible for the care of the patient.

Levels of Supervision for Common Specialty Clinical Activities and Invasive Procedures

Please list each clinical activity/procedure by PGY-level, with specific CPR Level of Supervision language:

Clinical Activity/Procedure	Resident level (PGY)	Location	Supervision Level
Sleep study interpretation	Fellow	HMC, VA Puget Sound ,Seattle Childrens	Oversight
Clinic	Fellow	HMC, UWMC, VA Puget Sound, Seattle Childrens	Primarily direct but indirect when clinically appropriate
Consults	Fellow	HMC, UWMC, VA Puget Sound ,Seattle Childrens	Indirect with direct supervision available
Sleep Lab Home Call	Fellow	HMC	Indirect with direct supervision available

Circumstances and Events in which Supervising Faculty Member (s) MUST be Contacted

Following evaluation of a clinic patient or a new hospital consult

Knowledge of imminent or recent clinical situation that poses significant harm to a patient

Supervision of Consults

Fellows performing consultations on patients are expected to communicate verbally with their supervising attending at the following time intervals: every 24 hours.

Emergency Procedures

It is recognized that in the provision of medical care, unanticipated and life-threatening events may occur.  The fellow may attempt any of the procedures normally requiring supervision in a case where death or irreversible loss of function in a patient is imminent, and an appropriate supervisory physician is not immediately available, and to wait for the availability of an appropriate supervisory physician would likely result in death or significant harm. The assistance of more qualified individuals should be requested as soon as practically possible. The appropriate supervising practitioner must be contacted and apprised of the situation as soon as possible.

Faculty Supervision Assignment

Faculty supervision assignments are typically of at least one month duration and therefore are of sufficient length to assess the knowledge and skills of each resident/fellow and to delegate to the resident/fellow the appropriate level of patient care authority and responsibility.

Supervision of Handoffs

Fellows conducting hand-offs are expected to use structured verbal and electronic processes for patient transfers between services and locations, these include CORES with verbal handoff with IPASS (illness severity, patient information, action list, situational awareness and contingency plans, and synthesis by the receiver).

Fellows may be supervised directly or indirectly when conducting hand-offs.

Faculty must assess resident and fellow readiness to move from direct to indirect supervision when conducting hand-offs and patient transfers using the following: direct observation and fellow evaluations in MedHub.