Resident Supervision
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 Health Science Center. 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 is required in the OR/Delivery Room or for non-routine invasive procedures like Cardiac Cath, Endoscopy, and Interventional Radiology. The standards for resident supervision in patient care settings are described in GME Policy #410.
Pollard, Lucy - PGY - 3
Department of Surgery-Nashville
Resident Supervision
All General Surgery residents are supervised either directly or indirectly with the supervisor available to provide direct supervision.
General Surgery trainees can perform the procedures listed below with either direct, indirect or a combination of both direct and indirect supervision:
General Surgery Residency Program |
PGY1 |
PGY2 |
PGY3 |
PGY4 |
PGY5 |
Clinical Activity: |
|
|
|
|
|
Assessment Abdominal Pain |
Direct and Indirect |
Direct and Indirect |
Indirect |
Indirect |
Indirect |
Assessment of Intra-abdominal Abscess |
Direct and Indirect |
Direct and Indirect |
Direct and Indirect |
Direct and Indirect |
Indirect |
Performing Exploratory Laparotomy |
Direct |
Direct |
Direct |
Indirect |
Indirect |
Performing Laparoscopic Exploratory Laparotomy |
Direct |
Direct |
Direct |
Indirect |
Indirect |
Open Peritoneal Dialysis Catheter Insertion |
Direct |
Direct |
Direct |
Indirect |
Indirect |
Drainage Intra-abdominal Abscess |
|
|
Direct |
Direct |
Indirect |
Assess and Diagnose Femoral, Inguinal, Ventral and Miscellaneous Abdominal Hernias |
Direct and Indirect |
Direct and Indirect |
Direct and Indirect |
Indirect |
Indirect |
Able to competently choose material to use for repair of hernias, and management |
Direct and Indirect |
Direct and Indirect |
Direct and Indirect |
Indirect |
Indirect |
Perform repair open of inguinal, femoral hernia |
Direct |
Direct |
Indirect |
Indirect |
Indirect |
Perform repair laparoscopic of inguinal, femoral hernia |
|
Direct |
Direct |
Indirect |
Indirect |
Perform open ventral hernia repair |
Direct |
Direct |
Direct |
Direct |
Indirect |
Perform laparoscopic ventral hernia repair |
Direct |
Direct |
Direct |
Direct |
Indirect |
Perform abdominal wall reconstruction, component separation |
|
|
|
Direct |
Direct |
Perform cholecystectomy with and without cholangiography OPEN and laparoscopic |
Direct |
Direct |
Direct |
Direct |
Indirect |
Perform choledochoenteric anastomosis |
|
|
Direct |
Direct |
Direct |
Perform choledochoscopy |
|
|
Direct |
Direct |
Direct |
Perform common bile duct exploration – open |
|
|
Direct |
Direct |
Direct |
Perform operation for gall bladder cancer incidentally identified |
|
|
|
Direct |
Direct |
Perform hepatic biopsy – OPEN and laparoscopic |
|
Direct |
Direct |
Direct |
Direct |
Perform hepatic abscess drainage |
|
|
|
Direct |
Direct |
Perform hepatic segmentectomy, lobectomy |
|
|
|
Direct |
Direct |
Perform pancreatectomy – distal |
|
|
Direct |
Direct |
Direct |
Perform pancreatic debridement |
|
|
Direct |
Direct |
Direct |
Perform pseudocyst drainage |
|
Direct |
Direct |
Direct |
Direct |
Perform pancreaticojejunostomy |
|
|
Direct |
Direct |
Direct |
Perform splenectomy OPEN and laparoscopic |
|
Direct |
Direct |
Direct |
Direct |
Perform splenectomy vs splenorrhaphy – partial |
|
Direct |
Direct |
Direct |
Indirect |
Perform antireflux procedures open and laparoscopic |
|
|
Direct |
Direct |
Direct |
Perform/seen cricopharyngeal myotomy with Zenker’s diverticulum (excision), esophageal perforation – repair, paraesophageal hernia repair open and laparoscopic |
|
|
Direct |
Direct |
Direct |
Perform/seen gastrostomy – open and percutaneous (endoscopic assist), repair of ducdenal perforation, gastrectomy (partial, total), vagotomy and drainage procedures, surgery for morbid obesity |
|
Direct |
Direct |
Direct |
Direct |
Perform adhesiolysis (open and laparoscopic), feeding jejunostomy (laparoscopic and open), ileostomy, ileostomy closure, small intestinal resection |
|
Direct |
Direct |
Direct |
Direct |
Perform superior mesenteric artery embolectomy/thrombectomy, strictureoplasty for Crohn’s disease |
