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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, 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.

• 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

M. Saad Sikanderkhel, MD Ìý

PGY-6 (3rd Year) Fellow

Cardiovascular Disease

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. The 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)

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.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-4, PGY-5, and PGY-6 Cardiovascular Disease fellows can perform the procedures listed below with Indirect Supervision:

Ìý

PGY-4 Cardiovascular Disease Fellows can perform the procedures under Indirect Supervision or Oversight highlighted in blue.

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PGY-5 Cardiovasular Disease Fellows can perform the proceduresÌýunder Indirect Supervision or Oversight highlighted in orange.

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PGY-6 Cardiovascular Disease Fellows can perform the procedures under Indirect Supervision or Oversight highlighted in grey.

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ÌýDifferential Diagnosis, Treatment, and Patient Care SkillsÌý Ìý Ìý Ìý Ìý Ìý	PGY-4 (1st Year)Ìý	PGY-5 (2nd Year)Ìý	PGY-6 (3rd Year)Ìý
Ìý Ìý Perform all Internal Medicine related procedures since they are already eligible for the Internal Medicine Boards or are already ABIM certified.Ìý	X	X	X
Ìý Ìý Cardiology consults in the Emergency Department	ÌýX	X	X
Ìý Ìý Clinical and Social History	ÌýX	X	X
Ìý Ìý Communicate with patients and family members	ÌýX	X	X
Ìý Ìý EKG - perform and interpret	ÌýXÌý	X	X
Ìý Ìý Formulate diagnostic and treatment plans	ÌýX	X	X
Ìý Ìý Formulate pre-and post-operative treatment plans	ÌýX	X	X
Ìý Ìý Interpret basic x-rays and imaging studies	ÌýX	X	X
Ìý Ìý Interpret laboratory and diagnostic studies and tests	ÌýX	X	X
Ìý Ìý Mark diagnostic procedures on patients	ÌýX	X	X
Ìý Ìý Order radiologic, laboratory, or other diagnostic tests	ÌýX	X	X
Ìý Ìý Participate in and run a code (adults)	ÌýX	X	X
Ìý Ìý Request specialty and subspecialty consults	ÌýX	X	X
Ìý Ìý See patients and write patient orders	ÌýX	X	X
Ìý Ìý Supervise Medical Students, Residents, and more junior CardiovascularÌý Ìý ÌýFellows	ÌýX	X	X
Ìý ÌýÌýPhysical Examination	ÌýX	X	X
Ìý Ìý Write admission, treatment orders, and notes in the Electronic Health ÌýRecord	X	X	X
Ìý	Ìý	Ìý	Ìý
Cardiopulmonary Resuscitation and Airway Maintenance	Ìý	Ìý	ÌýÌý
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)Ìý	X	ÌýX	ÌýX
Adult Resuscitation	X	ÌýX	ÌýX
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
Ìý	Ìý	Ìý	Ìý
ÌýAdditional Specific Skills	Ìý	Ìý	Ìý
Ìý ÌýArterial puncture for Arterial Blood Gas Collection	X	X	ÌýX
Ìý ÌýInterpret Arterial Blood GasesÌý	X	ÌýX	ÌýX
Ìý ÌýArthrocentesis	X	XÌý	ÌýX
Ìý ÌýEchocardiography	X	X	X
Ìý ÌýExercise stress testing	X	X	X
Ìý ÌýInterpret ambulatory ECG recordings	X	X	X
Ìý ÌýInterpret electrocardiograms	X	X	X
Ìý ÌýInterpret nuclear cardiology studies	X	X	X
Ìý ÌýIntravenous catheterization	X	X	X
Ìý ÌýJoint Injection	X	X	X
Ìý ÌýLumbar Puncture	X	XÌý	X
Ìý ÌýThoracentesis	X	ÌýX	X
Ìý ÌýNasotracheal or orotracheal intubation	X	ÌýX	X
Ìý ÌýParacentesis	X	ÌýX	X
Ìý ÌýPerform bladder catheterrization	X	X	X
Ìý ÌýPulmonary catheter insertion	X	ÌýX	X
Ìý ÌýNG Tube Placement	X	ÌýX	X
Ìý ÌýParticipate in and supervise medical critical care patients	X	ÌýX	X
Ìý ÌýSplinting of Fractures & Dislocations	X	X	X
Ìý ÌýSupervise residents assigned to Cardiology	X	ÌýX	X
Ìý ÌýSupervise an Inpatient Cardiology Team	X	ÌýX	X
Ìý ÌýSutures	X	ÌýX	X
Ìý ÌýVenipuncture	X	ÌýX	X
Ìý ÌýEmergency Use of External Temporary Pacemakers	X	X	X
Ìý ÌýEmergency Treatment of 1st, 2nd, & 3rd Degree Burns	X	X	X
Ìý ÌýDiagnostic Peritoneal Lavage	X	X	X

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

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