Geriatric Medicine Fellowship ProgramSupervision policy for fellowsUpdated August 2013
1. Please refer to the UNC GME supervision policy for all residents.
2. This policy recognizes that fellows in the Geriatric Medicine program have completed residency training and although require supervision as they learn the skills needed to care for older patients as a geriatrician, also need a certain level of autonomy.
3. All fellows will be supervised by a faculty member on site (either a member of the Division of Geriatric Medicine or an attending with Board or a Certificate of Added Qualifications in Geriatric Medicine) during all of their clinical, geriatric focused activities (Geriatric subspecialty clinic, long term care, inpatient geriatric service, home visits).
4. Fellows rotating on other services will be supervised by UNC faculty with expertise in that area (PMR, Geriatric Psychiatry, Palliative care, memory disorders/neurology). If the rotation involves a site outside of UNC Health Care system, a formal Program Letter of Agreement (PLA) will be available.
5. Fellows in the Geriatric Clinic will be supervised as per ACGME/RRC guidelines with no more than 4 fellows being supervised by one attending (and that attending will be a dedicated preceptor and not seeing his/her own patients at the same time).
6. Graduated level of supervision: For the first 6 months of training, all patients in the long term care setting and in the clinic setting must be seen by the attending physician. After this, all patients seen by a fellow must be discussed with the attending physician who is available on site, but the attending physician may make the decision that the patient does not need to be seen. The patient encounter will be billed under the “primary care exemption”.
7. As per the guidelines set by the RRC in Geriatric Medicine, fellows should be directly supervised by an attending physician when seeing scheduled patients in the long term care or home setting. However, fellows may see patients who need an urgent visit in the long term care or home setting independently. The attending physician must be available via phone and the case must be discussed and a note written for the attending physician or program director to review and sign.
8. In the inpatient setting, fellows may work independently with the residents on the team in seeing and evaluating patients, but all patients must be seen daily by the attending physician.
9. For back up purposes (when on call or doing urgent visits that may not be with an attending physician), the Program Director will at all times be available via phone for questions or concerns.