|
|
Direct |
Direct |
Direct |
Perform appendectomy, open and laparoscopic, colectomy – partial laparoscopic and open, colostomy, colostomy closure, colectomy total/subtotal |
|
Direct |
Direct |
Direct |
Direct |
Perform and fistulotomy, seton placement, anal sphincterotomy, anorectal abscess drainage, banding for internal hemorrhoids, hemorrhoidectomy, perianal condyloma excision, excision anal cancer and repair of rectal prolapse |
Direct |
Direct |
Direct |
Direct |
Direct |
Perform bronchoalveolar lavage, bronchoscopy, colonoscopy, esophagogastroduodenoscopy, laryngoscopy, proctoscopy |
Direct |
Direct |
Direct |
Direct |
Direct |
Perform axillary lymphadenectomy, axillary sentinel lymph node biopsy, breast biopsy with or without Needle localization, breast cyst aspiration, duct excision, mastectomy (radical, modified radical, partial, simple), image guided biopsy |
Direct |
Direct |
Direct |
Indirect |
Indirect |
Perform parathyroidectomy, thyroidectomy (partial or total) |
Direct |
Direct |
Direct |
Indirect |
Indirect |
Perform melanoma wide local excision, pilonidal cystectomy, sentinel lymph node biopsy for melanoma, skin/soft tissue lesions (incisional and excisional biopsy), soft tissue debridements, drainage |
Direct |
Direct |
Direct |
Direct |
Direct |
Perform airway management, ventilator management, arterial catheter placement, compartment pressure measurements, defibrillation, cardioversion, intubation, enteral feeding tube insertion/placement, thoracentesis, ultrasound use for intravascular access, urinary catherization |
Direct |
Direct |
Direct |
Indirect |
Indirect |
Perform focused abdominal sonography for trauma, gastrointestinal tract injury – operative choices, temporary closure of abdomen, wounds complex, abdominal aortic injury repair, vena caval injury repair, cardiac injury repair, duodenal trauma – management, esophageal injury – operative, exploratory laparoscopy and laparotomy, fasciotomy for injury, hepatic injury – packing and repair, neck exploration for injury, pancreatic injury – operative, renal injury – repair/resection, splenectomy/splenorrhaphy, thoracoscopy for management of hemothorax |
Direct |
Direct |
Direct |
Indirect |
Indirect |
Perform amputations lower extremities, carotid endarterectomy, embolectomy/thrombecomy, endovascular AAA repair, open repair, aortobifemoral bypass grafting, extraanatomic bypass, femoral to popliteal bypass and infrapopliteal bypass, vena caval filter insertion, arteriovenous graft fistula, percutaneous vascular access, venous access devices insertion |
Direct |
Direct |
Direct |
Indirect |
Indirect |
Perform chest tube insertion and management, partial pulmonary resection, pericardial window |
Direct |
Direct |
Direct |
Direct |
Indirect |
Perform inguinal hernia repair, umbilical hernia repair intussusception operation, malrotation, Meckel’s diverticulum, pyloromyotomy |
|
Direct |
Direct |
Direct |
Indirect |
NOTE: Lists of approved clinical activities should be maintained for each resident so they can be made available for review by all patient care personnel.
Definitions:
Resident Level – at which an activity can be performed (your RRC may define a list of achieved competencies under which PGY–1 residents progress to be indirectly supervised, with direct supervision available).
Method of Instruction – e.g., Direct Clinical Instruction, Course (ACLS)
Level of Instructor and Direct Supervisor– PGY year or Attending Faculty (your RC may specify who is qualified to supervise, in addition to attendings).
Supervision Level – Direct (physical presence of supervisor), Indirect (w/ direct immediately available or direct available; e.g., home call backup).
Certification Requirements to Perform Activity without Direct Supervision – e.g., PGY year; a given # of successfully performed, observed procedures; a total # of procedures performed; general impression of competence/professionalism perceived by faculty.
Method to Confirm Certification of Resident to Perform Activity without Direct Supervision – e.g., Program Certification, Direct Observation, PGY year.