College-Directed Supervision Framework – Responsibilities and Outline by Level
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.
Examples:
- 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 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:
- should performance concerns be identified during the course of supervision, acknowledges and provides a plan for practice improvement;
- abides by the imposed level of supervision, as decided by the Registrar or College Committee in accordance with College policy.
- 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 Oversight | Low | Standard | Intermediate | High | |
| Most Responsible Physician | Physician under Sponsorship | Physician under Supervision | Physician under Supervision | Physician under Supervision (may be shared) | Supervisor |
| Available Tools and Activities | 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 – Regular formative feedback – 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/ outcomes – 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 Requirement | Feedback or Performance Appraisal | Occasionally (informal) | Usually (informal) | Usually (informal or formal) | Always (informal and formal) |
| Availability of Supervisor (Frequency of contact) | Not applicable | May be remotely located (infrequent – as needed) | May be remotely located Available for monthly site visits | Same facility or NSH Zone On-site in prescribed circumstances (Daily to weekly) | Always on-site or available during patient care (Daily) |
| Frequency of Report (may vary) | Annual | Every 3-4 months | Every 2-3 months | Weekly to once per month | Weekly to once per month |
| Typical Indication | – Established Defined Licensee, licensed prior to January 1, 2015. – In good standing with NSHA/IWK and College (5) | – Established Defined Licence in good standing with NSHA/IWK and College – Restricted licence | – Defined licence – Restricted licence with identified quality issue without safety concerns | – Significant change in practice Scope – Referred for context-specific safety concerns | – Return to practice if deemed our of current (7) – Major change in practice scope (7) – Referred for global safety concerns |
Resources
- CPSO Guidelines for College-Directed Supervision
- Guidelines for College-directed Supervision
- Supervision Levels for College-directed Supervision
- Approval of Supervisors for College-directed Supervision
- Sponsor-only Oversight of a Defined licence physician
- Currency of Practice Experience
- Newly Graduated Canadian-trained PGTs Licences and Fees
- Guideline for the Conduct of Return to Practice Assessments
| Applicable Legislation: | N/A |
| Approved by: | Assessment Committee & Council |
| Approval Date(s): | October 21, 2022 & December 9, 2022 |
| Review Date: | October 2024 |