Supervision and Procedures: Rivet, Joshua (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, Department of Plastic 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.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
Joshua Jude Rivet, MDÌý
Fellow (PGY-9)
Plastic Surgery Trauma
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. |
| Basic Life Support (BLS) |
| Advanced Cardiac Life Support (ACLS) |
| Advanced Trauma Life Support (ATLS) |
The Plastic Surgery Fellow in the Plastic Surgery Trauma Mini Fellowship is able to perform any general surgery or plastic surgery skill or procedure deemed appropriate by his/her attending physician. ÌýThe Fellow should be able to perform most procedures under Indirect Supervision with an attending physician who is available. 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.
Patient ÌýCare Skils or Procedures that do not require the physical presence of a supervising physician (Indirect or General Supervision) are listed below:
|
Ìý ÌýDifferential Diagnosis, Treatment, Patient Care SkillsÌý or ProceduresÌý Ìý Ìý Ìý Ìý Ìý Ìý Ìý Ìý ÌýÌý |
Fellow (PGY-9 or above) |
| ÌýÌýÌý Amputation of extremity or digit | X |
| ÌýÌýÌý Appendectomy | X |
| ÌýÌýÌý Arterial Puncture | X |
| ÌýÌýÌý Breast Biopsy | X |
| ÌýÌýÌý Bronchoscopy | X |
| ÌýÌýÌý Central Venous PressureLines | X |
| ÌýÌýÌý Chief Resident administrative and supervisory responsibilities | X |
| Ìý Ìý Clinical and Social History | X |
| Ìý Ìý Communicate with patients and family members | ÌýX |
| ÌýÌýÌý Diverting Loop Colostomy | ÌýX |
| ÌýÌýÌý Drainage of Extremity | ÌýX |
| ÌýÌýÌý Drainage of Subcutaneous Abscess | ÌýX |
| Ìý Ìý EKG - perform and interpret | ÌýX |
| ÌýÌýÌý Emergency Treatment of 1st, 2nd, and 3rd Degree Burns | ÌýX |
| ÌýÌýÌý Epigastric, umbilical, or inguinal hernia | ÌýX |
| ÌýÌýÌý Excision of subcutaneous or dermal lesion | ÌýX |
| ÌýÌýÌý Facial bone fracture (mandible - Alveolar ridge) | ÌýX |
| ÌýÌýÌý Facial bone fracture (nasal) | X |
| ÌýÌýÌý Facial laceration (soft tissue, acute repair) | X |
| Ìý Ìý Formulate diagnostic and treatment plans | ÌýX |
| Ìý Ìý Formulate pre-and post-operative treatment plans | ÌýX |
| Ìý Ìý Initial Emergency Department consults | ÌýX |
| Ìý Ìý Interpret basic x-rays and imaging studies | ÌýX |
| Ìý Ìý Interpret laboratory and diagnostic studies and tests | ÌýX |
| ÌýÌýÌý Intravenous Line | ÌýX |
| ÌýÌýÌý Knot tying | ÌýX |
| Ìý Ìý Mark surgical procedures on patients | ÌýX |
| ÌýÌýÌý Minor surgical procures | ÌýX |
| ÌýÌýÌý Nasotracheal intubation | ÌýX |
| Ìý Ìý Order radiologic, laboratory, or other diagnostic tests | ÌýX |
| ÌýÌýÌý Orotracheal intubation | ÌýX |
| Ìý Ìý Participate in and supervise a patient code (adults) | ÌýX |
| Ìý Ìý Participate in and superise trauma patient care | X |
| Ìý Ìý Perform procedures in the OR and assist more junior residents with procedures in the OR | ÌýX |
| ÌýÌýÌý Perforated duodenal ulcer | ÌýX |
| ÌýÌýÌý Peritoneal lavage | ÌýX |
| Ìý Ìý Physical Examination | ÌýX |
| ÌýÌýÌý Portacath, venous action | ÌýX |
| ÌýÌýÌý Pressure sores-flap (debridement) | X |
| Ìý Ìý Request specialty and subspecialty consults | ÌýX |
| ÌýÌýÌý Roll with patient to surgery when staff is notified the attending is "on the way to the OR" | ÌýX |
| Ìý Ìý See patients and write patient orders | ÌýX |
