Policy on Clinical Supervision of Medical Students
This policy applies to all required and elective clinical learning experiences involving medical students, including experiences at affiliated hospitals and clinics, community-based settings, telehealth settings, and approved away or visiting elective sites, whether domestic or international. In all clinical learning situations involving patient care, medical students must be appropriately supervised at all times.
For required clerkships, ultimate supervision of the student’s learning experience must be provided by physician members of the McGovern Medical School (MMS) faculty. Supervision may be delegated, when appropriate, to residents, fellows, or other licensed health professionals; however, delegated supervision may supplement, but not replace, MMS faculty physician supervision. The level of responsibility assigned to a medical student must be appropriate to the student’s level of training, demonstrated ability, and experience, as well as the acuity, complexity, and risk of the clinical situation. All supervised activities must be within the scope of practice of the supervising health professional.
For approved away electives, the host institution’s designated supervising faculty is responsible for day-to-day clinical supervision in accordance with host-institution policy, while MMS retains responsibility for approving the educational experience and responding to reported supervision concerns.
Definitions of Student Clinical Involvement
- Observe
A student who is observing is present during a patient encounter, procedure, or clinical discussion for the purpose of learning. Observation does not include independent clinical decision-making or hands-on participation in patient care activities. - Perform under Direct Supervision
A student who performs under direct supervision actively carries out a clinical task, examination, or procedure while the supervising professional is physically present with the student and patient. - Perform under Indirect Supervision
A student who performs under indirect supervision actively carries out a clinical task or examination while the supervising faculty physician is physically present within the patient care site and immediately available to provide direct supervision if needed. Indirect supervision is appropriate only when the activity does not otherwise require direct supervision.
Qualified Supervisors
Medical students may be supervised by the following professionals, acting within the scope of their credentials and clinical responsibilities:
a. An attending physician (MD or DO) with a faculty appointment at MMS
b. An adjunct/volunteer (without-salary) physician (MD or DO) with a faculty appointment at MMS
c. A resident physician or fellow physician in an MMS-affiliated graduate medical education program, or, for approved away electives, a resident or fellow physician serving in an appropriate supervisory role at the host institution.
d. Other licensed health professionals (including advanced practice clinicians, nurses, pharmacists, respiratory therapists, physical therapists, or other credentialed professionals)
Ultimate responsibility for supervising medical students in patient care settings rests with the supervising faculty physician. When aspects of supervision are delegated to a resident/fellow, or other licensed health professional, the supervising faculty physician remains responsible for the appropriateness of that arrangement, the quality and safety of the student’s clinical activities, and the integrity of the clinical instruction provided to the student. Faculty physicians, residents, fellows, and other health professionals who supervise medical students must be informed of applicable supervision expectations, student roles, limitations on student authority, and procedures for addressing supervision concerns.
Delegation of Supervision
The supervising faculty physician may delegate aspects of direct supervision to a resident/fellow, or other licensed health professional when doing so is appropriate to the clinical activity, the student’s level of training, and the qualifications and scope of practice of the delegated supervisor. Such delegation does not transfer ultimate responsibility from the supervising faculty physician. The supervising faculty physician must be physically present at the clinical site and remain available to the student and the delegated supervisor and be prepared to provide direct supervision when needed.
When supervision is provided by a licensed health professional other than a physician, that individual must be appropriately credentialed, must be acting within the scope of practice of that profession, and may supervise only those student activities that fall within that scope.
Levels of Supervision
- Direct Supervision
Direct supervision is required whenever a medical student performs a clinical activity that poses a significant risk to patient safety, performs an invasive procedure, or participates in any activity for which direct supervision is otherwise required by the clerkship or course requirements.Direct supervision means that the supervising clinician is physically present in the same room with both the student and patient and actively involved during key portions of the encounter during an in-person clinical encounter or procedure, or present in the same virtual encounter when care is delivered by telehealth. Direct supervision may be provided by a faculty physician or, when appropriate, by a resident/fellow, or other licensed health professional acting within scope and under the oversight of the supervising faculty physician. - Indirect Supervision
Indirect supervision means that the supervising faculty physician is not physically present with the student and patient during the interaction, but is physically present within the patient care site and immediately available to provide direct supervision. “Immediately available” means the supervising physician is located within the clinical site and able to be present at the patient encounter promptly when direct supervision is required. For telehealth encounters, immediately available means able to join the virtual encounter in real time through the approved platform without unreasonable delay.Indirect supervision is appropriate only for clinical activities that do not require direct supervision and only when the student has the requisite preparation, skill, and experience for the activity.
