Graduate Medical Education

Graduate Medical Education Policies and Procedures

Policy on Teaching Service: Responsibility for Care of Patients


The physician of record maintains ultimate responsibility for patient care. In choosing to admit a patient to a teaching service, the attending commits to delegate primary management to the resident team under his or her direct supervision. Only the attending or staff physician may admit to hospital services. When the attending or staff decides to admit to a teaching service, then it is his or her responsibility to call the appropriate Senior Resident and advise the resident about the admission. The Senior Resident then assumes responsibility.

The senior resident should conduct a preliminary assessment to assure the patient's stability, or provide urgent care, then call the intern or student when assigned. The intern or student completes a thorough evaluation, then contacts the Senior Resident to staff the patient. On completing a full and independent assessment, the Senior Resident reviews and supervises the intern's management. Patients not primarily evaluated directly by an attending or staff physician are to be staffed by the attending of record with a call from the Senior Medical Resident to the attending of record. The patient is to be evaluated directly by the attending of record within an appropriate time, never exceeding 24 hours. On services to which an intern is not assigned, all resident responsibility are those of the Senior Medical Resident.

The attending or staff of record must always be notified for unanticipated deterioration in the patient's condition, transfer to or from a critical care service, when invasive or expensive studies are planned, in cases where there is a question of or actual discharge against medical advice, or in the unanticipated death of a patient.

When a patient is hospitalized, the resident of record must be notified and should assume care responsibility for his or her patient when possible. It is the responsibility of the admitting intern to call the primary resident when his/her patient is admitted. The responsible attending in the in-patient setting will be the teaching attending on the in-patient service.

Approved by GMEC: 1/23/2015