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Physician teachers: What you need to know
Watch this module to learn about being a physician teacher at NYGH.
Watch the module — The obligations and responsibilities of physician teachers are also available in the following audiovisual module that will take about 10 minutes to review. Access the module now.

Obligations and responsibilities
Physicians with faculty appointments at the University of Toronto when teaching at NYGH

General
  • All NYGH physicians who teach or assess medical students and/or residents from the University of Toronto require a faculty appointment at the University of Toronto (if you do not have a faculty appointment, contact the NYGH Centre for Education cfe@nygh.on.ca).
  • Obligations and responsibilities of physician teachers extend to all teaching activities — whether they occur in the hospital, office, clinic or home visit.
  • NYGH has an affiliation agreement with the University of Toronto. This agreement extends to formal placements of students and/or residents in the hospital and also in offices of physicians with “active” hospital privileges.
  • All students and residents at North York General (in hospital or office) must be registered through the NYGH Centre for Education.
  • The NYGH Centre for Education advances health professional education at the hospital through leading, supporting, fostering and enhancing: (1) The student and teacher experience; (2) Education scholarship; and (3) Partnerships related to education. The Centre for Education can be found at our General site, 6North, Room 630 www.nygh.on.ca/CentreforEducation cfe@nygh.on.ca


Who is a student?

Any student at NYGH enrolled in an education program at an academic institution or organization with a current academic affiliation agreement with NYGH who is on a rotation/placement at NYGH. This includes medical residents. All medical students and residents (including electives) at North York General must also be registered through the University of Toronto.

See NYGH's Student Policy. Download: Student Policy

Can a medical student "shadow me" for the day?

As part of MD Program at University of Toronto, medical students must do enriched educational experiences — EEE. These shadowing experiences are like electives for year 1 and 2 University of Toronto medical students and must get logged as “EEE” and registered through the Centre for Education.
See the webpage Seeking an Enriched Education Experience.
 
Can someone else "shadow me" for the day?

NYGH has a Student Observer Policy Download: Student Observer Policy that allows for student observers as per policy guidelines.

As part of the policy, student observers must:
  • Be a postsecondary or secondary school student who requires an observational experience as part of the application process for a postsecondary health care program OR enrolled in a postsecondary educational program seeking an observational experience to enhance their studies.
  • Be a Canadian citizen or a Canadian resident or in Canada on a student visa.
  • Not interfere in any way with the learning experience of students from any of NYGH's academic partners.
  • Have a primary supervisor for the observer who is a staff member (full or part-time) or physician (active staff) at NYGH.
  • Be approved by the supervisor's physician chief or manager.
  • Be approved by the Centre for Education.

Observerships are supervised by individual staff and physicians on a volunteer basis. Hospital departments and programs may determine their own policy whether to accept observers or not (within the confines of the hospital policy). Observerships are not intended to count for academic credit, and documentation will not be provided by the hospital. Observerships cannot exceed 4 weeks duration in a 12-month period. Observers are not allowed to participate in health information gathering or in any aspect of provision of patient care and are not allowed to access patient records.

 
What should a student or resident do in an emergency or crisis situation?

What is the Red Button?
The Red Button is intended as a quick reference for students and residents at NYGH who find themselves in an emergency or crisis situation of various kinds. The major scenarios are:
  1. ''I've experienced a workplace injury." (e.g. needle-stick)
  2. "I need to know about being absent from my clinical duties."
  3. "I am experiencing a personal crisis."
  4. "I am worried about a friend in crisis."
  5. "I feel threatened."
  6. "I have experienced or witnessed student/resident mistreatment."
  7. "I want to talk to someone about a breach of professionalism that I witnessed."
  8. "I am concerned about my personal safety in certain patient encounter situations."


How are workplace injuries reported?
A workplace injury is any injury or accident that occurs while the student or resident is on a placement at NYGH (including in an office outside of the hospital).

