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 Critical Care Fellowship program at the following sites:
University of Washington Medical Center, Harborview Medical Center, VA Puget Sound Health Care System
Last updated: March 18, 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 Qgenda to residents/fellows, faculty members, other members of the health care team, and patients.
The Critical Care Medicine 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:
Direct Supervision
- The supervising physician is physically present with the fellow and patient during key portions of the patient interaction; or,
- 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.
Indirect Supervision
The supervising physician is not providing physical or concurretn visual or audio supervision but is immediately available to the resident for guidance and is available to provide appropriate direct supervision within 30 minutes.
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 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 by PGY-Level
Fellows
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, junior and intermediate 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 consult the table below to find the specific CPR Level of Supervision by clinical activity/procedure and PGY-level.
| Clinical Activity/Procedure | Resident level (PGY) | Location | Supervision Level |
|---|---|---|---|
| Arterial Catheterization | PGY-4 and above | UW, HMC, VAPSHCS | Direct and indirect |
| Bronchoscopy | PGY-4 and above | All sites | Direct only |
| Central venous catheterization | PGY-4 and above | UW, HMC, VAPSHCS | Direct and indirect |
| ECMO cannulation | PGY-4 and above | HMC | Direct only |
| Endotracheal intubation | PGY-4 and above | UW, HMC, VAPSHCS | Direct only |
| Lumbar puncture | PGY-4 and above | All sites | Direct and indirect |
| Paracentesis | PGY-4 and above | All sites | Direct and indirect |
| Right heart catheterization | PGY-4 and above | UW, HMC, VAPSHCS | Direct only |
| Thoracentesis | PGY-4 and above | All sites | Direct and indirect |
| Thoracostomy tubes | PGY-4 and above | UW, HMC, VAPSHCS | Direct and indirect |
| Ultrasound | PGY-4 and above | All sites | Direct and indirect |
| Ventilator management | PGY-4 and above | UW, HMC, VAPSHCS | Direct and indirect |
Circumstances and Events in which Supervising Faculty Member(s) MUST be Contacted
Fellows should communicate with the appropriate supervising faculty member regarding all anticipated and unanticipated deaths and unexpected changes in clinical condition.
Supervision of Consults
Fellows performing consultations on patients are expected to communicate verbally with their supervising attending at the following time intervals: at least daily
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 apprised of the situation as soon as possible.
Faculty Supervision Assignment
Faculty supervision assignments are of 1-2 weeks duration 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 conducting hand-offs are expected to use structured verbal and electronic processes for patient transfers between services and locations, these include CORES with verbal handoff with IPASS (illness severity, patient information, action list, situational awareness and contingency plans, and synthesis by the receiver). Fellows may be supervised directly or indirectly when conducting hand-offs. Faculty must assess fellow readiness to move from direct to indirect supervision when conducting hand-offs and patient transfers using the following: direct observation and fellow evaluations in MedHub.