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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 Orthopaedic 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.

• 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

Tyler Goodwin, MD Ìý

PGY-2 ResidentÌý

Orthopaedic SurgeryÌý

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 entered training at the UTCOMC.ÌýÌýÌý Ìý Ìý Ìý Ìý Ìý ÌýÌý

Basic Life Support (BLS)

Advanced Cardiac Life Support (ACLS)

Advanced Trauma Life Support (ATLS)

As a 2nd Year Orthopaedic Surgery Resident, the Resident can perform any Orthopaedic Surgery 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 is assigned for rotation (e.g., Emergency Medicine, Trauma Surgery, Surgical Critical Care, PICU, etc.).Ìý Residents are expected to progressively assume more responsibility throughout each level of training and demonstrate competence in skills/procedures requiring less Direct Supervision.Ìý 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.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.ÌýÌý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý ÌýÌý

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

PGY-2, 3, 4, or 5 Orthopaedic Surgery trainees can perform the procedures listed below with indirect supervision:

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

PGY-3 Orthopaedic Surgery residents can perform the procedures listed belowÌýunder Indirect Supervision or Oversight highlighted in green.

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

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

ÌýDifferential Diagnosis, Treatment, and Patient Care SkillsÌý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý ÌýÌý	PGY-1Ìý	PGY-2Ìý	PGY-3Ìý	PGY-4	PGY-5
Ìý Ìý Clinical and Social History	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Communicate with patients and family members	ÌýX	ÌýX	ÌýX	ÌýXÌý	ÌýX
Ìý Ìý EKG - perform and interpret	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Formulate diagnostic and treatment plans	ÌýXÌý	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Formulate pre-and post-operative treatment plans	ÌýX	ÌýX	ÌýX	ÌýXÌý	ÌýX
Ìý Ìý Initial Emergency Department consults	ÌýX	ÌýX	ÌýX	X	ÌýX
Ìý Ìý Interpret basic x-rays and imaging studies (e.g., skull, spine, chest, abdomen, and extremities)	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Interpret laboratory and diagnostic studies and tests	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Mark surgical procedures on patients	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Order radiologic, laboratory, or other diagnostic tests	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Participate in and run a code (adults), including trauma	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Participate in a code (pediatrics), including trauma	Ìý	X	X	ÌýX	XÌý
Ìý Ìý Participate in a trauma code	X	X	X	ÌýX	ÌýX
Ìý Ìý Participate in the care of medical and surgical critical care patients	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Peripheral Intravenous Access	Ìý	X	X	ÌýX	ÌýX
Ìý Ìý Physical Examination	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Request specialty and subspecialty consults	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý See patients and write patient orders	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Supervise Medical Students	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý Ìý Write admission, treatment orders, and notes in the Electronic Health Record	X	X	X	ÌýX	ÌýX
Ìý Ìý Venipuncture	X	X	X	ÌýX	ÌýX
Ìý Ìý Wound debridement	X	X	X	X	X
Ìý	Ìý	Ìý	Ìý	Ìý	Ìý
ÌýCardiopulmonary Resuscitation and Airway Maintenance	Ìý	Ìý	ÌýÌý	Ìý	Ìý
Ìý ÌýPerform Basic CPR and related procedures (airway management, emergency drug therapy, rhythm strip interpretation, intravenous catheterization,Ìý closed chest massage, electrocardioversion & defibrillation, and venous cut-down)Ìý	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý ÌýAdult Resuscitation	X	X	X	ÌýX	ÌýX
Ìý	Ìý	Ìý	Ìý	Ìý	Ìý
ÌýAdditional Specific Skills	Ìý	Ìý	Ìý	Ìý	Ìý
Ìý ÌýArterial puncture for Arterial Blood Gas Collection	Ìý	X	ÌýX	ÌýX	ÌýX
Ìý ÌýChief Resident andÌý Administrative Supervisory Responsiblities	Ìý	Ìý	Ìý	Ìý	XÌý
Ìý ÌýClosed treatment of simple fractures and dislocations	X	X	X	X	X
Ìý ÌýClosed treatment of more complicated fractures and dislocations	Ìý	X	X	X	X
Ìý ÌýConscious and moderate sedationÌý	Ìý	Ìý	ÌýX	ÌýX	ÌýX
Ìý ÌýEmergency closed reduction techniques	Ìý	Ìý	X	X	X
Ìý ÌýFollow rehabilitation protocols	X	X	X	X	X
Ìý ÌýInterpret Arterial Blood Gases	Ìý	ÌýX	X	ÌýX	X
Ìý ÌýIntravenous Lines	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý ÌýJoint injections and aspirationsÌý	Ìý	ÌýX	ÌýX	ÌýX	ÌýX
Ìý ÌýLocal anesthesia blockÌý	Ìý	Ìý	ÌýX	ÌýX	ÌýX
Ìý ÌýMinor surgical procedures	Ìý	ÌýX	ÌýX	ÌýX	ÌýX
Ìý ÌýResident Surgeon on more simplified major orthopaedic proceduresÌý	Ìý	Ìý	Ìý	Ìý	ÌýX
Ìý ÌýRoll with patient to surgery when staff is notified the attending is "on the way to the OR"Ìý	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý ÌýSplinting of fractures and dislocations & casting	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý ÌýSupervise more junior residentsÌý	Ìý	ÌýX	ÌýX	ÌýX	ÌýX
Ìý ÌýSuture simple wound/laceration	ÌýX	X	X	ÌýX	ÌýX
Ìý ÌýTraction Pin InsertionÌý	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX
Ìý ÌýTriage adult and pediatric trauma patientsÌý	ÌýX	ÌýX	ÌýX	ÌýX	ÌýX

Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý ÌýÌý

AllÌýother procedures not listed should be performed under direct supervision of a faculty member or more senior resident.ÌýÌý