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POLICY: Medical Practice Observation/Experience

1. Preamble

There are many instances in which a physician may be asked to allow an observer to follow them in their practice. These observers include high school students participating in job shadowing programs in their schools, high school and university undergraduates who are considering a career in medicine, medical students participating in non-curricular clinical activities and International Medical Graduates (IMGs) who do not meet the requirements for registration with the College of Physicians & Surgeons of Saskatchewan (CPSS or the “College”). 

Participating observers are not required to be registered with, or hold a licence issued by, the CPSS to undertake an observership. The College will not issue a licence for that purpose as the limitations described in this policy mean that the observer is not engaged in the practice of medicine as defined in The Medical Profession Act, 1981.

Members who bring observers into their practice are expected to adhere to this policy.

2. Purpose and scope of this policy

This policy is intended to help physicians understand their legal, professional and ethical obligations when allowing observers in their practice.  It describes the roles and expectations of the supervising physician as well as the roles and limitations of the observer.

The policy is not intended to provide comprehensive rules for all situations that may arise during an observership.  The supervising physician is expected to exercise appropriate judgment and discretion in determining what may be appropriate for a particular observer.  In doing so, the physician should consider in all situations the patient’s circumstances and expressed wishes, and the observer’s experience and maturity. 
 

Medical Students

This policy is not intended to apply to curricular clinical activities performed by medical students licensed by the CPSS for the purpose of their educational program.  Their curricular clinical activities are governed by policies and procedures of the College of Medicine, Undergraduate Medical Education, University of Saskatchewan (CoM UGME).

The policy is, however, intended to apply to non-curricular clinical activities such as externships for example as arranged through the Physician Rural Externship Program (PREP), or co-curricular clinical activities such as shadowing arranged independently by the medical students.

3. Expectations and guidance

Participants in a Medical Practice Observation/Experience (“observers”) will interact with patients and will have access to personal health information. For these reasons, observers require supervision by a physician who holds a regular or provisional licence to practise in Saskatchewan. The supervising physician will be responsible for all actions of the observer in their practice.

3.1 Before allowing a person to participate as an observer, the supervising physician must:

• In the case of students, have the observer provide evidence of current enrolment in high school or university.
• If the observer is a high school student, ensure that the student is mature enough to handle the responsibility of confidentiality and to interact appropriately with patients.
• In the case of IMGs, have the observer provide evidence of their medical degree.
• Meet with the observer to discuss the expectations of the observership, including the expectation of confidentiality and professional behaviour when interacting with patients. Expectations regarding dress and grooming should also be provided in advance.
• Ensure that the observer has signed a confidentiality agreement which describes the obligation of confidentiality for all information obtained while an observer. A sample agreement is attached to this policy.
• Depending on the practice setting where the observership will take place, determine any facility requirements and/or rules and regulations with respect to observers or observerships.

3.2 Before allowing a person to participate as an observer, the supervising physician must obtain informed consent from each patient.

The consent discussion should include the following:

• why the observer wishes to observe
• the status of the observer, for example a high school student, a university student, a medical student or a physician not currently registered to practise in Saskatchewan
• what the role of the observer will be, including:
  • accessing the patient’s medical record relevant to that episode of care
  • observing any examinations
  • discussing the patient information with the physician.

The patient’s consent must be documented in the patient’s medical record.  The patient is entitled to withhold or withdraw consent.  A patient’s decision to provide, withhold or withdraw consent must not alter the patient’s access to health care or the quality of health care provided in any manner.  If the patient does not consent or withdraws consent, the observer should not review the patient’s information, participate in any examination or interview or participate in any way in the assessment of the patient.
 

3.3 Supervising physicians who allow observers into their practice must:

• Be present at all times when the observer interacts with a patient. The only exception to this is for non-curricular clinical activities by medical students who have completed Year 2, in which case it is in the discretion of the supervising physician.
• Ensure they have obtained permission in advance from any facility (hospital, nursing home, etc.) if they intend to have the observer accompany them on rounds or clinics in facilities outside their own private office. This permission should be specific to the status of the observer and their expected activity while in the facility.
• Comply with any facility requirements and/or rules and regulations with respect to observers or observerships.

3.4 With patient consent, supervising physicians may permit observers to:

• Observe the supervising physician in the practice of medicine.
• Interview patients or patients’ family members.
• Perform limited physical examinations of patients in the presence of the supervising physician with the exception of sensitive examinations. [1]
• Assist the supervising physician in the performance of medical procedures[2].

3.5 Supervising physicians must not permit observers to:

• Receive any form of remuneration from the supervising physician or clinic.
• Make entries on a patient’s medical record.[3]
• Give medical advice to a patient or make a medical diagnosis.
• Prescribe treatment.
• Take a telephone call regarding clinical matters on behalf of the supervising physician or other physicians.
• Discharge a patient from care.
• When in a clinical setting use the title “doctor” or any other word or title which may imply that the person is entitled to practise medicine in Saskatchewan.
• Present themselves to patients, physicians, in their curriculum vitae, or on any application form, as being a “Physician Assistant,” “Assistant Physician,” “Clinical Associate,” Clinical Assistant,” or any type of medical trainee[4] as a consequence of or while participating in a Medical Practice Observation/Experience.

3.6 Supervising physicians must not:

• Rely in whole or in part on the history, physical examination, or assessment of patients performed by the observer when determining the diagnosis and management of patients.
• Bill Saskatchewan Medical Services Plan for any services provided by the observer.
• Remunerate an observer in any way.
• Receive remuneration from an observer for acting as the supervising physician. This does not apply to situations where the supervising physician is participating in a structured assessment program related to licensure for the participant.

The duration of a Medical Practice Observation/Experience is at the discretion of the supervising physician. IMG participants are encouraged to obtain Medical Practice Observations/ Experiences with more than one physician to enhance their opportunity to make connections in the medical profession.

Acknowledgement

The College of Physicians and Surgeons of Saskatchewan has adapted this from a document prepared by the Alberta College of Physicians and Surgeons. The Saskatchewan College gratefully acknowledges that work.

Other Resources

CPSS Regulatory Bylaw 7.1 - The Code of Ethics

CPSS Regulatory Bylaw 7.2 -  Code of Conduct

CPSS Guideline – Confidentiality of Patient Information

CPSS Policy – Informed Consent and Determining Capacity to Consent

CPSS Policy – Professional Responsibilities in Postgraduate and Undergraduate Education

Sample Observer's Confidentiality Agreement

Between:

____________________________________ (the observer)

and

____________________________________ (Supervising physician)

The observer agrees as follows:

1. 1. I acknowledge that I have asked to observe the supervising physician in the physician’s practice.
2. 2. I acknowledge that all information received about patients in relation to the observership is private and confidential, and must never be disclosed to or discussed with anyone other than the supervising physician.
3. 3. I will not access any information about patients unless the supervising physician specifically authorizes me to do so.
4. 4. I agree that all of my obligations under this agreement will last forever and continue after the end of the observership.
5. 5. I acknowledge that any breach of this agreement may have consequences for me, including immediate termination of the observership and the possibility that I may be prosecuted for an offence under The Health Information Protection Act of Saskatchewan.

__________________________                                 _____________________________
 Observer’s signature                                        Date              

__________________________                                 _____________________________
 Witness’ signature                                             Witness’ name (printed)