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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, Gastroenterology Fellowship. ÌýAny 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

Peter DeLeeuw, DO

PGY-5 (2nd Year Fellow)

Gastroenterology

Resident Supervision will consist of four categories/levels:

• 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/fellow entered training at the UTCOMC.ÌýÌýÌý Ìý Ìý Ìý Ìý Ìý ÌýÌý

Basic Life Support (BLS)

Advanced Cardiac Life Support (ACLS)

As a 2nd Year Fellow in the Gastroenterology Fellowship (PGY-5), the Fellow can perform any Gastroenterology or Internal Medicine physician skill or procedure deemed appropriate by his/her attending physician or specialty physician skill or procedure deemed by an attending physician in a department in which the Resident or Fellow is assigned for rotation (e.g., Emergency Medicine, Critical Care, etc.). ÌýResidents and Fellows are expected to progressively assume more responsibility throughout each level of training and demonstrate competence in skills/procedures requiring less Direct Supervision. ÌýThe 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.Ìý 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.Ìý

PGY-4, PGY-5, and PGY-6 Gastroenterology Fellows can perform the procedures listed below with Indirect Supervision:

PGY-4 Gastroenterology Fellows can perform the procedures under Indirect Supervision or Oversight highlighted in blue.

PGY-5 Gastroenterology Fellows can perform the proceduresÌýunder Indirect Supervision or Oversight highlighted in orange.

PGY-6 Gastroenterology Fellows can perform the procedures under Indirect Supervision or Oversight highlighted in grey.