Immediately after the accident:
  1. Students and residents are to inform their supervisor of any workplace injuries and get immediate assistance (first aid) as required.
  2. All student and/or residents who sustain a workplace injury should go to:
    a. Occupational Health and Safety Department Monday–Friday 7:30 a.m. to 4 p.m., or
    b. Emergency Department all other times
  3. Incident report (SLIP) should be completed by the student with the assistance of staff or physician.

Access the incident report.

In addition, at the earliest opportunity:

  1. All students and residents should inform the Manager, Centre for Education.
  2. Medical students should inform their academy director and site coordinator
  3. Residents should notify their program director and site coordinator.


Policies and procedures

North York General Hospital and University of Toronto policies that govern students and teachers generally apply whether the student is in the hospital proper or physician's clinic or private office.
To view these policies, visit the Centre for Education Policies page.

Supervision of students and residents
Professional responsibilities in undergraduate medical education (Students)

Excerpts and summary of College of Physicians and Surgeons of Ontario policy, September 2003
View the complete policy. Download: Professional responsibilities in undergraduate medical education

Identification of medical students
Medical students will be involved in observation and interaction with patients from the start of their undergraduate medical education. The supervisor and/or MRP are responsible for ensuring that the educational status of medical students and nature of their role are made clear to the patient, the patient's family, and members of the health care team as early as possible during the educational process.

Students must be introduced as medical students and it should be made clear to patients that they are not physicians. An explanation could be provided that the student is a member of the health/clinical care team and the experience forms an important part of their undergraduate medical education program. Where appropriate, medical students may introduce themselves to patients instead of relying on a supervisor and/or MRP to make a formal introduction.

Supervision and education of medical students
The supervisor and/or MRP must provide appropriate supervision. This includes:
 
  1. Determining the medical student's willingness and competency or capacity to participate in the clinical care of patients, as a learning experience;
  2. Closely observing interactions between the medical student and the patient to assess:
    a) the medical student's performance, capabilities and educational needs,
    b) whether the medical student has the requisite competence (knowledge, skill and judgment) to safely
    participate in a patient's care without compromising that care, and
    c) whether the medical student demonstrates the necessary competencies and expertise to interact
    with patients without the supervisor being present in the room;
  3. Meeting at appropriate intervals with the medical student to discuss their assessments;
  4. Ensuring that the medical student only engages in acts based on previously agreed-upon arrangements with the MRP;
  5. Reviewing, providing feedback and countersigning documentation by a medical student of a patient's history, physical examination, diagnosis, and progress notes as soon as possible;
  6. Managing and documenting patient care, regardless of the level of involvement of medical students; and
  7. Counter-signing all orders concerning investigation or treatment of a patient, written under the supervision or direction of a physician. Prescriptions, telephone or other transmitted orders may be transcribed by the medical student, but must be countersigned.
In addition, appropriate supervision and education requires clear communication between the MRP and supervisor in order to ensure the best possible care for the patient.

Consent and the educational nature of the undergraduate environment
The MRP and/or supervisor are responsible for communicating to patients that patient care in teaching hospitals and other affiliated sites where education occurs relies on a team-based approach, i.e., care is provided by multiple health care professionals, including students.

Student involvement in patient care will vary according to the student's stage in the undergraduate medical education program as well as their individual level of competency. Student-patient interaction may be limited to observation alone, while students who develop and demonstrate competencies may be actively involved in patient care, including performance of procedures. While patient consent is necessary for treatment in any setting, there are circumstances unique to the undergraduate environment, which require additional consideration:

  1. Significant component of procedure performed independently by student:
    In the rare situation where a significant component, or all, of a medical procedure is to be performed by a student and the MRP and/or supervisor is not physically present in the room, the patient must be made aware of this fact and, where possible, express consent must be obtained. Express consent is directly given, either orally or in writing.
  2. Investigations and procedures performed solely for educational purposes:
    An investigation or procedure is defined as solely “educational” when it is unrelated to or unnecessary for patient care or treatment. An explanation of the educational purpose behind the proposed investigation or procedure must be provided to the patient and his or her express consent must be obtained. This must occur whether or not the patient will be conscious during the examination. If express consent cannot be obtained, e.g., the patient is unconscious, then the examination cannot be performed. The most responsible physician and/or supervisor should be confident that the proposed examination or clinical demonstration will not be detrimental to the patient, either physically or psychologically.


