Neuroradiology Supervision Policy

This is unpublished

Neuroradiology Fellowship Supervision Policy

Policy is applicable to these practice sites: University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC)

Please reference complete UW GME Institutional Supervision and Accountability Policy for additional definitions and background.

 

Responsibilities and Accountability

Each patient must have an identifiable and appropriately credentialed and privileged attending physician (or licensed independent practitioner as specified by the applicable Review Committee) who is responsible and accountable for the patient’s care. This information will be available to residents/fellows, faculty members, other members of the health care team, and patients through scheduling sites or upon request.

The neuroradiology fellows and faculty members must inform each patient of their respective roles in that patient’s care when providing direct patient care.

The program will provide the appropriate level of supervision for each fellow based on each fellow’s level of training and ability, as well as patient complexity and acuity. Supervision may be exercised through a variety of methods, as appropriate to the situation.

As part of their education program, fellows are given graded progressive responsibility according to the individual’s clinical experience, judgment, knowledge, and technical skill. Each fellow must know the limits of their scope of authority, and the circumstances under which the fellow is permitted to act with conditional independence.

Supervision Definitions

To promote oversight of fellow supervision while providing for graded authority and responsibility, the following levels of supervision are recognized:

  1. Direct Supervision:
    1. the supervising physician is physically present with the fellow and patient during the key portions of the patient interaction; or,

    2. the supervising physician and/or patient is not physically present with the fellow and the supervising physician is concurrently monitoring the patient care through appropriate telecommunication technology.

  2. Indirect Supervision: The supervising physician is not providing physical or concurrent visual or audio supervision but is immediately available to the resident for guidance and is available to provide appropriate direct supervision within 15 – 30 minutes.

  3. Oversight: The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

Fellow Competence & Delegated Authority

The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each fellow must be assigned by the program director and faculty members.

The program director must evaluate each fellow’s abilities based on specific criteria, guided by the Milestones.

Faculty members functioning as supervising physicians must delegate portions of care to fellows based on the needs of the patient and the skills of each fellow.

Clinical Responsibilities

Fellows may be directly or indirectly supervised. They may provide direct patient care, supervisory care or consultative services, with progressive graded responsibilities as merited.  Fellows should serve in a supervisory role to medical students and residents in recognition of their progress towards independence, as appropriate to the needs of each patient and the skills of the fellow; however, the attending physician is responsible for the care of the patient.

Levels of Supervision for Common Specialty Clinical Activities and Invasive Procedures

Please list each clinical activity/procedure by PGY-level, with specific CPR Level of Supervision language:

Clinical Activity/Procedure PGY Level Location Supervision Level
Interpretation Imaging Exams (CT, MRI, X-ray) PGY 6 HMC, UWMC Direct or Indirect
Fluorscopic-guided lumbar punctures and myelograms PGY 6 HMC, UWMC Direct or Indirect
Any cervical puncture PGY 6 HMC, UWMC Direct only
Image-guided biopsy PGY 6 HMC, UWMC Direct only
Diagnostic or therapeutic Angiography PGY 6 HMC, UWMC Direct only
Spine intervention procedures PGY 6 HMC, UWMC Direct only
Moderate sedation PGY 6 HMC, UWMC Direct - first three cases; then direct or indirect (within the building) - after three cases

 

Circumstances and Events in which Supervising Faculty Member (s) MUST be Contacted

  1. After-hour emergent MRI request in an ED patient or inpatient with a pacemaker or ICD (full policy available in MyRad).
  2. Any invasive procedure must be discussed with an attending prior to performing.
  3. Any procedure requiring moderate sedation must be discussed with an attending and the attending must be present (if direct supervision) or in the building (if indirect supervision).
  4. An attending physician or senior resident/fellow asks for an attending opinion on an exam which will immediately impact patient care.

Emergency Procedures

It is recognized that in the provision of medical care, unanticipated and life-threatening events may occur.  The fellow may attempt any of the procedures normally requiring supervision in a case where death or irreversible loss of function in a patient is imminent, and an appropriate supervisory physician is not immediately available, and to wait for the availability of an appropriate supervisory physician would likely result in death or significant harm. The assistance of more qualified individuals should be requested as soon as practically possible. The appropriate supervising practitioner must be contacted and appraised of the situation as soon as possible.

Faculty Supervision Assignment

Faculty supervision assignments cover daily shifts throughout the week or entire weekend shifts and therefore are of sufficient length to assess the knowledge and skills of each fellow and to delegate to the fellow the appropriate level of patient care authority and responsibility.

Supervision of Handoffs

Fellows may be supervised indirectly when conducting hand-offs.  A hand-off should occur between the arriving UW Swing Shift/Night Float fellow and the departing UW daytime fellow(s) regarding active requests or interpretations for urgent MRI cases at UW. The arriving UW Swing Shift/Night Float fellow will then triage any pending UW inpatient MRI cases with the UW MRI technologists. On Holiday or weekend call, a hand-off of any pending MRI or procedural requests or any pending imaging interpretation request should occur at 7 a.m. between the on-call fellow going off shift and the incoming on-call fellow or if a normal business day the fellow assigned to the relevant clinical service. A stroke code in progress by an overnight radiology resident may be handed off to the arriving neuroradiology fellow at HMC or UWMC on call days or regular workdays after appropriate notification and sign-out to the fellow by the resident.

 (Revised 03/23/2026)