Pediatric Resident Supervision Guide

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  1. Support resident learning goals
  2. Assess resident’s training level when you first work with them to determine degree of supervision needed
  3. Review and addend resident notes within 24 hours of appointment.
  4. If you are working with a resident for a prolonged period of time, check in at the midpoint on how things are going
  5. Provide feedback to resident. Use the Direct Observation Form as a tool to guide feedback. Full completion of the form is not required. Please send form to site coordinator, Lye-Ching Wong, to send to residency coordinator for records.
  6. Change resident expectations based on resident experience, training level, and feedback from resident


  1. Viewing the resident schedule:
    • The resident resource is generally “L1B”. You can find their schedule on Powerchart by clicking on Schedule, then typing in L1B into the Resource and then pressing Enter.
    • If the resource is not L1B, you can check the whiteboards by the nursing stations, check the outpatient provider schedule that Mien Chyi sends out monthly, or ask the resident how to find their schedule for the day
    • Preceptors should review patients on the resident schedule at the start of the day
  2. Addending resident notes:
    • For training purposes, attendings must add an addendum to the note. The length and details of this addendum varies according to attending preference. The minimum is something stating the preceptor reviewed the chart and agree with the documentation (e.g.: Agree with documentation, assessment, and plan by Dr. _.)
    • For Medicare patients, a more detailed addendum is required which includes key summaries of the history, exam, and decision-making
    • To add an addendum, when the resident sends you a note to review, you should right click on the note in your inbox and click modify. After adding your addendum, you can click sign.
  3. Supervision:
    • For first year residents, all patients must be staffed with the preceptor prior to the patient leaving the hospital
    • For 2nd and 3rd year residents, all patients discharging to a village must be staffed with the preceptor prior to the patient leaving the hospital
    • For 2nd and 3rd year residents, all other patients should be staffed with the preceptor by the end of the day
  4. Procedures:
    • There are no specific rules about procedure supervision. It is best to assess the resident’s level of experience and determine level of supervision accordingly.
    • It is also helpful to have a clear discussion with the resident on who will be doing the procedure to avoid confusion
  5. Consults
    • For complicated consults, it is helpful to have the consultant on speaker phone so that both the resident and preceptor can participate in the discussion
  6. Medevacs, transfers, and admissions
    • Preceptors must personally examine acute patients who require transfer or admission
    • Provider to provider verbal communication for any patient transferring to the ER or Inpatient is required. (A resident can function as a provider based on attending assessment of resident competency, but the decision to transfer must be made between the resident and preceptor.)
    • The inpatient pediatrician is always a resource. TigerText Peds Wards On Call for assistance with complicated patients
    • If a patient needs follow up over the weekend, consider notifying the inpatient pediatrician of complicated patients


  1. Inpatient
    • For 2nd and 3rd year residents, let them take over the TigerText Peds Wards On Duty role based on preceptor assessment of resident competency.
    • All inpatients must be seen by the preceptor
    • All notes must be addended and cosigned by the end of the day including documentation that supports the attending reviewed the resident’s note and evaluated/examined the patient directly. (e.g.: “Agree with documentation, assessment, and plan by Dr. _. I have discussed and examined the patient with the resident with no changes to documentation as mentioned. Briefly, pt is a 4 y/o F with no significant past medical history admitted for right leg cellulitis. Vitals stable. Exam with improving redness and pain. Switch to oral antibiotics and continue inpatient monitoring to confirm continued improvement prior to discharge.”)
  2. RMT
    • Residents must include documentation in their RMT response stating that the case and plan was discussed with the attending (e.g. “Case and plan discussed with attending Dr _”)
    • Additional addendum and cosignature from preceptor are not necessary and dependent on preceptor preference
  1. Consults
    • The resident must staff all consults with the preceptor. It is helpful to put the consultant on speaker phone so all parties can be involved in the conversation.
  2. ER
    • Residents must discuss all patients with the preceptor prior to discharge
    • Preceptors must examine all patients prior to discharge
    • All notes must be addended and cosigned by the end of the day similar to inpatient documentation
    • See above for procedure supervision, consults, and medevacs/ transfers/ admissions

Thank you for helping to educate our next generation of pediatricians! Please contact Lye-Ching Wong ( with concerns or questions about working with residents.

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