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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, Surgical Critical Care 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.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

William Lee, MD Ìý

PGY-5

Fellow, Surgical Critical Care

Resident Supervision will consist of four categories/levels:

• Direct SupervisionÌý- the supervising physician is physically present with the resident and patient.
• Indirect Supervision with Direct Supervision IMMEDIATELY availableÌý- 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 availableÌý- 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
• °¿±¹±ð°ù²õ¾±²µ³ó³ÙÌý- 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 asÌýOversightÌýin 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. ÌýThe appropriate Medical Staff member should be notified as soon as possible.ÌýÌý
• 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)

Advanced Trauma Life Support (ATLS)

As aÌý Fellow in the one-year Surgical Critical Care Fellowship (typically at the PGY-4 or PGY-5 level), the Fellow can perform any Surgery or Surgical Critical Care physician skill or procedure deemed appropriate by his/her attending physician.Ìý Residents and Fellows 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.Ìý

Surgical Critical Care Fellows (typically at the PGY-4 or PGY-5 level) can perform the procedures under Indirect Supervision or Oversight highlighted in grey.

Patient Care SkillsÌýand ProceduresÌý Ìý Ìý Ìý Ìý	ÌýSCC Fellow PGY-4 and 5Ìý
Ìý Ìý Perform all minor surgery related procedures as the Fellow is at an advanced level of training.Ìý	X
Ìý Ìý Surgery, Trauma, and Surgical Critical Care consults in the Emergency Department	ÌýX
Ìý Ìý Clinical and Social History	ÌýX
Ìý Ìý Communicate with patients and family members	ÌýX
Ìý Ìý EKG - perform and interpret	ÌýX
Ìý Ìý Formulate diagnostic and treatment plans	ÌýX
Ìý Ìý Formulate pre-and post-operative treatment plans	ÌýX
Ìý Ìý Incision and Drainage Superficial Abscesses & Hematomas	ÌýX
Ìý Ìý Interpret basic x-rays and imaging studies, including but not limited to skull, spine, chest, abdomen, and extremitiesÌý	ÌýX
Ìý Ìý Interpret laboratory and diagnostic studies and tests	ÌýX
Ìý Ìý Mark diagnostic and surgical procedures on patients	ÌýX
Ìý Ìý Obtain consent for endoscopic procedures	X
Ìý Ìý Order radiologic, laboratory, or other diagnostic tests	ÌýX
Ìý Ìý Participate in and run a code (adults)	ÌýX
Ìý Ìý Request specialty and subspecialty consults	ÌýX
Ìý Ìý See patients and write patient orders	ÌýX
Ìý Ìý Supervise Medical Students, Residents, and more junior Surgical Critical CareÌý ÌýFellows	ÌýX
Ìý ÌýÌýPhysical Examination	ÌýX
Ìý Ìý Write admission, treatment orders, and notes in the Electronic Health ÌýRecord	X
Ìý	Ìý
ÌýCardiopulmonary Resuscitation and Airway Maintenance	ÌýÌýSCC Fellow PGY-4, 5, 6, or 7
Ìý ÌýPerform 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
ÌýAdult Resuscitation	ÌýX
Pediatric Resuscitation	X
Insertion of Oral Pharyngeal Airway	X
Endotracheal Intubation	X
Ìý	Ìý
ÌýAdditional Specific Patient Skills and Procedures	ÌýSCC Fellow PGY-4, 5, 6, or 7
Ìý ÌýAmputation of extremity or digitÌý	ÌýX
Ìý ÌýAppendectomyÌý	ÌýX
Ìý ÌýArterial PunctureÌý	ÌýX
Ìý ÌýBreast BiopsyÌý	X
Ìý ÌýBronchoscopyÌý	X
Ìý ÌýCentral Venous Pressure LinesÌý	X
Ìý ÌýDiverting Loop ColostomyÌý	X
Ìý ÌýDrainage of ExtremityÌý	ÌýX
Ìý ÌýEpigastric, Umbilical, or Inguinal HerniaÌý	ÌýX
Ìý ÌýExcision of subcutaneous or dermal lesionÌý	X
Ìý ÌýIntravenous LineÌý	X
Ìý ÌýKnot Tying	X
Ìý ÌýNasotracheal IntubationÌý	X
Ìý ÌýOrotracheal IntubationÌý	ÌýX
Ìý ÌýParticipate in and supervise patients in the Surgical ICU	ÌýX
Ìý ÌýPerform procedures in the OR and assist junior residents with procedures in the ORÌý	ÌýX
Ìý ÌýPerforated Duodenal UlcerÌý	X
Ìý ÌýPeritoneal Lavage	ÌýX
Ìý ÌýPortacath, venous accessÌý	ÌýX
Ìý ÌýRoll with the patient to surgery when staff is notified the attending is "on the way to the OR"Ìý	ÌýX
Ìý ÌýSkin GraftÌý	X
Ìý ÌýSmall bowel obstructionÌý	X
Ìý ÌýSuture Simple Wound/LacerationÌý	X
Ìý ÌýSwan Ganz CatheterizationÌý	ÌýX
Ìý ÌýThoracentesisÌý	ÌýX
Ìý ÌýTriage adult and pediatric trauma patientsÌý	ÌýX
Ìý ÌýTube ThoracostomyÌý	ÌýX
Ìý ÌýVenipunctureÌý	ÌýX
Ìý ÌýWound DebridementÌý	ÌýX
Ìý	Ìý

Ìý

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