Physician Responsibilities for Clinical Observers and their Practice
Preamble
Physicians not otherwise licensed to practise medicine in Nova Scotia may apply for an observership permit under which they may observe, learn and gain insight into the practise of medicine in this province.
Medical students who wish to participate in an educational experience outside of their undergraduate medical education program must obtain a medical student observership permit. The applicant must be enrolled in a medical school that meets the criteria in the policy University or School Approved by Council.
Clinical observers are not authorized to practice independently and are under the supervision of a physician licensed to practice in Nova Scotia. A clinical observership permit is valid for a maximum of three months. Renewal will be at the discretion of the Registrar.
A Clinical Observership is not a pathway to licensure in Nova Scotia.
This Standard sets out the requirements for the supervising physician and the permitted activities for holders of an observer permit.
Professional Standards
The supervising physician is responsible for all actions of the observer in their practice. Supervision may not be delegated.
The physician supervising the observer in practice must:
- be aware of the role and responsibilities of the clinical observer’s activities;
- inform patients that the clinical observer is participating in an educational experience under their supervision;
- obtain verbal informed consent from patients to allow the clinical observer to participate in the care situation;
- create a positive learning environment;
- be responsible for the supervision of any clinical contact by the observer with patients; and
- ensure the observer does not deviate from the standards of medical practice and the ethical responsibilities defined in the Canadian Medical Association Code of Ethics and Professionalism.
Clinical Observers may with the patient’s consent:
- observe any aspect of a patient’s care;
- view medical records;
- conduct clinical assessments (history and/or physical examination) in whole or in part, under the direct and immediate oversight of the supervising physician; and
- in situations where clinical observers have demonstrated an appropriate level of competence and performance, the supervising physician may allow them to interact alone with the patient, provided that the clinical observer-patient interview is followed by direct interaction between the supervising physician and the patient to confirm the findings, diagnosis and suggested investigations or treatment.
Clinical observers are not permitted to:
- make entries in the 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 their supervisor or other physicians;
- perform or assist in medical procedures (exclusive of the clinical assessment above);
- conduct handover; and
- discharge a patient from care.
No set of rules exist for all situations that may arise during an observership. As such, the supervising physician must use discretion and judgment in considering the patient’s circumstances and the observer’s experience and ability in all situations.
Resources
College of Physicians and Surgeons of Nova Scotia
Canadian Medical Protective Association
Acknowledgements
The development of this College Standard was informed by the College of Physicians and Surgeons of Alberta’s document Medical Practice Observation/Experience and the College of Physicians and Surgeons of British Columbia’s document on Clinical Observers.
Document History
This Standard replaces the Professional Standard Regarding Professional Responsibilities in Postgraduate Medical Education and Professional Standard Regarding Professional Responsibilities in Undergraduate Medical Education and was approved by the Council of the College of Physicians and Surgeons of Nova Scotia: December 8, 2023.
Approximate date of next review: 2027