Physician Responsibilities for Clinical Observers and their Practice
Preamble
The College recognizes the longstanding tradition in medicine of clinical observers. The College sees value in clinical observerships, which allow unlicensed individuals to be introduced or oriented to medical practice.
The College has no legal jurisdiction over clinical observers. The College’s jurisdiction is limited to the physicians hosting the clinic observer. This Standard sets out the requirements for the supervising physician and the permitted activities for observers of their practice.
A clinical observership is not a pathway to medical licensure in Nova Scotia. Participating observers are not required to be registered with, or hold a permit issued by, the College.
Professional Standards
The physician overseeing the observer must:
- Ensure the observer abides by all relevant policies and bylaws of the department, hospital, and health authority, including those that pertain to public health directives, workplace safety, and confidentiality;
- Ensure the observer:
- is currently enrolled in secondary school or university, or
- holds a medical degree from a faculty or university outside of Canada;
- Obtain verbal informed consent from patients to allow the clinical observer to participate in the care situation; and
- Be present at all times when the clinical observer interacts with a patient.
The physician supervising the observer in practice must not:
- Rely, in whole or in part, on the history, physical examination or patient assessments performed by the clinical observer when determining the diagnosis and management of patients;
- Remunerate a clinical observer in any way; or
- Receive remuneration from a clinical observer for acting as the supervising physician.
Clinical Observers may, with the patient’s consent:
- observe any aspect of a patient’s care;
- view medical records; and
- conduct clinical assessments (history and/or physical examination) in whole or in part, under the direct and immediate oversight of the supervising physician.
Clinical observers are not permitted to:
- receive any form of remuneration from the supervising physician or clinic;
- 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.
Approved by the Council of the College of Physicians and Surgeons of Nova Scotia as Professional Standards Regarding Physician Responsibilities for Clinical Observers and their Practice: March 21, 2025
Approved by the Executive Committee of the College of Physicians and Surgeons of Nova Scotia: June 20, 2025
Approximate date of next review: 2027