Availability of the Supervising Physician
The supervising physician must be physically present at the clinical site and available at all times consistent with the level of supervision (direct vs. indirect) required for the student’s clinical activities.
If the assigned supervising physician becomes unavailable, an alternative qualified faculty physician must be identified to ensure continuity of supervision. If a student is unable to reach the supervising physician in a circumstance requiring supervision, the student must immediately stop the activity and notify the clerkship or course director to arrange appropriate supervision.
Progressive Responsibility
Medical students must be supervised in a manner that permits progressively increasing responsibility, but only to the extent justified by the student’s level of training, demonstrated competence, prior experience, and the clinical context.
The level of responsibility assigned to a medical student must be determined by the supervising physician in accordance with applicable course- and clerkship-specific expectations.
In determining the appropriateness of a student’s clinical responsibilities, supervisors should consider:
a. The student’s year of training
b. The student’s knowledge, skill, and experience with the specific clinical activity or situation
c. The supervising physician’s familiarity with the student’s abilities
d. The acuity of the patient’s condition
e. The complexity of the clinical situation
f. The potential risk to patient safety
Limitations on Student Authority
Medical students may not independently enter, authorize, sign, release, or implement patient care orders. When permitted by the clinical site and electronic health record system, medical students may enter proposed orders for review and signature by a supervising physician or other authorized clinician.
Medical students may not perform procedures without direct supervision.
Medical students may not function independently in any clinical circumstance in which patient or student safety may be compromised.
Clinical Setting Expectations
- Inpatient care
In the inpatient setting, the supervising physician must personally evaluate the patient within a timeframe appropriate to the clinical situation, confirm or revise the medical student’s findings and assessment as appropriate, and discuss the care plan with the student. Supervision of medical students in the inpatient care setting may be provided by residents, fellows, or other licensed health professionals as appropriate to their role, under the oversight of the supervising faculty physician.At least daily, and more often as clinical circumstances require, the student and supervising physician must review the patient’s clinical progress, reassess the care plan, and determine the appropriate scope of the student’s participation and documentation in the medical record.The supervising physician is responsible for ensuring the completeness, accuracy, and appropriate authentication of the medical record. - Outpatient and Ambulatory Care
In outpatient and ambulatory settings, a supervising physician must be available during clinical sessions and must ensure appropriate oversight of the student’s patient care activities and coordination of care. Supervision of medical students in outpatient and ambulatory care settings may be provided by residents, fellows, or other licensed health professionals, as appropriate to their roles, under the oversight of the supervising faculty physician. In outpatient and ambulatory settings, patients evaluated by medical students must also be evaluated by the supervising physician or other authorized clinician in accordance with site policy, billing rules, and patient safety requirements. - Procedures
A procedure is a hands-on diagnostic or therapeutic clinical activity performed on or with a patient that involves use of instruments, manipulation of tissues or body structures, collection of specimens, administration of treatment, or other patient care activity that presents more than minimal risk to patient safety, comfort, privacy, or dignity.A medical student may assist with or perform components of a procedure only when, in the judgment of the supervising physician, the student has received appropriate prior instruction and has sufficient knowledge and skill for the assigned role. Supervision of medical students during procedures may be provided by residents, fellows, or other licensed health professionals as appropriate to their role, under the oversight of the supervising faculty physician.All student involvement in procedures requires direct supervision.The supervising clinician must be identified in the procedure documentation, and the supervising faculty physician remains ultimately responsible for the procedure and for the appropriateness of the student’s participation. - Telehealth
In telehealth settings, direct supervision means the supervising clinician is present in the same virtual encounter or immediately able to join the encounter in real time, consistent with patient safety, privacy, and site requirements.
Student Reporting of Supervision Concerns
MMS is committed to maintaining a safe and supportive learning environment in which medical students may raise concerns about clinical supervision without fear of retaliation. See HOOP Policy 108 – Protection from Retaliation (external link)for further information.
Medical students may report concerns regarding inadequate, inappropriate, or unavailable supervision through clerkship or course evaluation processes, directly to the clerkship or course director, to the site director, or through other established school reporting mechanisms.
Concerns regarding clinical supervision should be reviewed promptly by the responsible educational leader. When concerns are substantiated or remain unresolved at the local level, they must be escalated to the assistant dean of clinical education or other appropriate school official for further review and action.