| ÌýÌýÌý Skin and soft tissue - malignant | ÌýX |
| ÌýÌýÌý Skin and soft tissue - non malignant (benign) | ÌýX |
| ÌýÌýÌý Skin graft | ÌýX |
| ÌýÌýÌý Small bowel obstruction | ÌýX |
| Ìý Ìý Supervise Medical Students and more junior residents | ÌýX |
| ÌýÌýÌý Suture simple wound or lacerations | ÌýX |
| ÌýÌýÌý Swan Ganz catheterization | ÌýX |
| ÌýÌýÌý Thoracentesis | ÌýX |
| ÌýÌýÌý Thoracic or abdominal flaps - thoracic abdominal defects (debridements) | X |
| ÌýÌýÌý Triage adult and pediatric trauma patients | ÌýX |
| ÌýÌýÌý Tube thoracostomy | ÌýX |
| ÌýÌýÌý Upper extremity fingertip injuries and reconstruction | ÌýX |
| ÌýÌýÌý Upper extremity skin repair | ÌýX |
| Ìý Ìý Venipuncture | ÌýX |
| Ìý Ìý Wound debridement | ÌýX |
| Ìý Ìý Write admission, treatment orders, and notes in the Electronic Health Record | ÌýX |
| Ìý | Ìý |
| ÌýCardiopulmonary Resuscitation and Airway Maintenance | 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 |
| Ìý ÌýAdult Resuscitation | ÌýX |
| Ìý | Ìý |
| Specific Plastic Surgery skills and procedures that can be performed with Indirect Supervision with Direct Supervision available either immediately or via phone or other electronic media: | Ìý |
| Section:Ìý Head & Neck Congenital | Ìý |
| Primary cleft lip repair, unilateral | ÌýX |
| Primary cleft lip repair, bilateral | ÌýX |
| Secondary cleft lip repair | ÌýX |
| Lip adhesions | ÌýX |
| Cleft palate repair primary | ÌýX |
| Cleft palate repair secondary, including fist. | ÌýX |
| Pharyngeal flap or plasty | ÌýX |
| Cleft lip nasal deformity | ÌýX |
| Mandib osteo with bone graft | ÌýX |
| Mandib osteo without bone graft | ÌýX |
| Maxillary osteo with bone graft | ÌýX |
| Maxillary osteo without bone graft | ÌýX |
| Major craniofacial reconstruction | ÌýX |
| Contouring cranial or facial bones | ÌýX |
| Other major congenital:Ìý Cranial/maxilofacial surgery | ÌýX |
| Otoplasty | ÌýX |
| Microtia reconstruction w/cart graft (ear only) | ÌýX |
| Microtia reconstruction w/fasc flap/cart (ear) | ÌýX |
| Microtia rev soft tiss only (ear only) | ÌýX |
| Other major microtia rep, ear | ÌýX |
| Eyelid reconstruction | ÌýX |
| Neck cysts & sinuses | ÌýX |
| Neck angiomas & hygroma | ÌýX |
| Other major neck procedures, congenital | ÌýX |
| ÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌý | Ìý |
| Section:Ìý Head & Neck Neoplasm | Ìý |
| Lip extirpation (hnn) | ÌýX |
| Oropharyng extirp for neck (see node diss) | ÌýX |
| Salivary (etirp hnn) | ÌýX |
| Antral/orbital neo (hnn) | ÌýX |
| Other major extirp (hnn) | ÌýX |
| Graft, skin (recon hnn) | ÌýX |
| Graft, bone (recon hnn) | ÌýX |
| Graft, other, including nerve (recon hnn) | ÌýX |
| Flap, skin (recon hnn) | ÌýX |
| Free tissue transfer (rcon hnn) | ÌýX |
| Tissue expander (recon hnn) | ÌýX |
| Other major recon (hnn) | ÌýX |
| Cerv node dissc (indep or combined) | ÌýX |
| Endoscopy (hnn) | ÌýX |
| Incision and Drainage (recon hnn) | ÌýX |
| Tracheostomy (recon hnn) | ÌýX |
| Other major head and neck procedures | ÌýX |
| ÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌý | Ìý |
| Section:Ìý Head and Neck Trauma | Ìý |
| Lacerations, immediate repair | ÌýX |
| Eyelid lacerations, immediate repair | ÌýX |
| Facial nerve lacerations, immediate repair | ÌýX |
| Debridement (hnt) | ÌýX |
| Canthal procedure | ÌýX |
| Other major immediate soft tissue repair | ÌýX |
