The ACGME and Joint Commission require that supervision expectations be readily available to trainees and faculty wherever training occurs. This page satisfies that requirement for the Medical Genetics and Genomics Residency program at the following sites:
University of Washington Medical Center, Seattle Children's Hospital.
Updated: May 6, 2026
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 through the EPIC schedule to residents, fellows, faculty members, other members of the health care team, and patients.
The Medical Genetics and Genomics residents, 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 resident based on each resident’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, residents are given graded progressive responsibility according to the individual’s clinical experience, judgment, knowledge, and technical skill. Each resident must know the limits of their scope of authority, and the circumstances under which the resident is permitted to act with conditional independence.
Supervision Definitions
To promote oversight of resident supervision while providing for graded authority and responsibility, the following levels of supervision are recognized:
1. Direct Supervision
- The supervising physician is physically present with the resident and patient during the key portions of the patient interaction; or,
- The supervising physician and/or patient is not physically present with the resident, 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 60 minutes.
3. Oversight
- The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.
Resident Competence & Delegated Authority
The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident must be assigned by the program director and faculty members.
The program director must evaluate each resident’s abilities based on specific criteria, guided by the Milestones.
Faculty members functioning as supervising physicians must delegate portions of care to residents based on the needs of the patient and the skills of each resident.
Clinical Responsibilities by PGY-Level
PGY-1 Residents
PGY-1 residents are initially directly supervised (see definitions above). This does not apply to Medical Genetics and Genomics residents, who by ACGME requirements, begin at a PGY2 level or higher.
Intermediate Residents (PGY-2 and above)
Intermediate residents may be directly or indirectly supervised by an attending physician or senior resident but will provide all services under supervision. They may supervise PGY-1 residents and/or medical students; however, the attending physician is responsible for the care of the patient.
Senior Residents (PGY-3 and above)
Senior residents may be directly or indirectly supervised. They may provide direct patient care, supervisory care or consultative services, with progressive graded responsibilities as merited. Senior residents or fellows should serve in a supervisory role to medical students,
junior and intermediate residents in recognition of their progress towards independence, as appropriate to the needs of each patient and the skills of the senior resident; however, the attending physician is responsible for the care of the patient.
Levels of Supervision for Common Specialty Clinical Activities and Invasive Procedures
| Clinical Activity/Procedure | Resident Level (PGY) | Location | Supervision Level |
|---|---|---|---|
| Skin Biopsy | PGY2 or higher | Outpatient Clinic | Direct |
Circumstances and Events in which Supervising Faculty Member(s) MUST be Contacted
Any complication, near miss or patient problem/safety issue.
Supervision of Consults
Residents performing consultations on patients are expected to communicate verbally with their supervising attending at the following time intervals: Daily, and within 24 hours of the resident seeing the patient, or sooner if medically necessary.
Emergency Procedures
It is recognized that in the provision of medical care, unanticipated and life-threatening events may occur. The resident 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 apprised of the situation as soon as possible.
Faculty Supervision Assignment
Faculty supervision assignments are of one week to four weeks duration and therefore are of sufficient length to assess the knowledge and skills of each resident/fellow and to delegate to the resident/fellow the appropriate level of patient care authority and
responsibility.
Supervision of Handoffs
Residents conducting hand-offs are expected to use structured verbal and electronic processes for patient transfers between services and locations. Handoffs for pediatric genetics are both written and verbal. Supervision of handoffs for Biochemical genetics patients include a weekly email list that summarizes all of the current patients including
inpatient consults previously seen who are being followed in the hospital, new consults, primary biochemical patients, active phone calls, and any infusion-related events. There is also a verbal sign out between attendings, and a review of the weekly list at a Monday team meeting. The resident on service is cc’d on the email and also present at the sign-out/team meeting. The resident participates in the verbal sign-out with direct supervision from the attending.
Residents may be supervised directly or indirectly when conducting hand-offs. PGY-1 residents are not yet genetics residents, so would not participate in handoffs. Faculty must assess resident and fellow readiness to move from direct to indirect supervision when conducting hand-offs and patient transfers using direct observation.