Legal standards of conduct for students and residents: implications for health professions educators.
Students and residents are responsible for providing much of the patient care in academic medical centers. Though experiential learning has been central to equipping students with the professional knowledge and skills needed in their careers, it raises significant medicolegal questions. One such question addresses the standard of care being provided by health care practitioners in training. Referred to as "standard of conduct" in a legal setting, the applicable standard for students and residents has been addressed by the courts on several occasions. Some early cases supported the notion that there is a special standard of conduct for students and interns, one that is lesser than that expected of fully licensed, certified practitioners. Cases since the late 1970s, however, indicate a trend away from that view, generally finding that any persons holding themselves to be practitioners, including students and residents, should be held to the standard of conduct of a practicing professional. Further, providers are being held to a national rather than a community-based standard of care, heightening the extent of the duty that all providers, including those still in training, have to their patients. A significant reason that students and residents are being held by the courts to the same standard of conduct as practicing professionals is that they are providing care under the supervision of licensed, experienced faculty. Case law indicates that while personnel in training have a duty to their patients to render care of a nationally recognized standard, supervising faculty have a parallel duty to those patients to provide adequate levels of supervision to ensure that such a standard be met, as well as to ensure that the care be in compliance with relevant policies and statutes. The findings discussed in this paper hold several implications for educators and administrators. First, faculty have a duty to maintain their knowledge bases and skill levels in accordance with nationally recognized standards in their professions in order to adequately fulfill their teaching and patient care responsibilities. Second, faculty have a duty to maintain an appropriate level of supervision during the provision of patient care. Administrators and educators also have supervisory responsibilities regarding the monitoring of pertinent policies and statutes to ensure the continued appropriateness of those documents and to foster compliance of all involved. Finally, alternative modes of education that would provide opportunities for students to develop competence in technical skills before using them on real patients (such as patient simulators) should be explored.