Clinical Supervision of Medical Students

Students of the UCSF School of Medicine must be appropriately supervised when participating in required or elective clinical activities.

1. Medical students may not provide care in an unsupervised fashion.
2. Supervisors must either hold a faculty appointment or receive oversight in their teaching and assessment role by a faculty member. Supervisors may include physicians, residents, fellows, and other licensed health professionals supervising an activity within their scope of expertise or practice.
3. Students may be supervised at one of three  levels, as determined by the supervisor:
   1. Direct observation: the supervisor is present with the student and the patient
   2. Immediately available indirect supervision: the supervisor, while not in the presence of the student and/or patient, is immediately available to the learner and/or at the site of care to provide direct supervision if necessary
   3. Telemedicine supervision will abide by the same rules as in-person.
4. The appropriate level of supervision must be determined by the supervisor and must be consistent with patient and learner safety, the clerkship or rotation objectives, the student's level of training, and the student's demonstrated competence. In determining the appropriate level of supervision, the supervisor should consider:
   1. the student's level of training;
   2. the student's prior experience and demonstrated skill with clinical activity;
   3. the supervisor's familiarity with the student's abilities; and 
   4. the acuity and complexity of the clinical situation and the potential risk to the patient
5. The following expectations provide general guidance by phase training:
   1. Foundations 2 (Early Clerkships):  Indirect supervision (with direct supervision available if necessary) is acceptable for history-taking and examination for specific clinical situations and clerkships. Direct supervision is required for procedures and clinical decision-making.  
   2. Career Launch (Late Clerkships/Advanced Electives): Indirect supervision acceptable for history-taking and management proposals; direct supervision required for invasive procedures and final clinical decisions. 
   3. Acting Internships: Students are expected to function with increased autonomy, proposing management plans to patients under indirect supervision, but all plans must be reviewed and co-signed by a licensed physician. 
6.  Students may not perform procedures without direct supervision.
7. The Office of Medical Education informs all faculty with supervisory responsibilities of supervision expectations via a centralized annual policy attestation monitoring process as outlined in the Orientation to Teaching Responsibilities policy.
8. The Office of Medical Education/Educational Evaluation unit monitors each clerkship’s quality of supervision through the review of data from clerkship evaluation and national surveys, including data on the sufficiency of direct observation, mid-clerkship feedback, and clinical educator effectiveness ratings.