Levels of Supervision
Supervisory Lines of Responsibility
- All patient care by the fellow is supervised by qualified faculty
- All on-duty faculty and fellows are available by pager at all times
The levels of supervision used in this policy are defined by the ACGME Common Program Requirements:
- Direct Supervision: The supervising physician is physically present with the fellow during the key portions of the patient interaction.
UW clinics and bedside teaching rounds are generally conducted under direct supervision.
- Indirect Supervision: The supervising physician is not providing physical or concurrent visual or audio supervision but is immediately available to the fellow for guidance and is available to provide appropriate direct supervision.
Even when fellows provide consultations, or answer patient calls overnight without discussing with an attending physician in real-time, the attending faculty nonetheless are available to provide guidance to any fellow on any case at any time.
- Oversight: The supervising physician is available to provide review of procedures / encounters with feedback provided after care is delivered.
Neuromuscular fellows may be supervised for patient clinical encounters at any level during the course of the year, but it is expected that most patient encounters will be supervised at the levels of without direct supervision immediately available to oversight. The attending physician must be immediately made aware of any unexpected deterioration of a patient under the care of the fellow.
Our Culture of Safety
Ours is an interdisciplinary team effort designed to provide the best possible care for our patients as we develop the clinical skills in the next generation of physicians certified in Neuromuscular disorders. We strive to maintain in our program a culture of safety, meaning not only that the safe and appropriate care of our patients is always paramount, but also that our trainees and colleagues are always empowered to raise concerns about the care in which they’re participating.
Fellows should never hesitate to admit that they need help, don’t know something, may have committed or identified an error, etc. The program will never retaliate against anyone taking such actions in good faith.
Chain of Command
Fellows should never feel isolated and out of their depth, as there is always more experienced backup available. Similarly, our nursing, allied health, and other clinical colleagues should know that if a patient appears to not be receiving the proper care from a junior resident, backup is available in the form of senior residents and fellows. Following is the chain of command for neurology patients:
- Junior resident. Listed as first call in all call schedules on WebXchange
- Senior resident. In order to avoid misdirected pages after hours, the senior resident is not always listed in WebXchange, but there is always someone on call—just call telecommunications (2-2122) to have the neurology senior resident paged.
- Neuromuscular Fellow: Will be listed in the call pool in WebXchange when they are on service and/or taking call.
- Attending physician. Always listed in the call schedules.
- Fellowship program director. Not always available on pager, but telecommunications can call his/her cell phone at any time.
Fellow Responsibility
Neuromuscular fellows will have graduated from a neurology or physical medicine and rehabilitation residency program in good standing and will be given responsibilities in accordance with that level of training. After six months of direct supervision, studies may be performed with indirect supervision, based on the discretion of the attending neuromuscular physician.
Procedural Supervision
Electromyogram (EMG) and nerve conduction studies (NCS), with or without ultrasound
Fellows may be permitted to perform the studies under indirect supervision, with direct supervision immediately available.
Needle muscle biopsies
Fellows may assist in this procedure with direct supervision of the attending physician.
Skin punch biopsies
Fellows may assist in this procedure with direct supervision of the attending physician.
***Procedures will be documented in a procedure log in MedHub.
Latest revision: 12/4/2023, Michael Hansen, MD
