Adequate supervision of resident-performed procedures is necessary, to assure that high quality patient care is delivered and to be certain that resident physicians learn the procedural techniques and demonstrate proficiency. The attending physicians are ultimately responsible for the procedures performed on all clinic patients, whether the attending physician is present or not. Resident physicians are expected to gain autonomy as they proceed through their training years. It may not be necessary to have an attending present when procedures are performed by a resident who has demonstrated competence for that procedure. The resident is required to notify the attending physician when a procedure is to be performed, and it is determined by the attending whether or not the resident requires direct supervision. Generally, R-1's will be directly supervised by an attending physician or senior resident. R-2's and R-3's may or may not require a supervising attending physician to be present, depending on their prior experience and demonstration of competency. The patient or, in the case of a minor, the parents have the right to request that only the attending physician performs the required procedure, and such a request will be honored. There is no credentialing process, per se, for residents in training. Because each resident's training experience is unique, each resident-performed procedure must be evaluated separately by the attending. Documentation of the procedure is the responsibility of the resident and may be required for attaining future privileges.