Faculty Supervision of Residents: Policies and Program Structure

The chain of command applies to both clinical and administrative issues. Decisions regarding patient care should be reviewed with upper level residents. In general, residents should consult the team member directly above them. Final decisions regarding management should be discussed with the senior team member who will discuss the plan with the attending. Use consultation freely within the chain of command, as this is optimal for learning, teaching, and patient care. Chief residents are expected to provide leadership throughout the residency.
If questions or problems arise with a particular assignment, resident, or schedule then this matter should be addressed with one of the Administrative Chief Residents. If a satisfactory resolution cannot be decided, then the issue can be referred to the Residency Program Director. The GME administrative office of University Hospital may serve to resolve administrative disputes, grievances or problems that cannot be managed by the Department of Obstetrics and Gynecology Administrative and Educational System.

  1. General Considerations
    1. The Ob/Gyn residents are supervised by attending physicians who make up the faculty of the residency program.
    2. Supervision takes place in all facets of training and during all rotations
    3. Supervision is provided by:
      1. In-house faculty 24-hours a day
      2. Individual attending physicians
      3. Faculty supervising the residents receive guidance regarding the competency of the resident through updates from the RExEC and as promotion to the next PGY level occurs. Each faculty is expected to also make his/her own determination of the degree of involvement in patient care for each resident based on the complexity of each patient and the abilities of the resident.
  2. Faculty
    1. Physicians in the Department of Ob/Gyn are considered to be working faculty if they have full-time unrestricted Hospital privileges.
    2. The designation of faculty dictates these physicians are responsible for teaching, evaluating and supervising the residents: therefore, they have the privilege of having resident physicians assist them with patient care.
    3. Resident supervision of patient care by the faculty falls into three broad categories
      1. Private patients of the faculty physicians and medical transports
      2. Patients of the resident’s continuity-of-care clinic
      3. Patients admitted through Emergency Room otherwise “unassigned”.
    4. Faculty physicians, fellow physicians, in a addition to nurses, are responsible for resident supervision during the care of patients
    5. The Chairman of the Department makes the final determination as to which physicians are designated faculty and the extent of their supervisory roles
    6. The Chairman seeks counsel and advice about resident supervision from
      1. Resident Program Director
      2. Resident Education Committee
      3. Residents
      4. Division Directors
      5. Nursing Staff
      6. Hospital Administration
      7. House Staff GME
      8. Dean’s Counsel on Graduate Medical Education
      9. Annual reports from the Education Directorate
      10. Anonymous reviews of faculty and curriculum by residents
  3. Supervision of Private Patients
    1. These are the patients of the faculty physicians
    2. These patients comprise the majority of the patents seen at UAB and participating hospitals
    3. Each of these patients has a private attending physician before entering the hospital, if not, one is assigned
    4. The patient’s attending physician is responsible for supervising the residents who care for their private patients
    5. The upper level residents are consulted by lower level residents regarding patient care questions. If additional feedback is needed the upper level resident will speak directly to the attending and discuss an alternative plan of care.
    6. The attending is the sole judge of the degree of responsibility the resident will have in caring for their private patient
    7. Private patients are seen by the residents on these rotations and others:
      1. UAB Obstetrics
      2. UAB Gynecology / Urogynecology Service
      3. Reproductive Endocrinology and Infertility
      4. Gynecologic Oncology (University Hospital and Private Hospitals)
      5. Medicine: Inpatient and Outpatient
      6. Oncology Clinics
      7. Night Float
      8. Continuity Clinics
      9. Brookwood Women's Health, PC and Eastern OBGYN, PC Gyn rotation

  4. Supervision of the Continuity-of-Care Clinics
    1. This is the resident’s outpatient Continuity Clinic with the sole purpose of teaching ambulatory care.
    2. Residents are supervised by the faculty teaching team
      1. Dr. Margaret Boozer is the primary attending in the continuity clinic and Director. Her primary job is resident education in ambulatory care and supervision of the continuity clinic on a weekly basis throughout the academic year.
    3. When the clinic is open, there is always a teaching faculty team leader present to supervise the residents.
    4. The faculty is responsible for evaluating and determining the degree of involvement for each resident based on the complexity of each patient and the abilities of the resident.
    5. Faculty approves and supervises the scheduling of all clinic surgery after discussing the patient’s workup with the resident.  

  5. Supervision of “Unassigned” Patients
    1. Unassigned patients are those with no –re-assigned physician at the time of admission and become the patients of the faculty member taking in-house call for the particular day
    2. These patients receive care from the residents under the supervision of the faculty member who has been assigned to the patient
  6. Supervision of Patients on the Obstetric Services
    1. These patients are the responsibility of the faculty member on service (postpartum patients, antepartum or High Risk Obstetric patients) or the faculty member assigned to cover the MEU and/or L&D.
    2. The upper level residents are consulted by lower level residents regarding patient care questions. If additional feedback is needed, the upper level resident will speak directly to the attending and discuss an alternative plan of care. All patients admitted and discharged to the inpatient Obstetric service are discussed with the attending and seen and evaluated by the faculty. There are always at least 2 faculty or fellows in house to provide direct supervision of patient care.
    3. Patients seen in the OBCC are evaluated by the residents who are supervised by the faculty in clinic that day. The faculty member is available to directly supervise care as needed and reviews the medical record and plan for each patient before discharge from clinic.
    4. The faculty is ultimately responsible for evaluating and determining the degree of involvement for each resident based on the complexity of each patient and the abilities of the resident.  

  7. Mentoring
    1. All residents are encouraged to select a faculty member to serve as an individual mentor.
    2. All residents are assigned to a vertical mentoring team comprised of a resident at each PGY level and a faculty member.
    3. This faculty mentor serves as a role model and confidant, in addition to supervising the growth and development of the individual resident.