Approved by the MUSC COM UCC on June 15, 2012
Medical students are learners and are not licensed to provide patient care. At all times the supervising attending physician retains medical and legal responsibility for the patient’s care and is ultimately responsible for the evaluation and management of the patient. While some of the day-to-day supervision of medical students may be delegated to house staff, the supervising attending physician retains full responsibility for the supervision of the medical students assigned to the clinical rotation.
While engaged in clinical rotations or clinical activities associated with prescribed course work, medical students should be incorporated into and accepted as an integral part of the team, permitted to participate in team care of the patient, and expected to demonstrate individual ownership of patient care responsibilities.
To facilitate the education of medical students, supervising attending physicians and/or resident physicians should do the following:
- Provide opportunities for students to demonstrate responsibility and ownership for patient care responsibilities:
- Take patient histories, perform complete and/or focused physical examinations and enter findings in the medical record of the patient with the approval of the patient's supervising attending physician and under the supervision of the attending physician or designated house staff. Students may write the patient’s daily note, enter orders, and coordinate care in a fashion commensurate with their training level. The findings entered in the medical record of the patient will be for educational and student evaluation purposes only and cannot be used in lieu of any required medical staff and/or house staff documentation. Students must clearly sign all entries in the medical record, along with the designation that they are medical students. Because student notes are not official patient care documents, no signature by the supervising attending physician or designated house staff is needed.*
- Be encouraged to write their own admission orders for education purposes even if the orders will not be entered as the official patient documentation.
- Be assigned and directed to provide additional patient care services under the direct in-person supervision of the attending physician or designated house staff. In addition, specific approved procedures identified in course curricula may be performed by students under the appropriate level of supervision by the attending physician or authorized house staff. Documentation of supervision is required. In all such patient care contacts, the patient shall be made aware that the individual providing the care and/or performing the procedure is a student.
- Be encouraged to review focused topics related to patients on the service and report information back to the team to demonstrate self-directed, clinical learning and application of knowledge to the care of patients.
- Provide students with regular feedback, both positive and constructive. The clerkship or course director should be notified immediately if serious academic or professional gaps in student performance exist. Students should also be encouraged to perform self-assessment and report to the attending physician and resident identified areas for improvement along with a plan for improvement. Students should be encouraged to contact the attending and/or the clerkship or course director with problems or concerns in clinical, administrative, professional or educational matters. Students may also directly contact the Associate Dean for Curriculum-Clinical Sciences.
- Set a model example of professionalism and collegiality, and demonstrate the attributes becoming of a professional (altruistic, dutiful, knowledgeable, and skillful) and those prescribed in the MUSC Code of Conduct (integrity, trustworthiness, respect, etc.)
Individual courses/course directors will provide specific guidance to students to explain the student’s level of responsibility and the scope of approved activities and procedures expected or permitted on rotation. This information will be shared with all teaching faculty, residents and staff annually.
*This portion of the policy was edited to reflect the new procedure for managing student notes within EPIC that became effective on July 1, 2014.