"Direct Supervision" for interns

[quickfeet]

My first rotation of intern year is the medicine wards/general medical floor. In the syllabus/expectation list for the rotation, it says the following:

"A PGY 1 (intern) will have direct supervision at all times. Senior residents will be given more independence and progressive responsibility when compared to interns."​

Now in the residency's policy manual, levels of supervision are defined the same way as the ACGME requires:

"Direct Supervision – the supervising physician is physically present with the resident and patient."​

If that's true, the attending is going to be in the room with me every single time I do an H&P or subsequent follow-up visit (e.g. pre-round) with patients? That seems completely unrealistic and impractical in a program with 5-6 interns per service. Also pretty unnecessary especially if medical students don't even require direct supervision each time they do an H&P. Is this kind of thing common?

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[DrBowtie]

My first rotation of intern year is the medicine wards/general medical floor. In the syllabus/expectation list for the rotation, it says the following:

"A PGY 1 (intern) will have direct supervision at all times. Senior residents will be given more independence and progressive responsibility when compared to interns."​

Now in the residency's policy manual, levels of supervision are defined the same way as the ACGME requires:

"Direct Supervision – the supervising physician is physically present with the resident and patient."​

If that's true, the attending is going to be in the room with me every single time I do an H&P or subsequent follow-up visit (e.g. pre-round) with patients? That seems completely unrealistic and impractical in a program with 5-6 interns per service. Also pretty unnecessary especially if medical students don't even require direct supervision each time they do an H&P. Is this kind of thing common?

I suspect your syllabus isn't using the ACGME definition of direct supervision. I think your program just means that there will always be a supervising resident or attending in house with you.

 

[Raryn]

My first rotation of intern year is the medicine wards/general medical floor. In the syllabus/expectation list for the rotation, it says the following:

"A PGY 1 (intern) will have direct supervision at all times. Senior residents will be given more independence and progressive responsibility when compared to interns."​

Now in the residency's policy manual, levels of supervision are defined the same way as the ACGME requires:

"Direct Supervision – the supervising physician is physically present with the resident and patient."​

If that's true, the attending is going to be in the room with me every single time I do an H&P or subsequent follow-up visit (e.g. pre-round) with patients? That seems completely unrealistic and impractical in a program with 5-6 interns per service. Also pretty unnecessary especially if medical students don't even require direct supervision each time they do an H&P. Is this kind of thing common?

From the ACGME:

"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 or fellow. 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 telephonic and/or electronic modalities. In some circumstances, supervision may include post-hoc review of resident-delivered care with feedback as to the appropriateness of that care."

It does then go on to define direct supervision as your program does, but nowhere is "attending in the room at all times" the norm. You'll need to staff all the patients with an attending, and probably physically be in the same room as the attending and pt at some point, but typically as long as a supervisor (and that supervisor can be a higher resident) is immediately available to come by if you have any concerns, you'll be fine.

 

[FlowLimited]

Physically present means in the hospital and available if needed. It doesn't necessarily mean physically present in the patient's room at the same time as you. As stated above, you will usually staff the patient with the attending and they will see the patient at that time or afterwards.

 

[HooliganSnail]

My first rotation of intern year is the medicine wards/general medical floor. In the syllabus/expectation list for the rotation, it says the following:

"A PGY 1 (intern) will have direct supervision at all times. Senior residents will be given more independence and progressive responsibility when compared to interns."​

Now in the residency's policy manual, levels of supervision are defined the same way as the ACGME requires:

"Direct Supervision – the supervising physician is physically present with the resident and patient."​

If that's true, the attending is going to be in the room with me every single time I do an H&P or subsequent follow-up visit (e.g. pre-round) with patients? That seems completely unrealistic and impractical in a program with 5-6 interns per service. Also pretty unnecessary especially if medical students don't even require direct supervision each time they do an H&P. Is this kind of thing common?

They will NOT be hovering over your shoulder 24/7. However, attending and senior residents keep VERY close tabs on the interns, especially in the first few months.

This statement is more to protect the hospital should something go wrong. If there is a bad outcome, then the hospital can point to their policy and say "see it wasn't followed". This is not to hang you out to dry btw, it is to put any blame on your attending.

In reality, the far more common intern scenario is that you really need help, but are afraid to make the call to get it. Don't be afraid. Make that call.

 

[mvenus929]

The way our PD explained it... there has to be immediate access to a senior physician at all times. Interns can also be supervised by senior residents, as senior residents do not require 24/7 direct supervision (just indirect supervision, meaning the attending can be at home answering questions).