Policy Title: Medical Student Clinical Supervision Policy
Approval Authority: Undergraduate Curriculum Committee (UCC)
Responsible Entity: College of Medicine-Undergraduate Medical Education
Policy Owner: Clinical Sciences Planning and Evaluation Committee
I. Policy Statement
This policy outlines the responsibility and expectations for supervision of medical students during clinical education activities throughout the curriculum as it relates to LCME element 9.3, which states: “A medical school ensures that medical students in clinical learning situations involving patient care are appropriately supervised at all times in order to ensure patient and student safety, that the level of responsibility delegated to the student is appropriate to his or her level of training, and that the activities supervised are within the scope of practice of the supervising health professional.”
This policy applies to students enrolled in the College of Medicine MD degree program and combined degree programs that include the MD degree.
III. Approval Authority
The Undergraduate Curriculum Committee is responsible for revising and approving the policy. The Clinical Sciences Planning and Evaluation Committee will review the policy and make recommendations to UCC at least every two years.
IV. The Policy
The medical school is committed to the safety of patients and students. Medical students are learners and are not licensed to provide patient care. At all times the supervising attending physician retains medical and legal responsibility for the patient’s care and is ultimately responsible for the evaluation and management of the patient.
All medical students must be supervised in one of two ways, either direct supervision or indirect supervision with immediate availability:
• Direct Supervision: the supervisor is present and directly observing the student with the patient.
• Indirect Supervision with Immediate Availability: the supervisor, while not in the presence of the student and/or patient, is at the clinical site and immediately available to provide direct supervision.
Medical students cannot perform any medical or surgical procedure without the appropriate supervision from a supervising clinician. Determination of the appropriate level of supervision and delegation of responsibility is made by the supervisor who considers the complexity and acuity of the patient’s condition as well as the experience and level of training of the student. The patient will be made aware of the role of the student.
All supervising clinicians must have faculty appointments in the College of Medicine, or be residents or fellows designated by the attending to supervise medical students; all supervisors must function and supervise within their scope of practice and licensure. While some of the day-to-day supervision of medical students may be delegated to residents or fellows, the supervising attending physician retains full responsibility for the supervision of the medical students assigned to the clinical rotation.
A supervising physician may delegate some medical student teaching and supervising responsibilities to non-physician care providers (e.g., Advanced Nurse Practitioner, Respiratory Therapist, etc.) after ensuring the non-physician providers are appropriately credentialed and working within the scope of their practice.
At the department level, the clerkship/course director and department chairperson, who are members of the medical school’s faculty, are directly responsible for assigning students to supervising physicians and residents, and for ensuring supervision of medical students.
At the regional campus, the campus dean assumes responsibility for ensuring consistent medical student supervision across clinical areas at that site.
Individual course and clerkship directors will provide specific guidance to students to explain the student’s level of responsibility, supervision and the scope of approved activities and procedures expected or permitted on rotation or in that clinical experience. This information will be shared with all teaching faculty, residents and staff annually.
While engaged in clinical rotations or clinical activities associated with prescribed course work, medical students should be incorporated into and accepted as an integral part of the team, and permitted to participate in team care of the patient. To facilitate the education of medical students and ensure that students attain the clinical skills necessary for graduation and transition to residency training, supervising attending physicians and/or resident physicians should provide the following opportunities for students to demonstrate progressive responsibility for patient care activities:
• Take patient histories, perform complete and/or focused physical examinations and enter findings in the medical record of the patient with the approval of the patient's supervising attending physician and under the supervision of the attending physician or designated house staff. Students may write the patient’s H&P or daily note, enter orders, and coordinate care in a fashion commensurate with their training level. The findings entered in the medical record of the patient by the student may be utilized by licensed physicians with proper editing and attestation but cannot be used in lieu of any required medical staff and/or house staff documentation. Students must clearly sign all entries in the medical record, along with the designation that they are medical students. Student notes do not require signature by the supervising attending physician or designated house staff unless they are used for billing.
• Write their own admission orders for education purposes even if the orders will not be entered as the official patient documentation.
• Be encouraged to review focused topics related to patients on the service and report information back to the team to demonstrate self-directed, clinical learning and application of knowledge to the care of patients.
• Be encouraged to perform self-assessment and report to the attending physician and resident identified areas for improvement along with a plan for improvement.
• Be encouraged to contact the attending and/or the clerkship or course director with problems or concerns in clinical, administrative, professional or educational matters. Students may also directly contact the Associate Dean for Curriculum-Clinical Sciences.
Supervising clinicians should provide students with regular feedback, both positive and constructive. The clerkship or course director should be notified immediately if serious academic or professional gaps in student performance exist.
Supervising clinicians are responsible for setting a model example of professionalism and collegiality, and demonstrating the attributes becoming of a professional (altruistic, dutiful, knowledgeable, and skillful) and those prescribed in the MUSC Code of Conduct (integrity, trustworthiness, respect, etc.)
V. Who Should Be Knowledgeable about This Policy
Medical Students, Residents, Faculty, and where applicable, Non-physician Care Providers.
VI. Sanctions for Non-compliance
Any violations of this policy will trigger investigation and possible removal of clinical sites or instructors that do not ensure appropriate levels of supervision for medical students.
VII. Communication Plan
Medical students, faculty, fellows, and residents are notified of this policy through required annual online modules and email communication.
VIII. Review Cycle
Reviewed at least every 2 years by CSPEC and UCC.
IX. Approval History
Approval Authority Date
Last Reviewed by CSPEC 08/18/18, 12/11/19
Approved by Undergraduate Curriculum Committee 06/15/12, 08/17/18, 12/12/19