Residency Program Supervision Policy
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Family Eye Care 

RESIDENCY PROGRAM SUPERVISION POLICY

The Residency Program is divided into 4 separate phases.

The phases reflect increasing levels of responsibility for the resident. Advancement is based on the resident demonstrating clinical competency and performance in levels of technical and cognitive clinical proficiency and professionalism. It is expected that residents will vary in their skill sets.

The residency supervisor will determine when the resident advances to the next level. Advancement is not based on the amount of time spent in the residency program.

The resident is expected to progress at an acceptable rate. The residency supervisor will remain available to the resident for the complete duration of the program for consultation and additional training, as needed or requested. The phases are described below:

Phase I:

This Acclimation period would typically last about one month. During this time the resident will be able to see patients when accompanied by the residency supervisor. The resident will be able to observe the residency supervisor, familiarize themselves with their exam rooms, facility and equipment.
  1. The resident will concentrate efforts to becoming oriented to staff policies, to the electronic health system records, proper chart documentation, practice layout, policies, procedures, understanding coding & billing, office forms, practice management software,
  2. The resident will become acquainted with the administrative and professional staff at the office and learn its referral networks. 
  3. By week #2 the resident should be able to scribe for the Residency Supervisor, and will discuss case management. 
  4. The Resident will be expected to learn to independently and accurately operate all ophthalmic equipment in the practice (anterior and posterior segment cameras, visual acuity software, OCT's, topographers,
  5. To advance to Phase II, the resident must complete the initial orientation and demonstrate to the supervisor’s satisfaction that he/she is functioning at professional entry-level competence.
  6. The resident is expected to maintain a log on google page of the various encounters and what was learned. This will be reviewed by the Resident Supervisor and will either be accepted as is, accepted with modification of the Residency Supervisor, or will be determined to require the resident to do further research.
  7. The purpose of this sequence is to ensure the resident moves along and increases in impendence and autonomy. If the Residency Supervisor determines the resident is not ready at each transition point of moving from one phase to the next, within the expected time frame, a written plan will be prepared, reviewed and signed by the Residency Supervisor and the resident. The plan will address deficiencies and the solutions to improvement. After an additional month of direct supervision, the Program Coordinator and resident will meet again to evaluate progress. If adequate competency is not demonstrated, the Residency Coordinator will be informed and updated on a monthly basis. At the end of each subsequent month the Program Coordinator will decide if the resident is ready to practice independently. Monthly meetings between the Residency Supervisor and the resident may take place until the end of a six-month period. At this time if sufficient competency is not demonstrated, termination of the resident may be instituted at the discretion of the Residency Supervisor and the Residency Director.

Phase II:

  1. It is anticipated that Phase II will last approximately 1 month for most residents, but the length of time in any Phase is solely dependent on demonstrated competence. To advance to the next phase, the resident must demonstrate acceptable progress in the supervisor’s judgment toward mastering procedures and cognitive tasks that will enable the resident to attain advanced clinical competency. Should the resident’s progression through Phase II be slower than anticipated, remediation will be considered at or around the fourth month.
  2. During Phase II the resident will examine a patient only when the residency supervisor is physically present. 
  3. The resident will begin direct patient care, and is expected to develop and record an assessment and plan for each patient encounter. The resident will discuss each case, including case management, with the residency supervisor prior to discussing with the patient.
  4. All charts will need to be reviewed, signed and approved by the residency supervisor
  5. The Residency Supervisor will review all charts for proper coding & billing, chart documentation, and adherence to standards of care for treatment plans, providing feedback as appropriate to the Resident. 
  6. The resident is expected to learn to independently and accurately operate all ophthalmic instruments. 
  7. The Resident will begin training in advanced procedures (e.g. foreign body removal, cyst drainage, etc.)
  8. During the direct supervision period, the resident will be closely supervised by the Program Coordinator and will be given oral feedback about their performance. 
  9. The Residency Supervisor will remain available to the Resident for the complete duration of the program for consultation and additional training, as needed/requested. 
  10. Once the direct supervision period is successfully completed, the resident will be notified, and his/her schedule will be opened. 
  11. All record reviews are done by the Residency Supervisor. The Supervisor will review the resident’s records on a daily basis. The record will be evaluated for appropriate documentation, legibility, follow up, and standard of care. Any deficiencies will be discussed with the resident on that particular day.
  12. To advance to Phase III, the resident must complete the initial orientation and demonstrate to the supervisor’s satisfaction that he/she is functioning at professional entry-level competence.

Phase III:

  1. It is anticipated that Phase III will begin approximately 2 months from the start of the program.
  2. The resident will be given increased autonomy in patient care. 
  3. Competency will be expected in the advanced procedures and orders learned in Phase II, and work on an education poster to be presented at a national meeting is expected to begin. It is anticipated that Phase III will last approximately 3 months for most Residents. 
  4. The residency supervisor must be physically accessible to the resident at the clinical location. 
  5. With regard to the on-call service the resident may perform initial triage and examine patients as necessary but must telephone the residency supervisor (or their designee) regarding each case in order to ensure standard of care has been met. The residency supervisor will make the ultimate decision that a patient’s symptoms do not designate an emergency appointment if a patient will not be examined after hours. The residency supervisor must be physically available to the resident for consultation. Feedback will be provided to the resident as necessary. The residency supervisor or designated faculty member will be physically or remotely accessible at all of the resident’s clinical assignments during this phase. The accessibility level will be determined by the Residency Supervisor and based upon the clinical competency of the Resident. Competence will be expected in advanced procedures learned in the prior Phase. To advance to Phase IV, the resident must demonstrate to the supervisor’s satisfaction the ability to successfully manage advanced clinical cases. Residents are expected to complete this Phase by or before the midpoint of the program. Should the resident not be ready to transition to the Final Phase by the midpoint of the program, remediation (see below) will be considered.

Phase IV:

  1. This Phase will typically be instituted midway into each program. The resident will be given full autonomy with regard to patient care. 
  2. When appropriate, the resident will also be given opportunities to precept student interns. The resident will work alongside the residency supervisor until which time they are deemed competent to independently oversee and educate students. Competency includes the ability to oversee multiple students and their patients simultaneously and possess the ability to make clinical decisions based upon student data collection. Once deemed fully competent by the residency supervisor and exposed to this opportunity, the resident can begin to precept students independently to the degree they are comfortable. The goal of the Residency Program is that all residents will successfully complete this Final Phase, being fully independent and autonomous in all aspects of patient care, by the completion of the Residency Program. 
  3. The Resident will be expected to present either a Clinical Case Report, a Grand Rounds Presentation, or an appropriate Continuing Education Lecture. 
  4. It is anticipated that Phase IV will last approximately 5 months for most Residents.

Remediation

In the event that the Resident is unable to progress through each Phase in the expected time period, or if the resident is unable to perform at the level expected when reaching Phase III or IV, remediation, as described in the Residency Handbook, will be implemented.