Supervision and Procedures: Sciarretta, Christopher (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 Emergency Medicine. 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

Christopher Sciarretta, MD

PGY-1 Resident

Emergency Medicine

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 entered training at the UTCOMC

Basic Life Support (BLS)

Advanced Cardiac Life Support (ACLS)

Pediatric Advanced Life Support (PALS)

Advanced Trauma Life Support (ATLS)

As a 1st Year Emergency Medicine Resident (PGY-1 level), the Resident can perform any Emergency 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.). 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. 

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

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

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

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

Differential Diagnosis, Treatment, and Patient Care Skills	PGY-1	PGY-2	PGY-3
Arterial puncture for Arterial Blood Gas Collection		X	X
Breast exam		X	X
Chief Resident and administrative and supervisory responsibilities			X
Clinical and Social History	X	X	X
Communicate with patients and family members	X	X	X
EKG - perform and interpret	X	X	X
Emergency treatment of 1st, 2nd, and 3rd degree burns		X	X
Formulate diagnostic and treatment plans	X	X	X
Formulate pre-and post-operative treatment plans	X	X	X
Incision and Drainage of an abscess		X	X
Initial Emergency Department consults	X	X	X
Interpret basic x-rays and imaging studies	X	X	X
Interpret laboratory and diagnostic studies and tests (including arterial blood gases)	X	X	X
Mark surgical procedures on patients	X	X	X
Order radiologic, laboratory, or other diagnostic tests	X	X	X
Participate in and supervise a code (adults)	X	X	X
Participate in and supervise a code (trauma)	X	X	X
Participate in and supervise a code (pediatrics)	X	X	X
Participate in the care of medical and surgical critical care patients		X	X
Pelvic Examination and Pap Smear		X	X
Physical Examination	X	X	X
Rectal Examination	X	X	X
Request specialty and subspecialty consults	X	X	X
Resuscitation (adult and pediatric patients)	X	X	X
See patients and write patient orders	X	X	X
Splinting and casting		X	X
Supervise Medical Students	X	X	X
Supervise more junior Residents		X	X
Suture simple wounds and lacerations	X	X	X
Venipuncture	X	X	X
Wound debridement	X	X	X
Write admission, treatment orders, and notes in the Electronic Health  Record	X	X	X
Cardiopulmonary Resuscitation
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)	X	X	X
Pediatric resuscitation	X	X	X

 

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