Supervision and Procedures: Winter, Kelly Ann (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 Surgery. 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

Kelly Ann Winter, MD
Colon and Rectal Surgery Fellow
(PGY-6) (training dates:  08/01/2022 - 07/31/2023)

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)

Advanced Trauma Life Support (ATLS)

As a Colon and Rectal Surgery Fellow (usually a PGY-6 or PGY-7), the Fellow can perform any general surgery or vascular surgery skill or procedure deemed appropriate by his/her attending physician.  Fellows 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. 

Colon and Rectal Surgery Fellows are supervised either directly or indirectly with the supervising attending available to provide direct supervision.

Patient Care Skills or Procedures that do not require Direct or Indirect Supervision presence of a supervising physician (i.e., Oversight/General Supervision) are included in the list that follows. 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.

Patient Care Skills or Procedures that do not require the physical presence of a supervising physician are denoted in gray below:

 

Differential Diagnosis, Treatment, Patient Care Skills or Procedures	Fellow, Colon and Rectal Surgery (PGY-6 or PGY-7)
Amputation of extremity or digit	X
Appendectomy	X
Arterial Puncture	X
Breast Biopsy	X
Bronchoscopy	X
Central Venous Pressure Lines	X
Clinical and Social History	X
Communicate with patients and family members	X
Diverting Loop Colostomy	X
Drainage of Extremity	X
Drainage of Subcutaneous Abscess	X
EKG – perform and interpret	X
Epigastric, Umbilical, or Inguinal Hernia Excision	X
Formulate diagnostic and treatment plans	X
Formulate pre- and post-operative treatment plans	X
Initial Emergency Department Consults	X
Interpret basic x-rays and imaging studies	X
Interpret laboratory and diagnostic studies and tests (including Arterial Blood Gases)	X
Intravenous Line	X
Knot Tying	X
Mark surgical procedure sites on patients	X
Minor surgical procedures	X
Nasotracheal Intubation	X
Orotracheal Intubation	X
Order radiologic, laboratory, or other diagnostic tests	X
Participate in and supervise a patient code	X
Participate in and supervise trauma patient care	X
Perform general surgery procedures in the OR and assist Surgery Residents in the OR	X
Perforated Duodenal Ulcer	X
Peritoneal Lavage	X
Physical Examination	X
Portacath, venous access	X
Request specialty and subspecialty consults	X
Roll with patient to surgery when staff is notified the attending is “on the way to the OR”	X
See patients and write patient orders	X
Skin Graft	X
Small bowel obstruction	X
Supervise Medical Students and Residents	X
Suture Simple Wound/Laceration	X
Swan Ganz Catheterization	X
Thoracentesis	X
Triage adult and pediatric trauma patients	X
Tube Thorocostomy	X
Venipuncture	X
Wound Debridement	X
Write admission and treatment orders (and notes) in the Electric Health Record	X

X

Colon and Rectal Surgery Procedures that the Fellow will be able to perform with Direct Supervision or Indirect Supervision with Direct Supervision Available (Categories – Anorectal, Sigmoidoscopy, Fiberoptic Endoscopy; and Abdominal (Open and Laparasocopy):	Fellow, Colon  and Rectal Surgery  (PGY-6 or PGY-7)
I.  Anorectal	X
Excisional hemorrhoidectomy	X
Non-excisional hemorrhoidectomy (ligation, injection, cryotherapy, laser)	X
Excision thrombosed external hemorrhoid	X
Incision and drainage of abscess (other than Crohn's disease)	X
Anal fistulotomy or fistulectomy	X
Lateral internal sphincterotomy	X
Anoplasty for stricture or ectropion	X
Excision or exteriorization, pilonidal disease	X
Excision or exteriorization, hidradenitis suppurativa	X
Excision or fulguration, condylomata acuminata	X
Drainage or fistulotomy, perineal Crohn's disease	X
Exam under anesthesia, with or without biopsy	X
Transanal excision or fulguration of rectal tumor	X
Repair incontinent anal sphincter	X
Endorectal flap procedure for ano-vaginal or ano-perineal fistula	X
Repair rectovaginal fistula (other than with flap)	X
Perineal procedure for prolapse (resection, banding, etc.)	X
Removal of rectal foreign body	X
II. Sigmoidoscopy (Rigid)	X
Diagnostic/Screening	X
Therapeutic (Fulguration, Snare)	X
Detorsion of Volvulus	X
III. Fiberoptic Endoscopy	X
Flexible Sigmoidoscopy	X
Diagnostic Colonoscopy (Inflammatory Bowel Disease)	X
Diagnostic Colonoscopy (Other)	X
Colonoscopic Polypectomy	X
Decompression of Volvulus or Presdo-obstruction	X
Endoscopic Laser Therapy	X
Dilatation of Strictures	X
Other (summary)	X
IV. Abdominal	X
Partial colectomy for cancer (left, right, segmental)	X
Low anterior or abdominal transsacral resection for cancer	X
(A) Stapled anastamosis	X
(B) Sutured anastamosis	X
Abdominoperineal resection for cancer	X
Resection for Crohn's disease	X
(A) Small bowel	X
(B) Ileocolic resection	X
(C) Colectomy with proctectomy	X
(D) Colectomy without proctectomy	X
Resection for ulcerative colitis	X
(A) With proctectomy	X
(B) Without proctectomy	X
Resection for polyposis syndrome	X
Colectomy with proctectomy	X
Colectomy without proctectomy	X
Ileonanal procedure (ulcerative colitis or polyposis)	X
Coloanal procedure	X
Continent ileostomy	X
Resection for diverticular disease	X
Resection for other reasons	X
Small bowel resection	X
Creation, revision, relocation or closure of colostomy or cecostomy	X
Creation, revision, relocation or closure of ileostomy	X
Exploratory laparotomy with or without adhesiolysis	X
Resection or fixation of rectal prolapse or intussusception	X
Colotomy for polypectomy or foreign body	X
Volvulus (detorsion, fixation, or resection)	X
Drainage of intraabdominal abscess	X
Perineal proctectomy	X
Repair abdominal wall or incisional hernia	X
Resection presacral tumor or cyst	X
Hepatic resection - wedge - lobe	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
Adult Resuscitation	X

All other procedures not listed should be performed under direct supervision of a faculty member.