EA-3211 Clinical Supervision

1.0       Purpose

VTCSOM is committed to fostering a positive and supportive learning environment and values the role of medical students in delivering excellent clinical care. Appropriate clinical supervision is essential to ensure the safety of both patients and learners, to provide a supportive environment for student learning, and to ensure that the responsibilities assigned to students align with their level of training. Supervised activities must also fall within the scope of practice of the supervising health professional. These expectations align with LCME Element 9.2 on Faculty Appointments and Element 9.3 on Clinical Supervision of Medical Students.

VTCSOM students and faculty share responsibility for educating competent physicians who uphold high standards of professional and personal conduct. To ensure patient safety and achieve the goals of the medical education program, faculty follow the principle of graded responsibility, providing appropriate supervision, incremental independence, and meaningful feedback within a safe and supportive learning environment. Student involvement in patient care reinforces preclinical learning, allows practice of clinical skills and procedures, supports professional development, and promotes mastery and retention of clinical knowledge.

2.0       Policy

The progress of students shall be monitored by the faculty to ensure and facilitate each student’s adherence to proper standards of performance including academic, professional skills, behavior, academic honesty, and satisfactory performance within all components of the curriculum. Medical students must have guidance and supervision from a physician (or other healthcare professionals), all of whom must be licensed to practice medicine in the Commonwealth of Virginia. Students and residents do not work independently and the ultimate responsibility for patient care lies with the attending physician.

• Medical students may not practice independently and require direct supervision or indirect supervision for all patient care activities.
• Students may be supervised at two levels, as determined by the supervisor:
  • Direct observation: the supervisor is physically present with the student and patient.
  • Immediately available indirect supervision: the supervisor is not present but is immediately available to provide guidance and direct supervision at the site of care if needed.
• The supervisor determines the appropriate level of supervision based on the student’s training, prior experience and skills, familiarity with the student’s abilities, and the acuity and risk of the clinical activity. Students may not perform procedures without direct supervision.
• Even under direct supervision, students may only perform clinical care that is part of their approved course, clerkship, or rotation, and within the scope of practice of their supervising provider.
• Students may be supervised by physician faculty, physician house staff (residents or fellows), and other licensed healthcare providers (e.g., RN, PA, APN, CNM, PT, OT, PharmD, RD, RT, LCSW, Chaplain) acting within their scope of practice.
• Supervisors must hold a VTCSOM faculty appointment or be supervised in their teaching and assessment role by an individual with a VTCSOM faculty appointment.
• Supervising providers must independently authenticate all student findings, including history, physical examination, ancillary data, and assessment/plan, as well as documentation and orders.
• Students should introduce themselves and clarify their role to every patient.
• Students must recognize the limits of their knowledge and skills and request assistance whenever a situation exceeds their competence or comfort. Seeking help for patient safety is a professional responsibility and should be done without fear of assessment or reprisal.

3.0       Procedures

VTCSOM students must be appropriately supervised when participating in required or elective clinical activities at all clinical training sites.

Responsibilities of Preceptors

1. Be familiar with the VTCSOM goals and objectives for the course, clerkship, rotation, or elective.
2. Provide appropriate level of supervision, guidance, and be available to answer clinical questions during work hours.
3. Offer clinical experiences aligned with the goals and objectives of the course or clerkship.
4. Give formative and summative feedback to each assigned student.
5. Assign relevant readings and facilitate discussion of patients and clinical correlations.
6. Review students’ progress towards required curricular elements.
7. Ensure patient consent for student participation in care; including students’ name and role in written consent procedures.
8. Review, confirm accuracy and sign students’ progress notes, clinical assessments, and orders in the EMR; student notes may be used for documentation per CMS guidelines.
9. Complete the final assessment of each student’s progress in One45.
10. Address professional or knowledge deficiencies according to VTCSOM and institutional policies.

Responsibilities of Students

1. Observe patients and physician–patient interactions to learn history-taking and physical examination.
2. Participate in patient examinations.
3. Participate in invasive procedures under direct supervision of the preceptor or certified resident.
4. Maintain professional behavior and attire.
5. Enter progress notes in the electronic medical record (EMR) in a timely manner.
6. Enter orders in the EMR after completing EMR and order-writing training; all orders must be co-signed by an attending or resident with ≥6 months of PGY-1 experience.
7. Complete HIPAA training and comply with all privacy regulations.
8. Request feedback appropriately during the rotation.
9. Complete One45 evaluation forms for the rotation, attending(s), and resident(s) in a timely manner.
10. Complete all Carilion Clinic required annual in-service modules/courses.
11. Receive all required vaccines unless a medical or religious exemption is approved.

Responsibilities of VTCSOM

1. Provide goals and objectives of the course, clerkship, and elective (e.g., orientations, syllabi).
2. Provide professional medical liability insurance for medical students.
3. Assure medical students undergo infection control, liability, and general hospital orientation prior to the learning experience.
4. Assure medical students are annually screened for tuberculosis and tested if needed.
5. Provide formal mechanism for student assessment and preceptor, resident and rotation evaluation.
6. Provide meal support for medical students on selected rotations for call and evening shifts.

The clerkship director is responsible for communicating supervision policies and procedures to faculty, residents, fellows, and students, and for monitoring compliance. Students may report concerns about inadequate or inappropriate supervision directly to the clerkship or elective director, the Director of Phase 1, 2, or 3, the Associate Dean for Educational Affairs, the Associate Dean for Student Affairs, the Senior Associate Dean for Medical Education, or via established anonymous reporting mechanisms such as One45 or The Beacon.

4.0       Definitions:

• Independent practice: A licensed practitioner provides medical care within their professional competence and scope of practice.
• Oversight: The supervisor is available to review encounters and provide feedback after care has been delivered.
• Indirect supervision: The supervisor is not physically present with the student and patient but is immediately available to provide guidance and direct supervision if needed. The supervisor must not be engaged in activities that would delay their response.
• Direct supervision: The supervisor is physically present with the student and patient while care is being provided.
• Medical procedure: Any diagnostic or therapeutic activity that is physically invasive to the patient, performed in an operating room, procedure suite, or at the bedside, requiring informed consent and documentation in a procedure note.

5.0       References

• Office of Educational Affairs
• Associate Dean for Educational Affairs
• Senior Associate Dean for Medical Education
• Associate Dean for Student Affairs

6.0       Approval and Revisions

Approved by the Medical Curriculum Committee on November 20, 2025