Supervision and Procedures: Miles, Victoria (MD)

Department of Surgery and Surgery Residency

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 in this department. 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. 

UTCOMC GME Policy 400 Resident Supervision
UTCOMC GME Policy 405 Patient Care Settings Resident Supervision Standards

Victoria Miles, MD
6th Year Chief Resident, Surgery (PGY-7)

The Surgery Residency is a six-year program.

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.  
• Supervising physicians may be more advanced residents or fellows. 

Certifications current when the Resident or Fellow entered training at the UTCOMC:

• Basic Life Support (BLS)
• Advanced Cardiac Life Support (ACLS)
• Advanced Trauma Life Support (ATLS)

The Resident can perform any general surgery 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, Trauma Surgery, Surgical Critical Care, PICU, etc.).  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.

1st Year (PGY-1) Surgery Residents are supervised either directly or indirectly with the supervising attending or more senior resident available to provide direct supervision. All surgery residents (PGY-1, 2, 3, 4, 5, and 6) can if marked with an 'X' perform the listed procedure under Indirect Supervision or Oversight. If no 'X' is present then performing the listed procedure would require Direct Supervision.

All other procedures not listed should be performed under direct supervision of a faculty member or more senior resident.
Differential Diagnosis, Treatment, and Patient Care Skills	1st Year PGY-1	2nd Year PGY-2	3rd Year PGY-3	4th Year PGY-4	5th Year PGY-5	6th Year Chief Resident PGY-6
Amputation or extremity or digit				X	X	X
Appendectomy				X	X	X
Arterial puncture	X	X	X	X	X	X
Breast biopsy		X	X	X	X	X
Bronchoscopy		X	X	X	X	X
Central venous pressure lines	X	X	X	X	X	X
Chief Resident and administrative supervision responsibilities						X
Clinical and Social History	X	X	X	X	X	X
Communicate with patients and family members	X	X	X	X	X	X
Diverting loop colostomy				X	X	X
Drainage of extremity				X	X	X
Drainage of subcutaneous abscess				X	X	X
EKG - perform and interpret	X	X	X	X	X	X
Emergency management of 1st, 2nd, and 3rd degree burns	X	X	X	X	X	X
Epigastric, Umbilical, or Inguinal Hernia				X	X	X
Excision of subcutaneous or dermal lesion		X	X	X	X	X
Formulate diagnostic and treatment plans	X	X	X	X	X	X
Formulate pre-and post-operative treatment plans	X	X	X	X	X	X
Initial Emergency Department consults	X	X	X	X	X	X
Interpret basic x-rays and imaging studies	X	X	X	X	X	X
Interpret laboratory and diagnostic studies and tests (including arterial blood gases)	X	X	X	X	X	X
Intravenous line	X	X	X	X	X	X
Knot tying	X	X	X	X	X	X
Mark surgical procedures on patients	X	X	X	X	X	X
Minor surgical procedures		X	X	X	X	X
Nasotracheal intubation	X	X	X	X	X	X
Order radiologic, laboratory, or other diagnostic tests	X	X	X	X	X	X
Orotracheal intubation	X	X	X	X	X	X
Participate in and supervise a code (adults), including trauma	X	X	X	X	X	X
Participate in a code (pediatrics), including trauma		X	X	X	X	X
Participate in and supervise a trauma code	X	X	X	X	X	X
Participate in the care of medical and surgical critical care patients	X	X	X	X	X	X
Perforated duodenal ulcer				X	X	X
Perform procedures in the OR with Direct Supervision present or immediately available	X	X	X	X	X	X
Perform procedures in the OR and assist junior Residents with procedures in the OR				X	X	X
Peripheral Intravenous Access		X	X	X	X	X
Peritoneal lavage	X	X	X	X	X	X
Physical Examination	X	X	X	X	X	X
Portacath, venous access				X	X	X
Request specialty and subspecialty consults	X	X	X	X	X	X
Roll with patient to surgery when staff is notified the attending is "on the way to the OR"	X	X	X	X	X	X
See patients and write patient orders	X	X	X	X	X	X
Skin graft				X	X	X
Small bowel obstruction				X	X	X
Supervise Medical Students	X	X	X	X	X	X
Supervise more junior Residents		X	X	X	X	X
Suture simple wounds and lacerations	X	X	X	X	X	X
Swan Ganz catheterization		X	X	X	X	X
Thoracentesis	X	X	X	X	X	X
Triage adult and pediatric trauma patients	X	X	X	X	X	X
Tube thoracostomy	X	X	X	X	X	X
Venipuncture	X	X	X	X	X	X
Wound debridement	X	X	X	X	X	X
Write admission, treatment orders, and notes in the Electronic Health Record	X	X	X	X	X	X
Cardiopulmonary Resuscitation and Airway Maintenance
Perform Basic CPR and related procedures (airway management, emergency drug therapy, rhythm strip interpretation, intravenous catheterization, closed chest massage, electrocardioversion and defibrillation, and venous cut-down)	X	X	X	X	X	X
Adult Resuscitation	X	X	X	X	X	X