Residency Program

Supervisory policies of MassGeneral Hospital for Children

Residents in the Pediatric program of MassGeneral Hospital for Children practice only under the supervision of staff attending physicians who are independently licensed and duly credentialed by the institutions participating in Partners Pediatrics and MGHfC. Each patient cared for by the resident physicians in MGHfC and its associated clinics will be assigned an attending physician of record who is responsible for his/her care and for determining and implementing the appropriate level of supervision of the trainee. This physician assumes responsibility for the actions of the trainee upon accepting the patient to their care.

The supervising physician’s involvement in a patient’s case shall be documented in the medical record in a timely manner.

• Such documentation will include a clear identification of the name of that physician immediately upon admission to the hospital in the admitting residents’ notes.
• The name of the attending physician shall be simultaneously provided to the patient’s parent or legal guardian together with a discussion of a means of communication with the attending physician.
• The attending physician will document their involvement and agreement with the patient care plan in the medical record within 24 hours of admission.

In addition to their teaching responsibilities, attendings will continue to establish a physician patient relationship that goes beyond their teaching role. Attendings will document they have taken a history and performed an exam for the important and relevant components needed for care and decision making in the case. In addition, the patient and family shall be made aware of the responsible caregiver for the admission or visit, irrespective of resident relationships.

Accepting attending physicians agree that they will be readily available to provide supervision at all times, or to have clearly designated, or to be able to immediately designate a covering physician at any time. Readily available must include availability for a telephone consult at any time[1], and availability to come promptly to the hospital to provide on-site supervision and consultation to the resident. Any attending physician may be requested to provide on-site consultation at any time.

Residents shall notify the following individuals or their designees if an attending physician is unavailable at any time:

• At MGH – the chief residents, the residency director or the Chief of Pediatrics
• At NWH – the house physician of the day, the director of residency training or the Chief of Pediatrics.
• At Cambridge – the attending physician of the month, the director of residency training or the Chief of Pediatrics.
• At NSCH – the staff emergency room physician on call at the time of requested assistance or the Pediatric Medical Director.
• At BWH – the Chief of Neonatology.

In cases where the attending of record cannot be promptly available the following backup physicians should be contacted (in order of immediate availability):

• At MGH – the chief residents, the ward attendings of the month, the Ellison unit chiefs (Drs. Israel and Curran), the residency director or the Chief of Pediatrics
• At NWH – the house physician of the day, the staff pediatrician in the emergency room, the in-house neonatologist, the director of residency training or the Chief of Pediatrics.
• At Cambridge – the staff on-call delivery room covering physician, the attending physician of the month, the director of residency training or the Chief of Pediatrics.
• At NSCH – the staff emergency room physician on call at the time of requested assistance or the Pediatric Medical Director.
• At BWH – the staff on-call neonatologist, or the Chief of Neonatology.

If the resident encounters a clinical load that he/she feels is too great for the in-house team of physicians, the resident should contact by phone or page the chief residents or the residency program director.

If the resident falls ill and cannot complete his/her assigned clinical duties, the resident should notify by phone or page the chief residents or the residency program director.

A verbal agreement between the attending physician, the supervising resident and the first year pediatric resident is expected at the time physician’s orders are first entered into the medical record, during the discharge process, at any time there is a significant change in a patient’s condition, and at any time there is a significant change in the management plan for a patient. Documentation of this agreement should be included in the medical record by the resident physician team.

First year pediatric residents shall not accept responsibility for care of any pediatric patient until their supervising resident and attending have been notified and simultaneously accept responsibility for the patient.

• The intern and their supervising resident will provide care as a team, acknowledging that independent development of management plans is essential for the educational progress of the intern, while also acknowledging that the supervising resident accepts responsibility for all decisions made by their supervisee.
• The supervisee has a duty to keep their supervisory resident immediately informed and in agreement with all management plans.

Supervising residents will be immediately available to actively participate in management of any patients admitted to their supervisees. Documentation in the medical record of the supervising resident’s participation will occur in a timely manner, triaged in the context of all other patients under their care. This documentation will be sufficient to demonstrate the supervising resident’s active participation in development of any management plan made by their supervisee.

• The supervising resident will provide care as part of a team led by the attending of record, acknowledging that independent development of management plans is good for the educational progress of the supervising resident, while also acknowledging that the attending physician of record accepts responsibility for decisions made by their supervisee(s).
• The supervising resident has a duty to keep the attending physician informed and in agreement with all management and discharge plans in a timely manner. The timing of these communications will be adjusted according to the severity of the illness of any patient under their care.

MassGeneral Hospital for Children Pediatric residents perform care in the Massachusetts General Hospital, the Brigham and Women’s Hospital, the Newton Wellesley Hospital, Cambridge Hospital and North Shore Children’s Hospital. Residents will also abide by specific supervisory policies set out by those separate institutions. A brief overview of the expectations for supervision at those sites is presented in the table below.

[1] Telephone contacts may include home telephones, beepers or cellular telephones but the preferred means of communication shall be clearly communicated with the responsible resident physicians.