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.

Hicks, Brannon - 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.

May 26, 2022

Resident Supervision

Hicks, Brannon - PGY - 3

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