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Delegation and supervision


Responsibilities of supervisors and trainees

Clinical learning environment


Female physician speaking to group of medical studentsIt is often appropriate to delegate tasks — from a physician to a trainee or to another healthcare provider who requires supervision.

Case: Limited knowledge
Elderly female patient receiving bedside assistance

Background

A patient has a central venous pressure (CVP) line post-operatively. The attending surgeon asks a senior resident to see the patient and remove the line.

A medical student in clinical clerkship goes along, and when the resident is delayed outside the room, the student decides to help the patient move from a chair to the bed.

Outcome

The CVP line is in the way so the clerk disconnects it.  

The patient suffers an air embolism and severe stroke. Subsequently she and her family launch a lawsuit naming all of the healthcare providers involved, including the student.

Lessons learned

Peer experts determined:
  • It was appropriate for the surgeon to delegate the removal of the central line to a senior resident.
  • The resident did not delegate this care and so was not responsible for the harm done.
  • The student chose to perform the act but did not have the knowledge or skill to do it safely.
  • The student was therefore responsible for the harm to the patient.
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Before accepting a delegated task, ask yourself:

  • Do I have the knowledge and technical skill to do it?
  • Has the patient consented to my doing it?
  • Do I understand the expectations of the supervisor?
  • Do I know what might go wrong?
  • Do I know what to do if problems arise?
  • Have I communicated any concerns to the supervisor?

If the answer to any of these questions is "no," the task should not be accepted.

As a staff physician or resident, ask yourself the following questions before delegating a task or decision:

  • Is this task or decision within your own competence?
  • Have you considered the level of training of the student or resident?
  • Does the task or decision need to be delegated or is the healthcare professional acting within his or her scope of practice and does not require supervision?
  • Is the individual accepting the delegation capable and competent to perform the task?
  • Have you made your expectations clear?
  • Are the indications and contraindications understood?
  • Is there a plan to deal with unexpected events?

If the answer to any of these questions is "no," the task or decision should not be delegated.

Supervision

The person delegating a task may have a responsibility for supervising the delegate, especially in a training situation. While it is important for trainees to gain independence, patient safety is equally important.

Supervisors should consider all the factors related to delegation, including the delegated person's training level and experience and what is the appropriate level of monitoring for this individual.

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A Statement of Completion or CME credits are available.