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Supervision and Procedures: Khan, Rafay (MD)

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, Cardiovascular Disease Fellowship. 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.

Rafay Khan, MD

Rafay Khan, MD 听

PGY-6 (3rd Year) Chief Fellow

Cardiovascular Disease

Resident Supervision will consist of four categories/levels:

  • Direct Supervision听- the supervising physician is physically present with the resident and patient.
  • Indirect Supervision with Direct Supervision IMMEDIATELY available听- 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听- 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
  • 翱惫别谤蝉颈驳丑迟听- 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听Oversight听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.听听
  • Supervising physicians may be more advanced residents or fellows.听
Certifications current when the resident/fellow entered training at the UTCOMC.听听听 听 听 听 听 听 听听
Basic Life Support (BLS)
Advanced Cardiac Life Support (ACLS)

As a 3rd Year Fellow in the Cardiovascular Disease Fellowship, the Fellow can perform any Cardiology 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 is assigned for rotation (e.g., Emergency Medicine, Critical Care, etc.). Residents are expected to progressively assume more responsibility throughout each level of training and demonstrate competence in skills/procedures requiring less Direct Supervision.听 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.听 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.听听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听听

PGY-4, PGY-5, and PGY-6 Cardiovascular Disease fellows can perform the procedures listed below with Indirect Supervision:
听
PGY-4 Cardiovascular Disease Fellows can perform the procedures under Indirect Supervision or Oversight highlighted in blue.
听
PGY-5 Cardiovasular Disease Fellows can perform the procedures听under Indirect Supervision or Oversight highlighted in orange.
听
PGY-6 Cardiovascular Disease Fellows can perform the procedures under Indirect Supervision or Oversight highlighted in grey.

听

听Differential Diagnosis, Treatment, and Patient Care Skills听 听 听 听 听 听 PGY-4
(1st Year)听		 PGY-5
(2nd Year)听		 PGY-6
(3rd Year)听
听 听 Perform all Internal Medicine related procedures since they are already eligible for the Internal Medicine Boards or are already ABIM certified.听 X X X
听 听 Cardiology consults in the Emergency Department 听X X X
听 听 Clinical and Social History 听X X X
听 听 Communicate with patients and family members 听X X X
听 听 EKG - perform and interpret 听X听 X X
听 听 Formulate diagnostic and treatment plans 听X X X
听 听 Formulate pre-and post-operative treatment plans 听X X X
听 听 Interpret basic x-rays and imaging studies 听X X X
听 听 Interpret laboratory and diagnostic studies and tests 听X X X
听 听 Mark diagnostic procedures on patients 听X X X
听 听 Order radiologic, laboratory, or other diagnostic tests 听X X X
听 听 Participate in and run a code (adults) 听X X X
听 听 Request specialty and subspecialty consults 听X X X
听 听 See patients and write patient orders 听X X X
听 听 Supervise Medical Students, Residents, and more junior Cardiovascular听 听
听Fellows		 听X X X
听 听听Physical Examination 听X X X
听 听 Write admission, treatment orders, and notes in the Electronic Health
听Record		 X X X
听 听 听 听
Cardiopulmonary Resuscitation and Airway Maintenance 听 听 听听

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)听

 X 听X 听X
Adult Resuscitation X 听X 听X
Pediatric Resuscitation X X X
Insertion of Oral Pharyngeal Airway X X X
Endotracheal Intubation X X X
Cricothyroidoctomy X X X
Use of Mechanical Respirators X X X
听 听 听 听
听Additional Specific Skills 听 听 听
听 听Arterial puncture for Arterial Blood Gas Collection X X 听X
听 听Interpret Arterial Blood Gases听 X 听X 听X
听 听Arthrocentesis X X听 听X
听 听Echocardiography X X X
听 听Exercise stress testing X X X
听 听Interpret ambulatory ECG recordings X X X
听 听Interpret electrocardiograms X X X
听 听Interpret nuclear cardiology studies X X X
听 听Intravenous catheterization X X X
听 听Joint Injection X X X
听 听Lumbar Puncture X X听 X
听 听Thoracentesis X 听X X
听 听Nasotracheal or orotracheal intubation X 听X X
听 听Paracentesis X 听X X
听 听Perform bladder catheterrization X X X
听 听Pulmonary catheter insertion X 听X X
听 听NG Tube Placement X 听X X
听 听Participate in and supervise medical critical care patients X 听X X
听 听Splinting of Fractures & Dislocations X X X
听 听Supervise residents assigned to Cardiology X 听X X
听 听Supervise an Inpatient Cardiology Team X 听X X
听 听Sutures X 听X X
听 听Venipuncture X 听X X
听 听Emergency Use of External Temporary Pacemakers X X X
听 听Emergency Treatment of 1st, 2nd, & 3rd Degree Burns X X X
听 听Diagnostic Peritoneal Lavage X X X

听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听听

All other procedures are performed under direct supervision of a faculty member or more听senior fellow.听听