Manual PMR Supervision

Manual PMR Supervision

PM&R Residency Program Manual
PM&R Resident Supervision & Attending Role Policies

PM&R Policy on Resident Supervision and Attending Role
The purpose of this policy is to ensure adequate supervision of PM&R resident physicians involved in postgraduate medical training in the Department of Physical Medicine and Rehabilitation.  This policy is designed to facilitate the educational and clinical progression and maturation of the resident from intern or PGY2, to senior resident. The following are general guidelines for the supervision of Physical Medicine and Rehabilitation residents in clinical settings.  (Please note that all supervision of resident care must conform to HCFA guidelines.)

  • All patient care must be supervised by qualified faculty.
  • The Program Director must ensure, direct, and document adequate supervision at all times.
  • Residents must be provided with rapid, reliable systems for communicating with supervising faculty.
  • Faculty schedules must be structured to provide residents with continuous supervision and consultation.
  • Faculty and residents must be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects.
  • Residents will be given the opportunity to evaluate patients in each clinical setting and formulate a treatment plan. The attending physician must confirm and document the key elements of the history, physical examination, and medical decision-making. The attending physician will review all pertinent clinical findings with the resident and instruct the resident on related examination techniques. The attending physician will discuss treatment options with the resident and then approve the treatment plan.
  • Attending physicians are encouraged to review with the resident his or her performance midway through the rotation and provide constructive comments.
  • At the completion of the rotation, a resident evaluation form should be completed, reviewed with the resident, and then submitted to the residency program director.  In addition, the resident receives an end of rotation examination for all rotations within the PMR department.  This too is discussed with the resident at the completion of the rotation.
  • Residents will receive semi-annual performance reviews with the residency program director.

Development of independent clinical skills during PM&R residency training: The attending physician must continue to provide supervision of residents in all clinical settings.  However, PM&R residents are allowed increasing autonomy as they progress through their residency training and begin to develop a sound foundation for clinical decision-making.  Initially, the attending physician will demonstrate appropriate history taking and examination skills and discuss their assessment and recommendations.  As the residents progress through the clinical rotations and training years, they will be provided with increasing opportunity to formulate a preliminary assessment and treatment plan which is then reviewed with the attending physician. Our intent is to prepare residents to be independent and skilled practitioners of the specialty of Physical Medicine and Rehabilitation upon completion of their residency-training program.

Defined PM&R resident supervisory role: Consults, Inpatient and Outpatient

  • PGY2 residents have orientation and supervision by PGY3 residents for the first two days of the academic year.
  • PGY3 residents supervise medical students and neurology residents on the consultation services. The resident teaches the importance of teamwork, and how to determine whether a patient is a candidate for acute inpatient rehabilitation.
Defined PM&R resident supervisory role: PM&R Program Electrodiagnosis Service
  • The senior PM&R resident will assist attending in teaching and training the junior resident in the use of the electrodiagnostic equipment and procedures. 
  • The senior resident will supervise the junior resident during history taking, physical examination and electrodiagnostic evaluation.  The senior resident also will practice with the junior resident new procedures previously taught by the attending physician. 

Development of teaching and supervisory skills during PM&R residency training: As PM&R residents progress through the PM&R residency training program, they will be given the opportunity to both supervise and instruct more junior residents and medical students. Senior residents will provide direct supervision of junior residents on the electrodiagnosis service.  Faculty will demonstrate teaching techniques and provide appropriate educational oversight.  Residents will also provide backup coverage and be available to assist in the supervision of more junior residents while on call.  Residents will present journal articles to other residents at Journal Club. The attending physicians will assist, advise, and supervise as well as teach how to most effectively give a scientific talk to small as well as large audiences. 

Guidelines for PM&R Attending instruction and supervision of PM&R residents
The purpose of this policy is to ensure the accurate teaching of the affective aspects of Physical Medicine and Rehabilitation:

  • Attending physiatrists will act as role models for the ideal patient encounter.
  • Residents will be given the opportunity to observe mannerism and the general approach to patient care, interaction with other team members, and interaction with patients’ families.
  • The attending physician will model important humanistic qualities to the residents such as kindness, understanding, supportive and positive attitudes that induce hope and trust in the patients and their families.  He/she will also stress the need for patience, responsiveness, availability, and emotional stability in the handling of patient problems.
  • The importance of cooperation and interacting in a professional manner with colleagues, peers, nurses, therapists, and other allied health professionals will also be stressed.
  • In addition, leadership qualities need to be nurtured in order to prepare for the appropriate role within the team.
  • When the resident is ready to perform these functions independently, he/she will be supervised, corrected, and/or counseled by the attending physician to assure that the proper professional behavior is modeled.