Differential Diagnosis, Treatment, and Patient Care SkillsÌý Ìý Ìý Ìý Ìý Ìý	PGY-4 1st Year FellowÌý	PGY-5 2nd Year FellowÌý	PGY-6 3rd Year FellowÌý
Ìý Ìý Perform all Internal Medicine related procedures since they are already eligible for the Internal Medicine Boards or are already ABIM certified.Ìý	X	X	X
Ìý Ìý Gastroenterology consults in the Emergency Department	ÌýX	ÌýX	ÌýX
Ìý Ìý Clinical and Social History	ÌýX	ÌýX	ÌýX
Ìý Ìý Communicate with patients and family members	ÌýX	ÌýX	ÌýX
Ìý Ìý EKG - perform and interpret	ÌýXÌý	ÌýX	ÌýX
Ìý Ìý Formulate diagnostic and treatment plans	ÌýX	ÌýX	ÌýX
Ìý Ìý Formulate pre-and post-operative treatment plans	ÌýX	ÌýX	ÌýX
Ìý Ìý Incision and Drainage Superficial Abscesses & Hematomas	ÌýX	ÌýX	ÌýX
Ìý Ìý Interpret basic x-rays and imaging studies, including but not limited to skull, spine, chest, abdomen, and extremitiesÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Interpret laboratory and diagnostic studies and tests	ÌýX	ÌýX	ÌýX
Ìý Ìý Mark diagnostic and surgical procedures on patients	ÌýX	ÌýX	ÌýX
Ìý Ìý Obtain consent for endoscopic procedures	X	X	X
Ìý Ìý Order radiologic, laboratory, or other diagnostic tests	ÌýX	ÌýX	ÌýX
Ìý Ìý Participate in and run a code (adults)	ÌýX	ÌýX	ÌýX
Ìý Ìý Participate in a code (pediatrics)	X	X	X
Ìý Ìý Request specialty and subspecialty consults	ÌýX	ÌýX	ÌýX
Ìý Ìý See patients and write patient orders	ÌýX	ÌýX	ÌýX
Ìý Ìý Supervise Medical Students, Residents, and more junior GatroenterologyÌýÌý ÌýFellows	ÌýX	ÌýX	ÌýX
Ìý ÌýÌýPhysical Examination	ÌýX	ÌýX	ÌýX
Ìý Ìý Rectal Examination (including DIgital)	X	X	X
Ìý Ìý Write admission, treatment orders, and notes in the Electronic Health ÌýRecord	X	X	X
Ìý	Ìý	Ìý	Ìý
ÌýCardiopulmonary Resuscitation and Airway Maintenance	PGY-4 1st Year Fellow	PGY-5 2nd Year Fellow	PGY-6 3rd Year Fellow
Perform Basic CPR and related procedures (airway management, emergency drug therapy, rhythm strip interpretation, intravenous catheterization, closed chest massage, adult resuscitation, electrocardioversion & defibrillation, and venous cut-down)Ìý	ÌýX	ÌýX	ÌýX
ÌýAdult Resuscitation	ÌýX	ÌýX	ÌýX
Pediatric Resuscitation	X	X	X
Insertion of Oral Pharyngeal Airway	X	X	X
Endotracheal Intubation	X	X	X
Ìý	Ìý	Ìý	Ìý
ÌýAdditional Specific Skills	PGY-4 1st Year Fellow	PGY5 2nd Year FellowÌý	PGY-6 3rd Year FellowÌý
Ìý ÌýArterial puncture for Arterial Blood Gas Collection	ÌýX	X	ÌýX
Ìý ÌýInterpret Arterial Blood GasesÌý	ÌýX	ÌýX	ÌýX
Ìý ÌýArthrocentesis	ÌýX	XÌý	ÌýX
Ìý ÌýCentral Line Placement	X	X	X
Ìý ÌýIntra-arterial Puncture or Catheterization	X	X	X
Ìý ÌýIntravenous Catheterization	X	X	X
ÌýÌýJoint Injection	ÌýX	X	X
Ìý ÌýLumbar Puncture	ÌýX	XÌý	ÌýX
Ìý ÌýThoracentesis	ÌýX	ÌýX	X
Ìý ÌýNasotracheal or orotracheal intubation	ÌýX	ÌýX	X
Ìý ÌýParacentesis	ÌýX	ÌýX	X
Ìý ÌýPerform bladder catherization	X	X	X
Ìý ÌýPulmonary catheter insertion	ÌýX	ÌýX	X
Ìý ÌýNG Tube Placement	ÌýX	ÌýX	ÌýX
Ìý ÌýParticipate in and supervise medical critical care patients	ÌýX	ÌýX	ÌýX
Ìý ÌýSplinting of Fractures & Dislocations	X	X	X
Ìý ÌýSupervise residents assigned to Gastroenterology	ÌýX	ÌýX	ÌýX
Ìý ÌýSupervise an Inpatient Gastroenterology Team	Ìý	ÌýX	ÌýX
Ìý ÌýSutures	ÌýX	ÌýX	ÌýX
Ìý ÌýVenipuncture	ÌýX	ÌýX	ÌýX
Ìý ÌýEmergency Use of External Temporary Pacemakers	X	X	X
Ìý ÌýEmergency Treatment of 1st, 2nd, & 3rd Degree Burns	X	X	X
Ìý ÌýDiagnostic Peritoneal Lavage	X	X	X
Ìý	Ìý	Ìý	Ìý
The following procedures may be performed by Gastroenterology Fellows underÌýDirect Supervision.Ìý After the Fellow has demonstrated to faculty competence in the procedure, with appropriate documentation from the Program Director, the Fellow may be able to perform the procedure without a faculty member being in the room but available.Ìý The latter will be at the discretion of the supervising physician and Program Director:	Ìý	Ìý	Ìý
Patient Care Skill or Procedure (Direct Supervision unless otherwiseÌýdirected by the supervising physician or Program Director)	PGY-4 1st Year Fellow	PGY-5 2nd Year Fellow	PGY-6 3rd Year Fellow
Ìý Ìý Biopsy of the mucosa of the esophagus, stomach, small bowel, and colonÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Capsule endoscopy	ÌýX	ÌýX	ÌýX
Ìý Ìý Colonoscopy with polypectomyÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Conscious sedationÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Esophageal dilation Enteral and parenteral alimentationÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý EsophagogastroduodenoscopyÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Non-variceal hemostasis, both upper and lower including actively bleeding patientsÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Other diagnostic & therapeutic procedures utilizing enteral intubationÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Percutaneous endoscopic gastrostomyÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Retrieval of foreign bodies from the esophagusÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Variceal hemostasis including actively bleeding patientsÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Endoscopic Retrograde Cholendochopancreatography, in all its diagnostic and therapeutic applications;Ìý	ÌýX	ÌýX	ÌýX
Ìý Ìý Imaging of the digestive system, including --	ÌýX	ÌýX	ÌýX
Ìý Ìý Ìý Ìý Computed tomography (CT); including CT entero/colographyÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Ìý Ìý Contrast radiographyÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Ìý Ìý Magnetic resonance imagingÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Ìý Ìý Nuclear medicine	ÌýX	ÌýX	ÌýX
Ìý Ìý Ìý Ìý Percutaneous cholangiographyÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Ìý Ìý Ultrasound, including endoscopic ultrasoundÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Ìý Ìý Vascular radiographyÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Ìý Ìý Wireless capsule endoscopyÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Interpret gastrointestinal and hepatic biopsiesÌý	ÌýX	ÌýX	ÌýX
Ìý Ìý Motility studies, including esophageal motility/pH studies	ÌýX	ÌýX	ÌýX
Ìý Ìý Gastrointestinal motility studies and 24- hour pH monitoringÌý	ÌýX	ÌýX	ÌýX

Ìý

All other procedures are performed under direct supervision of a faculty member or moreÌýsenior fellow.ÌýÌý