| Scar revision including dermabrasion & Z-plast | ÌýX |
| Graft, skin | ÌýX |
| Graft, other, including nerve | ÌýX |
| Flap, skin exc., Z-plasty, etc. | ÌýX |
| Flap, mult tissue and/or flap muscle | ÌýX |
| Free tissue transfer | ÌýX |
| Insertion of tissue expander hnt | ÌýX |
| Incision and drainage | ÌýX |
| Tracheostomy | ÌýX |
| Other major soft tissue revis/recon | ÌýX |
| Nasal fx, closed | ÌýX |
| Nasal fx, open | ÌýX |
| Bone graft for repair fx | ÌýX |
| Alloplastic implant for fx | ÌýX |
| Other major facial fx procedures | ÌýX |
| Mandibular osteotomy w/bone graft | ÌýX |
| Mandibuar osteotomy without bone graft | ÌýX |
| Maxillary osteomy with bone graft | ÌýX |
| Maxillary osteomy without bone graft | ÌýX |
| Major craniofacial reconstruction | ÌýX |
| Onlay bone grafts | ÌýX |
| Alloplastic implant | ÌýX |
| Removal of implant or fixation | ÌýX |
| Dacryocystorhinostomy | ÌýX |
| Sinus obliteration | ÌýX |
| Other late major facial reconst | ÌýX |
| ÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌý | Ìý |
| Section:Ìý Breast | Ìý |
| Reduction mammoplasty | ÌýX |
| Augmentation mammoplasty | ÌýX |
| Mastopexy | ÌýX |
| Prophylactic mastectomy | ÌýX |
| Reconstruction (immediate/del) with implant | ÌýX |
| Reconstruction (immediate/del) with tissue expander | ÌýX |
| Reconstruction (immediate/del) with Myocutan Flap (TRA) | ÌýX |
| Reconstruction (immediate/del) with free tissue transfer | ÌýX |
| Reconstruction (immediate/del) 2 procedures | ÌýX |
| Reconstruction (immediate/del) nipple reconstruction | ÌýX |
| Reconstruction (immediate/del) nipple reconstruction | ÌýX |
| Incision/excision | ÌýX |
| Implant removal | ÌýX |
| Capsulotomy | ÌýX |
| Other major breast procedures | ÌýX |
| ÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌý | Ìý |
| Section:Ìý Hand & Upper Extremity | Ìý |
| Graft, skin for skin repair | ÌýX |
| Flap, skin for skin repair | ÌýX |
| Flap, multi tissue and/or flap, muscle | ÌýX |
| Free tissue transfer for skin repair | ÌýX |
| Insertion tissue expander HUE | ÌýX |
| Fingertip injuries | ÌýX |
| Flexor, graft tendon repair | ÌýX |
| Implant of rod for tendon repair | ÌýX |
| Extensor tendon repair | ÌýX |
| Tenolysis' desis tendon balancing | ÌýX |
| Tendon transfer / balancing | ÌýX |
| Major nerve repair | ÌýX |
| Digital nerve repair | ÌýX |
| Graft for nerve repair | ÌýX |
| Neurolysis | ÌýX |
| Surgical TX of neuroma | ÌýX |
| Decompression for nerve repair | ÌýX |
| Phalang / metacarp fx with fix | ÌýX |
| Phalang / metacarp fx without fix | ÌýX |
| Wrist / radius / ulna fx, with int fix | ÌýX |
| Wrist / radius / ulna fx, without int fix | ÌýX |
| Collateral ligament | ÌýX |
| Grafts, bone | ÌýX |
| Release contr joints / tendon sh | ÌýX |
| Synovectomy for joint / tendon sh | ÌýX |
| Arthropl with imp joint / tendon sh | ÌýX |
| Arthropl without impl joint / tendon sh | ÌýX |
| Arthrod for joints / tendon sh | ÌýX |
| Trigger finger release | ÌýX |
| Pollicization or ray transfer | ÌýX |
| Foot to hand transfer | ÌýX |
| Benign tumors' including cyst | ÌýX |
| Malignant tumors | ÌýX |
| Dupuytren | ÌýX |
| Replantation / revasc | ÌýX |
| Amputations | ÌýX |
| Fasciotomy, deep I & D | ÌýX |
| Congenital syndactyly | ÌýX |
| Other major congenital hand / UE | ÌýX |
| Incision and drainage | ÌýX |
