Residents in the Pediatric Residency Program of MassGeneral Hospital for Children (MGHfC) practice only under the supervision of staff attending physicians who are independently licensed and credentialed by the institutions where residents work. 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 attending 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. Attendings must be readily available (by pager, home phone or cellular phone) for a telephone consult at any time.  Preferred means of communication shall be clearly communicated with the responsible resident physicians.  Attendings must be available 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. Note that in the Massachusetts General Hospital and Brigham and Women's Hospital (BWH) NICUs, a neonatology attending is available in-house at all times.

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

  • At Mass General – the chief residents, the residency director and/or the Chief of Pediatrics
  • At NWH – the hospitalist physician of the day, the director of residency training or the Chief of Pediatrics
  • At Cambridge – the director of residency training or the Chief of Pediatrics
  • At NSCH – the hospitalist physician of the day, or the Pediatric Medical Director
  • At BWH – the Chief of Neonatology

These faculty members will assist the resident(s) in immediately contacting a supervising attending. 

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 who will arrange for backup coverage. Similarly, 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 who will arrange for backup coverage.

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 discussion 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 the supervising resident and attending have been notified and simultaneously accept responsibility for the patient.

  • The intern and his/her 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
  • First year residents require in-house supervision at all times

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 provide care to pediatric patients at the Massachusetts General Hospital, Brigham and Women’s Hospital, 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 detailed below.

MGH - ED  

  • Attending physician: Staff physician in the MGH ED
  • Documentation expected: Attending physician note documenting understanding of and agreement with the patient’s exam and the care plan articulated by the resident physician.
  • Attending Supervisory Documentation: Within 24 hours of visit

MGH Inpatient

  • Attending physician: The admitting hospitalist attending, admitting PCP, or admitting subspecialty service attending
  • Documentation expected: Attending physician note documenting understanding of and agreement with the patient’s exam and the care plan articulated by the resident physician.
  • Attending Supervisory Documentation: Within 24 hours of admission and or any significant  change in management plan.
  • Supervising Resident: PGY3 resident in charge of the team.
  • Supervising Resident/Fellow Documentation: Written documentation sufficient to demonstrate understanding of and agreement with the patient’s exam and with the care plan articulated by the supervisee. This document shall include identification of the attending.

Intensive Care Unites (PICU, NICU)  

  • Attending physician: The admitting ICU attending
  • Documentation expected: Attending physician note documenting understanding of and agreement with the patient’s exam and the care plan articulated by the resident physician.
  • Attending Supervisory Documentation: Within 24 hours of admission and with critical care changes
  • Supervising Resident: ICU fellow or hospitalist  on call in the unit.
  • Supervising Resident/Fellow Documentation: Written documentation sufficient to demonstrate understanding of and agreement with the patient’s exam and with the care plan articulated by the supervisee.

MGH Medical Consults  

  • Attending physician: The hospitalist attending
  • Documentation expected: Attending physician note documenting understanding of and agreement with the patient’s exam and the proposedcare plan suggested to the primary service by the resident physician.
  • Attending Supervisory Documentation: Within 24 hours of consultation.

Cambridge ED

  • Attending physician: Staff physician in the ED
  • Documentation expected: Written documentation sufficient to demonstrate understanding of and agreement with the patient’s exam and the care plan articulated by the supervisee.
  • Attending Supervisory Documentation: Prior to discharge

NSCH inpatient  

  • Attending physician: The admitting hospitalist attending, admitting PCP, or admitting subspecialty service attending
  • Documentation expected: Written documentation sufficient to demonstrate understanding of and agreement with the patient’s exam and the care plan articulated by the supervisee.
  • Attending Supervisory Documentation: Within 24 hours of admission and any change in management plan.
  • Supervising Resident: PGY2 or 3 resident in charge of the team.
  • Supervising Resident/Fellow Documentation: Written documentation sufficient to demonstrate understanding of and agreement with the patient’s exam and with the care plan articulated by the supervisee. This document shall include identification of the attending.

NWH  

  • Attending physician: The admitting hospitalist attending, admitting PCP, or admitting subspecialty service attending
  • Documentation expected: Written documentation sufficient to demonstrate understanding of and agreement with the patient’s exam and the care plan articulated by the supervisee.
  • Attending Supervisory Documentation: Within 24 hours of admission and any change in management plan.
  • Supervising Resident: PGY2 or 3 resident in charge of the team.
  • Supervising Resident/Fellow Documentation: Written documentation sufficient to demonstrate understanding of and agreement with the patient’s exam and with the care plan articulated by the supervisee. This document shall include identification of the attending.