Supervision and Procedures: Threlkeld, Amanda (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 Urology. 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.听

Amanda Carter Threlkeld, MD

PGY-5 Chief Resident

Urology

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. 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)

Advanced Trauma Life Support (ATLS)

As a PGY-5 Chief Level Urology Resident , the Resident听 is typically provided direct supervision by more senior residents or faculty unless performing skills and procedures listed below under Indirect or General Supervision -- with an attending physician or more senior resident immediately available.听 Residents are expected to progressively assume more responsibility throughout each level of training and demonstrate competence in skills/procedures requiring less Direct Supervision. 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. 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

The Urology Residency is a five-year program.
听
PGY-1, PGY-2, PGY-3, PGY-4, and PGY-5 Urology Residents can perform the procedures listed below with Indirect Supervision (with Direct Supervision immediately available):

PGY-1 and PGY-2 Urology 听Residents can perform the procedures listed below under Indirect Supervision or Oversight highlighted in red.

PGY-3 Urology Residents can perform the procedures listed below under Indirect Supervision or Oversight highlighted in green.

PGY-4 Urology Residents can perform the procedures listed below under Indirect Supervision or Oversight highlighted in blue.

PGY-5 Urology Chief Residents can perform the procedures listed below under Indirect Supervision or Oversight highlighted in orange.

Differential Diagnosis, Treatment, Patient Care, and Procedural听听Skills	1st and 2nd Year (PGY-1 and听 PGY-2)	3rd听 Year (PGY-3)听	4th Year (PGY-4)	5th Year Chief Resident (PGY-5)
听听听 Arterial Puncture	X	X	X	X
听听听 At-Home Call	X	X	X	X
听听听 Bedside cystoscopy as a non-operative procedure to assist with difficult Foley catheter placement and/or urethral dilation of urethral stricture disease	X	X	X	X
听听听 Bimanual and speculum pelvic exam	X	X	X	X
听听听 Biopsy (tissue)	X	X	X	X
听听听 Bladder catheterization (transurethrally and subrapubic)	X	X	X	X
听听听 Central venous pressue line	X	X	X	X
听听听 Chief Resident administrative and supervisory responsibilities	听	听	听	X
听听听 Clinic activities (urology - both oncology and non-oncology).听 Note:听 Pediatric urology clinic activities require Direct Supervision.	听	X	X	X
听听 Clinical and Social History	听X	听X	听X	听X
听听听 Communicate with patients and family members	X	X	X	X
听听 Coordinate treatment with other disciplines	听X	听X	听X听	听X
听听 EKG - perform and interpret	听X	听X	听X	听X
听听听 Excision of subcutaneous or dermal lesion	X	X	X	X
听听听 Floor activities (urology - both oncology and non-oncology).听 Note:听 Pediatric urology floor activities require Direct Supervision.	X	X	X	X
听听听 Foley catheter placement or removal	X	X	X	X
听听 Formulate diagnostic and treatment plans	听X	听X	听X	听X
听听 Formulate pre-and post-operative treatment plans	听X	听X	听X听	听X
听听 Initial Emergency Department consults	听X	听X	X	听X
听听 Interpret basic x-rays and imaging studies	听X	听X	听X	听X
听听听 Intrepret all pre-op, intra-op, and post-op urologic imaging studies including KUB, IVP, bladder ultrasound, renal and scrotal ultrasound, cystogram, retrograde urethrogram, CT scan, and MRI (including trauma situations)	听	X	X	X
听听 Interpret laboratory and diagnostic studies and tests (including arterial blood gases)	听X	听X	听X	听X
听听听 Intravenous catheterization	X	X	X	X
听听听 Intravenous line	X	X	X	X
听听听 Knot tying	X	X	X	X
听听 Mark surgical procedures on patients	听X	听X	听X	听X
听听听 Minor urologic surgical procedures (except Pediatric urology procedures which always require Direct Supervision)	听	X	X	X
听听听 Nasotracheal intubation	X	X	X	X
听听听 Nephrostogram	X	X	X	X
听听 Order radiologic, laboratory, or other diagnostic tests	听X	听X	听X	听X
听听听 Orotracheal intubation	X	X	X	X
听听 Participate in and supervise a patient code	听X	听X	听X	听X
听听 Participate in and supervise trauma patient care	X	X	听X	X听
听听 Perform procedures in the OR with Indirect Supervision or Direct Supervision immediately available	听	听	听X	听X
听听 Peritoneal lavage	听X	听X	听X	听X
听听 Physical Examination	X	X	听X	听X
听听 Request specialty and subspecialty consults	听X	听X	听X	听X
听听 Retrograde Pyelogram	听X	听X	听X	听X
听听听 Roll with patient to surgery when staff is notified the attending is "on the way to the OR"	X	X	X	X
听听 See patients and write patient orders	听X	听X	听X	听X
听听听 Stent placement	听	X	X	X
听听 Supervise Medical Students	听X	听X	听X	听X
听听 Supervision more junior residents	X	X	听X	听X
听听听 Suprapubic tube placement	X	X	X	X
听听听 Suture simple wounds and lacerations	X	X	X	X
听听听 Swan Ganz catheterization	X	X	X	X
听听听 Thoracentesis	X	X	X	X
听听听 Transrectal ultrasound guided prostate biopsies with or without block (needle biopsy)	X	X	X	X
听听听 Triage adult and pediatric trauma patients	X	X	X	X
听听听 Tube thorocostomy	X	X	X	X
听听听 Urodynamics	X	X	X	X
听听 Venipuncture	X	X	听X	听X
听听 Wound care and debridement, including incision and drainage of scrotal wall abscesses or penile abscess and debridement	X	X	X	X
Write admission, treatment orders, and notes in the Electronic Health Record	X	X	X	X
听	听	听	听	听
听Cardiopulmonary Resuscitation and Airway Maintenance	听	听听	听	听
听听Perform Basic CPR and related procedures (airway management, emergency drug therapy, rhythm strip interpretation, intravenous catheterization,听 closed chest massage, electrocardioversion & defibrillation, and venous cut-down)听	听X	听X	听X	听X
听听Adult Resuscitation	X	X	听X	听X

听听听听听听听听听听听听听听听听听听

All听other procedures not listed should be performed under direct supervision of a faculty member or more senior resident.听听

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