Supervision and Procedures: Neighbors, Rebecca (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, 听Department of Family Medicine.听 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.

Rebecca Neighbors, MD听听听听

PGY-1 Resident

Family Medicine

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. 听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 entered training at the UTCOMC.听听听听听听听听听听

Basic Life Support (BLS)

Advanced Cardiac Life Support (ACLS)

Pediatric Advanced Life Support (PALS)

Advanced Life Support in Obstetrics (ALSO)

Neonatal Resuscitation Program (NRP)

As a 1st Year Family Medicine Resident (PGY-1 level), the Resident can perform any Family Medicine 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, Surgical Critical Care, etc.). 听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

PGY-1 Family Medicine Residents are supervised either directly or听indirectly with the supervising attending or more senior resident available to provide direct supervision.

PGY-2 Family Medicine residents can perform the procedures under Indirect Supervision or Oversight highlighted in red.

PGY-3 Family Medicine residents can perform the procedures听under Indirect Supervision or Oversight highlighted in green.

The procedures listed below do not require the immediate physical presence of a supervising physician:

听Differential Diagnosis, Treatment, and Patient Care Skills听听听听听听听听听听听听听	PGY-1听	PGY-2听	PGY-3听
听听听 Arterial puncture	听	X	X
听听听 Arthrocentesis	听	听	X
听听听 Chief Resident and administrative supervision responsibilities	听	听	X
听听 Clinical and Social History	听X	听X	听X
听听 Communicate with patients and family members	听X	听X	听X
听听 EKG - perform and interpret	听X	听X	听X
听听听 Emergency treatment of 1st, 2nd, and 3rd degree burns	听	X	X
听听听 Excision biopsy	听	听X	X
听听 Formulate diagnostic and treatment plans	听X听	听X	听X
听听 Formulate pre-and post-operative treatment plans	听X	听X	听X
听听听 Incision & Drainage of skin abscess	听	听X	X
听听 Initial Emergency Department consults	听X	听X	听X
听听 Interpret basic x-rays and imaging studies	听X	听X	听X
听听 Interpret laboratory and diagnostic studies and tests (including arterial blood gases)	听X	听X	听X
听听听 Joint injections	听	听	X
听听 Mark surgical procedures on patients	听X	听X	听X
听听听 Non-stress test (fetal)	听	听X	X
听听听 Obstetrical ultrasound (limited abdominal)	听	听X	X
听听 Order radiologic, laboratory, or other diagnostic tests	听X	听X	听X
听听听 Paracentesis	听	听	X
听听 Participate in and supervise a code (adults)	听X	听X	听X
听听听 Participate in and a pediatric code	X	X	X
听听听 Participate in neonatal resuscitation	X	X	X
听听 Participate in and supervise medical critical care patients	听	X	X
听听 Pelvic Examination and Pap Smear	听	听X	听X
听听听 Peripheral intravenous access	听X	听X	听X
听听听Physical Examination	听X	听X	听X
听听听 Punch biopsy (skin)	听	X	X
听听 Request specialty and subspecialty consults	听X	听X	听X
听听 See patients and write patient orders	听X	听X	听X
听听听 Splinting of fractures and dislocations	听	X	X
听听听 Supervise Family Medicine inpatient team	听	X	X
听听 Supervise Medical Students	X	X	X
听听听 Supervise more junior Residents	听	X	X
听听听 Suture simple wounds and lacerations	X	X	X
听听听 Venipuncture	X	X	X
听听听 Wound debridement	X	X	X
听听 Write admission, treatment orders, and notes in the Electronic Health 听Record	X	X	X
听	听	听	听
听Cardiopulmonary Resuscitation	听	听	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	听X	听X	听X
听	听	听	听

听

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

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