| Foreign body, implant removal | ÌýX |
| Debridement | ÌýX |
| Arthroscopy | ÌýX |
| Other major hand UE proced | ÌýX |
| ÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌý | Ìý |
| Section:Ìý Thoracic & Genital Urinary | Ìý |
| Repair traumatic deformity (genital male) | ÌýX |
| Hypospadias (male) | ÌýX |
| Penile reconstruction (male) | ÌýX |
| Other major procedures (male) | ÌýX |
| Vaginal reconstruction with graft, skin (female) | ÌýX |
| Vaginal reconstruction with flap (female) | ÌýX |
| Other major procedures (female) | ÌýX |
| Pressure sores, debridement | ÌýX |
| Pressure sores, repair direct | ÌýX |
| Pressure sores, graft, skin | ÌýX |
| Pressure sores, flap, skin | ÌýX |
| Pressure sores, flap, multi tissue or muscle | ÌýX |
| Pressure sores, other major procedures | ÌýX |
| Thoracic abd, debridement | ÌýX |
| Thoracic abd, repair direct | ÌýX |
| Thoracic abd, repair with graft, skin | ÌýX |
| Thoracic abd, repair with flap, skin | ÌýX |
| Thoracic abd, repair with flap, mult tissue, muscle | ÌýX |
| Thoracic abd, other major procedures | ÌýX |
| ÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌý | Ìý |
| Section:Ìý Lower Extremity | Ìý |
| Amputation:Ìý ak r bk LE | ÌýX |
| Amputation:Ìý foot or toes | ÌýX |
| Excision or debridement LE | ÌýX |
| Repair with graft, skin | ÌýX |
| Repair with flap, skin | ÌýX |
| Repair with free tissue transfer | ÌýX |
| Congenital | ÌýX |
| Insertion tissue expander LEX | ÌýX |
| Other major procedures LE | ÌýX |
| ÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌý | Ìý |
| Section:Ìý Skin & Soft Tissue | Ìý |
| Extirp benign neo (excl h/n; h/u ext) | ÌýX |
| Extirp malignant neoplasm | ÌýX |
| Graft, skin reconstruction | ÌýX |
| Flap, skin reconstruction | ÌýX |
| Flap, multi tissue or muscle | ÌýX |
| Free tissue transfer | ÌýX |
| Insertion of tissue expander SST | ÌýX |
| Node dissections | ÌýX |
| Other major procedures SST | ÌýX |
| ÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌý | Ìý |
| Section:Ìý Burns | Ìý |
| Non operative burn management requiring fluid resus | ÌýX |
| Escharotomy and/or fasciotomy for burns | ÌýX |
| Excision with temporary coverage for burn | ÌýX |
| Excision with permanent coverage for burn | ÌýX |
| Debridement of burn | ÌýX |
| Graft, skin for burn | ÌýX |
| Flap, skin for burn | ÌýX |
| Free tissue transfer for burn | ÌýX |
| Insertion of tissue expander for burn | ÌýX |
| Other major procedurer for burn | ÌýX |
| ÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌý | Ìý |
| Section:Ìý Cosmetic | Ìý |
| Facelift | ÌýX |
| Browlift | ÌýX |
| Blepharoplasty | ÌýX |
| Chemical Peel | ÌýX |
| Dermabrasion | ÌýX |
| Rhinoplasty | ÌýX |
| Septoplasty and / or turbinectomy (cosmetic) | ÌýX |
| Mentoplasty with implant (cosmetic) | ÌýX |
| Mentoplasty without implant (cosmetic) | ÌýX |
| Malar augmentation (cosmetic) | ÌýX |
| Abdominoplasty and / or ventral hernia rep | ÌýX |
| Suction lipect / neck and face | ÌýX |
| Suction lipect / trunk and extremities | ÌýX |
| Soft tissue augmentation | ÌýX |
| Other major cosmetic procedures | ÌýX |
| ÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌýÌý | Ìý |
| Section:Ìý Harvest Free Flaps | Ìý |
| Harvesting Free Flap | ÌýX |
ÌýÌý
| AllÌýother procedures not listed should be performed under direct supervision of a faculty member.ÌýÌý |