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The Residency Supervision Area is designed to assist hospitals and clinics with the protocols outlined for specific duties residents and fellows can perform. These guidelines are determined by the faculty of the University of Tennessee College of Medicine Chattanooga, Department of Surgery. Any questions about certain procedures not listed should be addressed to the faculty and not decided by the resident or fellow.

A credentialed and privileged attending physician ultimately provides supervision or oversight of each Resident's patient care activities. Direct supervision by a qualified attending physician (or a more senior Resident with Indirect Supervision immediately available) is required in the OR/Delivery Room or for non-routine invasive procedures like Cardiac Cath, Endoscopy, and Interventional Radiology.Ìý

• Click here to view our UTCOMC GME Policy 400 Resident Supervision
• Click here to view the UTCOMC GME Policy 405 Patient Care Settings Resident Supervision Standards

Laurel Barnes, MD
PGY-6 6th Year Surgery Chief Resident

• Direct Supervision - the supervising physician is physically present with the resident and patient.
• Indirect Supervision with Direct Supervision IMMEDIATELY available - the supervising physician is physically within the hospital or other sites of patient care, and is IMMEDIATELY available to provide Direct Supervision.
• Indirect Supervision with Direct Supervision available - the supervising physician is not physically present within the hospital or other sites of patient care, but is IMMEDIATELY available by means of telephone or other electronic means, and can be available if required for Direct Supervision
• Oversight - Supervising Physician is available to provide a review of procedures or the encounter with feedback after the care is provided but the procedure or care does not warrant the physical presence of the attending.
• In particular, PGY-1 residents should be supervised either directly or indirectly with direct supervision immediately available as described in the levels of supervision, unless denoted as Oversight in the list that follows.
• In an emergency, defined as a situation where immediate care is necessary to preserve life or prevent serious impairment, residents are permitted to initiate whatever care is necessary and reasonable to save a patient from serious harm even if an attending physician is not immediately available to supervise. The appropriate Medical Staff member should be notified as soon as possible. Ìý
• Supervising physicians may be more advanced residents or fellows.Ìý

Certifications current when the resident entered training at the UTCOMC.

Basic Life Support (BLS)

Advanced Cardiac Life Support (ACLS)

Advanced Trauma Life Support (ATLS)

As a 6th Year Surgery Chief Resident (PGY-6), the Resident can perform any general surgery physician skill or procedure deemed appropriate by his/her attending physician or specialty physician skill or procedure deemed appropriate by an attending physician in a department in which the Resident is assigned for rotation (e.g., Emergency Medicine, Trauma Surgery, Surgical Critical Care, PICU, etc.). ÌýResidents are expected to progressively assume more responsibility throughout each level of training and demonstrate competence in skills/procedures requiring less Direct Supervision. The supervising physician may make adjustments in the level of supervision required for that specific procedure.

Patient Care Skills or Procedures that do not require Direct or Indirect Supervision presence of a supervising physician (i.e., Oversight/General Supervision) are listed below. Anything not specifically listed requires either Direct Supervision, Indirect Supervision with Direct Supervision Immediately Available, or Indirect Supervision with Direct Supervision available by phone or other electronic media, at the discretion of the supervising physician.

1st Year (PGY-1) Surgery Residents are supervised either directly or indirectly with the supervising attending or more senior resident available to provide direct supervision. 1st Year Surgery Residents can perform the skills or procedures listed below under Indirect Supervision or Oversight highlighted in yellow.

2nd Year (PGY-2) Surgery residents can perform the procedures listed below under Indirect Supervision or Oversight highlighted in red.

3rd Year (PGY-3) Surgery residents can perform the procedures listed below under Indirect Supervision or Oversight highlighted in green.

4th Year (PGY-4) Surgery residents can perform the procedures listed below under Indirect Supervision or Oversight highlighted in blue.

5th Year (PGY-5) Surgery Residents can perform the procedures listed below under Indirect Supervision or Oversight highlighted in orange.

6th Year (PGY-6) Surgery Chief Residents can perform the procedures listed below under Indirect Supervision or Oversight highlighted in gray.

