GUIDELINE: Medical Practice Observation/Experience


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

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 and International Medical Graduates who do not meet the requirements for registration with the College of Physicians & Surgeons of Saskatchewan.  

Members who bring observers into their practice are expected to adhere to this guideline, which describes the roles and expectation of the member as well as the roles and limitations of the observer.  

Participants in a Medical Practice Observation/Experience will interact with patients and will have access to private, personal patient information. For these reasons, the participants 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.  

The primary concern in such arrangements is that the Saskatchewan physician who will interact with the patient will have a frank discussion with the patient before the observer is permitted to observe. Observation should only occur if the Saskatchewan physician explains to the patient why the observer wishes to observe, and what the role of the observer will be if the patient agrees to allow the observer to be present. If the patient does not agree, 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.

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

- If the observer is a high school student, conclude that the student is mature enough to handle the responsibility of confidentiality and to interact appropriately with patients.
- Meet with the observer to discuss the expectations of the observership, including the expectation of confidentiality and appropriate demeanour when interacting with patients. Expectations regarding dress and grooming will 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 guideline.  


Participants (Observers) in a Medical Practice Observation/Experience may, with consent:

- Observe the supervising physician in the practice of medicine.
- Interview patients or patients’ family members.
- Perform physical examinations1 of patients in the presence of the supervising physician.
- Assist the supervising physician in the performance of medical procedures.  

Participants in a Medical Practice Observation/Experience are not allowed to:

-  Receive any form of remuneration from the supervising physician or clinic.
-  Make entries on a patient’s medical record.
-  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 as a consequence of or while participating in a Medical Practice Observation/Experience.  

Supervising physicians who allow participants in a Medical Practice Observation/Experience into their practice must:

-  In the case of students, have the observer provide evidence of current enrolment in high school or university. In the case of International Medical Graduates, have the observer provide evidence of their medical degree.
-  Be present at all times when the participant interacts with a patient.
-  Obtain their patients’ consent for the participant’s presence and participation in the patient care encounter. This consent discussion must clearly identify the participant’s status as, for example, a high school student, university student, or a physician not currently registered to practice in Saskatchewan.
-  Advise any facility (hospital, nursing home, etc.) if they intend to have the participant accompany them on rounds or clinics in facilities outside their own private office. This advice should include the status of the participant and their expected activity while in the facility.
-  Comply with any facility requirements and/or rules and regulations with respect to observers or observerships.   

Supervising physicians must not:

-  Rely in whole or in part on the history, physical examination, or assessment of patients performed by the participant in a Medical Practice Observation/Experience when determining the diagnosis and management of patients.
-  Bill Saskatchewan Medical Services Plan on behalf of the participant.
-  Remunerate a participant in a Medical Practice Observation/Experience in any way.
-  Receive remuneration from a participant in a Medical Practice Observation/Experience 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. International Medical Graduate 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.    

 

1We expecphysical examination to include examination of a lump or bump or a swollen knee, for example. We do not expect supervising members to allow an observer to perform a sensitive examination such as a pelvic or rectal exam or to perform a Pap smear. We cannot make rules for all situations; the supervising physician must use discretion and consider the patient’s circumstances and expressed wishes, and the observer’s experience and maturity in all situations.    
  

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.    


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 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)  


 

STATUS:

APPROVED

Approved by Council:

March 2017

Amended:

n/a

To be reviewed:

March 2022