Professional responsibilities in postgraduate medical education (Residents)
Excerpts and summary of College of Physicians and Surgeons of Ontario policy, September 2003
View the complete policy. Download: Professional Responsibilities

Supervision and Training
The supervisor and/or most responsible physician must provide appropriate supervision to the trainee. This includes:
  1. Being familiar with program objectives;
  2. Making the patient or substitute decision-maker ( see CPSO Consent to Treatment Policy Download: Consent to Treatment Policy) aware of the identity of the most responsible physician, and the fact that the most responsible physician is ultimately accountable for the patient's care;
  3. Making the patient or substitute decision-maker aware of the identity of trainee(s) who are members of the treatment team, their stage in the postgraduate program, as well as their degree of involvement in patient care;
  4. Being willing and available to see patients when required or when requested;
  5. Regularly evaluating a trainee's clinical competence and learning needs, and assigning graduated responsibility accordingly;
  6. Making reasonable efforts to determine that the trainee has the necessary competence (knowledge, skill and judgment) to participate in a patient's care and does not compromise that care;
  7. Ensuring that all relevant clinical information is made available to the trainee, and directly assessing the patient as appropriate; and
  8. Communicating regularly with the trainee to discuss and review the trainee's patient assessments, management, and documentation of patient care in the medical record.

The trainee must:

  1. Participate in the care of patients as appropriate to his or her competencies, and specific circumstances, as well as to meet identified educational needs;
  2. Make the patient or substitute decision-maker aware of their name, role, stage in the postgraduate program, and degree of involvement in patient care;
  3. Make the patient or substitute decision-maker aware of the name and role of the most responsible physician, and the fact that the most responsible physician is ultimately accountable for the patient's care;
  4. Communicate with the supervisor and/or most responsible physician:
    a) in accordance with guidelines of the postgraduate program and/or clinical placement setting;
    b) about patient assessments performed by the trainee;
    c) when there is a significant change in a patient's condition;
    d) when the trainee is considering a significant change in a patient's treatment plan or has a question
    about the proper treatment plan;
    e) about a patient discharge;
    f) when a patient or substitute decision-maker and family expresses significant concerns; or
    g) in any emergency situation or when there is significant risk to the patient's well-being;
  5. Document his or her clinical findings and treatment plans and discuss these with the most responsible physician and/or the supervisor.

Patient care within the postgraduate educational environment
In the postgraduate environment, it is important for patients to understand that care involves a collaborative, team-based approach and that trainees are integral members of the health care team. The delivery of care relies on MRPs, supervisors, and trainees fulfilling each of their obligations as outlined in section one “Supervision and Training.” Trainee involvement in patient care will vary according to the trainee's stage in a postgraduate training program as well as their individual level of competency. Trainees are expected to take on a graduated level of clinical responsibility in step with their demonstrated growing competency, although never completely independent of appropriate supervision.

In accordance with the Health Care Consent Act and the CPSO's policy on Consent to Medical Treatment, patient consent is required in all situations where a treatment or a change in treatment is proposed. In addition, there are some factors unique to the postgraduate environment which should be disclosed to the patient in order for them to make an informed decision as to whether to give or refuse consent:

a) Significant component of procedure performed independently by trainee

When a significant component, or all, of a medical procedure is to be performed by a trainee without direct supervision, the patient must be made aware of this fact and, where possible, express consent must be obtained. Express consent is directly given, either orally or in writing.

b) Examinations performed solely for educational purposes

An examination is defined as solely “educational” when it is unrelated to or unnecessary for patient care or treatment. An explanation of the educational purpose behind the proposed examination or clinical demonstration must be provided to the patient and their express consent must be obtained. This must occur whether or not the patient will be conscious during the examination. If express consent cannot be obtained, e.g., the patient is unconscious then the examination cannot be performed. The most responsible physician and/or supervisor should be confident that the proposed examination or clinical demonstration will not be detrimental to the patient, either physically or psychologically.