Supervision and Procedures: Vukmer, Natalie (DO)

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 OB/GYN. 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

Natalie Vukmer, DO       

PGY-3 Resident

Obstetrics and Gynecology

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)

Neonatal Resuscitation Program (NRP)

As a 3rd Year Obstetrics and Gynecology Resident (PGY-3 level), the Resident can perform any obstetrical or gynecological 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.

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 Obstetrics and Gynecology Residents are supervised either directly or indirectly with the supervising attending or more senior resident available to provide direct supervision. PGY-1 Obstetrics and Gynecology Residents can perform the skills or procedures listed below under Indirect Supervision or Oversight highlighted in yellow.

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

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

PGY-4 Obstetrics and Gynecology Chief Residents can perform the procedures listed below under Indirect Supervision or Oversight highlighted in blue.

The physical presence of a supervising physician is not required when performing the skills and procedures listed below (by level):

 

Differential Diagnosis, Treatment, and Patient Care Skills	PGY-1	PGY-2	PGY-3	PGY-4 Chief Resident
Active rupture of membranes	X	X	X	X
Amniocentesis				X
Antepartum management of obstetrical patients			X	X
Antepartum management of high-risk obstetrical patients			X	X
Application of internal fetal scalp monitor			X	X
Bimanual and speculum pelvic exam	X	X	X	X
Bladder catheterization			X	X
C-Section delivery			X	X
Cervical biopsy			X	X
Chief Resident supervisory and administrative responsibilities				X
Circumcision		X	X	X
Clinical and Social History	X	X	X	X
Communicate with patients and family members	X	X	X	X
Culdocentesis			X	X
EKG - perform and interpret	X	X	X	X
Endometrial biospy			X	X
Formulate diagnostic and treatment plans	X	X	X	X
Formulate pre-and post-operative treatment plans	X	X	X	X
Incision & Drainage of Bartholin / Vulvular abscess			X	X
Initial Emergency Department consults	X	X	X	X
Initial evaluation / triage of Labor & Delivery patients	X	X	X	X
Initial evaluation of fetal heart tracings	X	X	X	X
Initial evaluation of post-operative complications		X	X	X
Initial gynecology consult	X	X	X	X
Initial obstetrical consult	X	X	X	X
Insertion of central venous pressure catheter			X	X
Insertion of internal uterine pressure catheter			X	X
Interpret basic x-rays and imaging studies	X	X	X	X
Interpret fetal monitor strip		X	X	X
Interpret laboratory and diagnostic studies and tests (including arterial blood gases)	X	X	X	X
Intravenous line	X	X	X	X
Laparoscopy			X	X
Mark surgical procedures on patients	X	X	X	X
Normal vaginal delivery		X	X	X
Order radiologic, laboratory, or other diagnostic tests	X	X	X	X
Pap smear	X	X	X	X
Participate in and supervise a code (adults)	X	X	X	X
Participate in neonatal resuscitation		X	X	X
Paracentesis			X	X
Perform as primary surgeon				X
Perform lesser major gynecologic procedures			X	X
Perform minor gynecologic procedures			X	X
Perform ultrasounds (fetal and gynecologic)				X
Peripheral Intravenous Access		X	X	X
Physical Examination	X	X	X	X
Placement of cervical ripening agent	X	X	X	X
Request specialty and subspecialty consults	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
See patients and write patient orders	X	X	X	X
Supervise Medical Students	X	X	X	X
Supervise minor surgeries and C-Sections			X	X
Supervise more junior Residents		X	X	X
Suture repair of vulvar / vaginal lacerations	X	X	X	X
Suture simple wounds and other lacerations	X	X	X	X
Thoracentesis			X	X
Venipuncture	X	X	X	X
Vulvar biopsy	X	X	X	X
Wet prep analysis	X	X	X	X
Wound debridement	X	X	X	X
Write admission, treatment orders, and notes in the Electronic Health Record	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 & defibrillation, and venous cut-down)	X	X	X	X
Adult Resuscitation	X	X	X	X
Neonatal Resuscitation	X	X	X	X

                                  

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