The procedures listed below (by level) do not require the immediate physical presence of the supervising physician:

ÌýDifferential Diagnosis, Treatment, and Patient Care Skills	1st Year PGY-1Ìý	2nd Year PGY-2Ìý	3rd Year PGY-3Ìý	4th Year PGY-4	5th Year PGY-5	6th Year PGY-6 Chief Resident
ÌýÌýÌý Amputation or extremity or digit	Ìý	Ìý	Ìý	ÌýX	ÌýX	X
ÌýÌýÌý Appendectomy	Ìý	Ìý	Ìý	ÌýX	ÌýX	X
ÌýÌýÌý Arterial puncture	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Breast biopsy	Ìý	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Bronchoscopy	Ìý	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Central venous pressure lines	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Chief Resident and administrative supervision responsibilities	Ìý	Ìý	Ìý	Ìý	Ìý	X
Ìý Ìý Clinical and Social History	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
Ìý Ìý Communicate with patients and family members	ÌýX	ÌýX	ÌýX	ÌýXÌý	ÌýX	X
ÌýÌýÌý Diverting loop colostomy	Ìý	Ìý	Ìý	ÌýX	ÌýX	X
ÌýÌýÌý Drainage of extremity	Ìý	Ìý	Ìý	ÌýX	ÌýX	X
ÌýÌýÌý Drainage of subcutaneous abscess	Ìý	Ìý	Ìý	ÌýX	ÌýX	X
Ìý Ìý EKG - perform and interpret	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Emergency management of 1st, 2nd, and 3rd degree burns	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Epigastric, Umbilical, or Inguinal Hernia	Ìý	Ìý	Ìý	ÌýX	ÌýX	ÌýX
ÌýÌýÌý Excision of subcutaneous or dermal lesion	Ìý	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Formulate diagnostic and treatment plans	ÌýXÌý	ÌýX	ÌýX	ÌýX	ÌýX	X
Ìý Ìý Formulate pre-and post-operative treatment plans	ÌýX	ÌýX	ÌýX	ÌýXÌý	ÌýX	X
Ìý Ìý Initial Emergency Department consults	ÌýX	ÌýX	ÌýX	X	ÌýX	X
Ìý Ìý Interpret basic x-rays and imaging studies	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
Ìý Ìý Interpret laboratory and diagnostic studies and tests (including arterial blood gases)	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Intravenous line	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Knot tying	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
Ìý Ìý Mark surgical procedures on patients	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Minor surgical procedures	Ìý	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Nasotracheal intubation	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
Ìý Ìý Order radiologic, laboratory, or other diagnostic tests	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Orotracheal intubation	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
Ìý Ìý Participate in and supervise a code (adults), including trauma	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
Ìý Ìý Participate in a code (pediatrics), including trauma	Ìý	X	X	ÌýX	XÌý	X
Ìý Ìý Participate in and supervise a trauma code	X	X	X	ÌýX	ÌýX	X
Ìý Ìý Participate in the care of medical and surgical critical care patients	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Perforated duodenal ulcer	Ìý	Ìý	Ìý	ÌýX	ÌýX	X
ÌýÌýÌý Perform procedures in the OR with Direct Supervision present or immediately available	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
ÌýÌýÌý Perform procedures in the OR and assist junior Residents with procedures in the OR	Ìý	Ìý	Ìý	ÌýX	ÌýX	X
Ìý Ìý Peripheral Intravenous Access	Ìý	X	X	ÌýX	ÌýX	X
ÌýÌýÌý Peritoneal lavage	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
Ìý Ìý Physical Examination	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Portacath, venous access	Ìý	Ìý	Ìý	ÌýX	ÌýX	X
Ìý Ìý Request specialty and subspecialty consults	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌý Roll with patient to surgery when staff is notified the attending is "on the way to the OR"Ìý	X	X	X	X	X	X
Ìý Ìý See patients and write patient orders	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Skin graft	Ìý	Ìý	Ìý	ÌýX	ÌýX	X
ÌýÌýÌý Small bowel obstruction	Ìý	Ìý	Ìý	ÌýX	ÌýX	X
Ìý Ìý Supervise Medical Students	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Supervise more junior Residents	Ìý	X	X	X	X	X
ÌýÌýÌý Suture simple wounds and lacerations	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Swan Ganz catheterization	Ìý	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Thoracentesis	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Triage adult and pediatric trauma patients	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
ÌýÌýÌý Tube thoracostomy	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
Ìý Ìý Venipuncture	X	X	X	ÌýX	ÌýX	X
ÌýÌýÌý Wound debridement	X	X	X	ÌýX	ÌýX	X
Ìý Ìý Write admission, treatment orders, and notes in the Electronic Health Record	X	X	X	X	X	X

Ìý

ÌýCardiopulmonary Resuscitation and Airway Maintenance	Ìý	Ìý	ÌýÌý	Ìý	Ìý	Ìý
Ìý ÌýPerform Basic CPR and related procedures (airway management, emergency drug therapy, rhythm strip interpretation, intravenous catheterization, closed chest massage, electrocardioversion and defibrillation, and venous cut-down)Ìý	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX	X
Ìý ÌýAdult Resuscitation	X	X	X	ÌýX	ÌýX	X

All other procedures not listed should be performed under direct supervision of a faculty member or more senior resident.Ìý