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College-Directed Supervision Framework – Responsibilities and Outline by Level

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Supervision: the process under which a physician (or group of physicians) formally assesses another physician’s practice for the purpose of ensuring that the care provided meets the expected standard. Supervision commonly includes an educational component for the Supervised Physician.


  • An applicant satisfies criteria for licensure under a Defined license with supervision.
  • Concerns have been raised regarding the standard of care in the Physician’s practice.
  • A physician is changing their scope of practice or re-entering practice after a prolonged absence.

Supervisor’s Responsibilities:

  • signs a Terms of Supervision agreement with the College;
  • reviews the Guidelines for College-Directed Supervision;
  • participates in orientation and/or training as required by the College;
  • reviews any pertinent background materials, including the Supervised Physician’s practice profile;
  • establishes and maintains a professional relationship with the Supervised Physician;
  • in the case of High-Level Supervision, provides care to the patient as the Most Responsible Physician (MRP);
  • provides and documents supervision, in accordance with the Terms of Supervision and Clinical Supervision Plan;
  • when required, submits objective progress reports and supporting documents, satisfactory to the College and prepared in accordance with the templates provided; and
  • reports to the College as required in the Guidelines for College-Directed Supervision section, Basis for Immediate Reports to the College.

Supervised Physician’s Responsibilities:

  • acknowledges that performance concerns have been identified, or that the physician is lacking Canadian certification and/or the LMCC (or acceptable alternative);
  • abides by the imposed level of supervision, as decided by the Registrar, Sponsor or College Committee in accordance with College policy.
  • proposes a Supervisor(s) for the College’s approval, if required by College Department or Committee;
  • gives consent to the College for the release, to the Supervisor(s), of any pertinent background information necessary to enable them to carry out duties effectively;
  • gives consent, where deemed necessary by the Supervisor or College, for the conduct of interviews with colleagues or patients;
  • is motivated and takes responsibility for improvement;
  • is open, honest and collegial with colleagues and the Supervisor;
  • demonstrates meaningful progress towards meeting the expectations of the College;
  • supports the Supervisor in fulfilling their obligations, including the provision of timely reports to the College;
  • provides notice to the Supervisor and College of planned absences or intent to leave practice;
  • assumes responsibility for the payment of all fees, costs, charges, and expenses arising from the supervision arrangement; and
  • agrees to information sharing amongst all involved Supervisors.

Expectations for College-directed Supervision by Level

 Sponsor-only OversightBasicLowStandardIntermediateHigh
Most Responsible PhysicianPhysician under SponsorshipPhysician under SupervisionPhysician under SupervisionPhysician under SupervisionPhysician under Supervision (may be shared)Supervisor
Available Tools and ActivitiesAnnual License Renewal- Sponsorship Evaluation (Completed by Sponsor)Annual License Renewal – Sponsorship Evaluation (Completed by Sponsor)– Retrospective record review

– Colleague interviews

– CPD Review
– Selective direct observation of care or procedures

– Case discussion

– Retrospective record review and discussion

– Practice metrics / outcomes

– Colleague interviews

– CPD Review
– Frequent direct observation of care or procedures Participation in care in defined circumstances

– Case discussion

– Retrospective record review and discussion

– Practice metrics/

– Structured assessments of skill or knowledge Colleague interviews

– Contribute to educational plan
– Direct observation / participation in care under all circumstances

– Active case management

– Field notes

– Real-time review of record keeping

– Structured assessments of skill or knowledge

– Colleague Interviews

– Contribute to educational plan
Educational RequirementFeedback or Performance AppraisalFeedback or Performance AppraisalOccasionally (informal)Usually (informal)Usually (informal or formal)Always (informal and formal)
Availability of  Supervisor (Frequency of contact)Not applicableMay be remotely located Non-urgent clinical scenarios (infrequent – as needed)May be remotely located (infrequent – as needed)May be remotely located Available for site visits (Every three months)Same facility or community On-site in prescribed circumstances (Daily to weekly)Always on-site or available during patient care (Daily)
Frequency of Report (may vary)AnnualAnnualEvery 3-4 monthsEvery 2-3 monthsWeekly to once per monthWeekly to once per month
Typical Indication– Established Defined Licensee, licensed prior to January 1, 2015.

– In good standing with NSHA/IWK and College (5)
– Defined Licensee, with Certification and satisfactorily completed 2 years of Standard level supervision

– Newly graduated Canadian Trained PGTs(6)

-Restricted licence
– Established Defined Licence in good standing with NSHA/IWK and College

– Restricted licence
– Newly issued Defined Licence

– Established Defined Licence with quality concerns

– Restricted licence – referred for quality issue without safety concerns
– Significant change in practice Scope

– Referred for context-specific safety concerns
– Return to practice (> 3 yr)(7)

– Major change in practice scope(7)

– Referred for global safety concerns


  1. CPSO Guidelines for College-Directed Supervision
  2. Guidelines for College-directed Supervision
  3. Supervision Levels for College-directed Supervision
  4. Approval of Supervisors for College-directed Supervision
  5. Sponsor-only Oversight of a Defined licence physician
  6. Newly Graduated Canadian-trained PGTs Licences and Fees
  7. Guideline for the Conduct of Return to Practice Assessments

Approval Dates: September 11, 2020 & October 9, 2020

Review Date: September 2022