UTHSC College of Medicine 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 on the GME web site: http://uthsc.edu/GME/pdf/supervision2011.pdf.

David Daniels

Daniels, David - PGY - 7

Department of Neurosurgery-Pediatric
Resident Supervision


Procedural Competence -Neurosurgery Pediatric Program

Progression to the next level assumes that resident can perform all tasks from preceding level.

Invasive procedures and operations, even though they may be performed independently, presume discussion with the attending physician beforehand, or, in the case of emergency, life-saving procedures, immediately afterwards as soon as the patient has been stabilized and communication is feasible.

PGY-2

All residents at this level may perform independently:

H&Ps and consultations
Write orders, including admission, pre-op, post-op, discharge
Obtain consent for surgery
Discharge day management
Interpretation of Laboratory Studies
Interpretation of Basic Radiographic Studies
Venipuncture
Arterial Puncture
Venous Cut-Down
Intubation (Nasotracheal or Orotracheal)
Basic Cardiopulmonary Resuscitation
Emergency Drug Treatments

Position patients for some surgical procedures (competence with more complicated positioning expected to be graduated with experience in subsequent years)
Application of Mayfield Headrest
Close wound/incision on uncomplicated cranial, spinal, and peripheral nerve operations
Lumbar puncture
Myelographic dye injection (via LP)

Some residents at this level may perform independently:

Place central venous line/Swann-Ganz catheter
Place intraparenchymal intracranial pressure monitor
Place ventriculostomy
Place lumbar drain
Begin opening for uncomplicated cases
Supervise Code Blue Cases/Perform ACLS


PGY-3

All residents at this level may perform independently:

Place central venous line/Swann-Ganz catheter
Place intraparenchymal intracranial pressure monitor
Place ventriculostomy
Place lumbar drain
Begin opening for uncomplicated cases, e.g.,

o Lumbar discectomy
o Burr holes for evacuation of chronic SDH

Some simple operative cases, e.g.,

o Excision of Lipoma or Skin Lesion
o Tagging Nerves in Acute Penetrating Trauma

Spine Clearance
Placement of Halo Vest

Some residents at this level may perform independently:

Supervise Code Blue Cases/Perform ACLS
Simple operative cases, e.g.,

o Carpal tunnel release
o Open depressed skull fracture (without underlying hematoma)
o Burr holes for evacuation of chronic SDH

PGY-4

All residents at this level may perform independently:

Some simple operative cases, e.g.,

o Carpal Tunnel Release
o Open Depressed Skull Fracture (without underlying hematoma)
o Burr Holes for Evacuation of Chronic SDH

Some residents at this level may perform independently:

Application of Gardner-Wells tongs/Closed Cervical Spinal Column Reduction
Some operations, e.g.,

o Lumbar Discectomy (without fusion)
o Cervical Discectomy (without fusion)
o Resection simple convexity meningioma
o Shunt Revision
o Stimulator or Pump Removal
o Placement of Stereotactic Biopsy Frame
o Uncomplicated cranioplasty


PGY-5

All residents at this level may perform independently:

Application of Gardner-Wells tongs/Closed Cervical Spinal Column Reduction
Some operations, e.g.,

o Lumbar Discectomy (without fusion)
o Cervical Discectomy (without fusion)
o Resection simple convexity meningioma
o Shunt Revision
o Stimulator or Pump Removal
o Placement of Stereotactic Biopsy Frame
o Uncomplicated cranioplasty

Some residents at this level may perform independently:

Some more complicated operative procedures, e.g.,

o Craniotomy for evacuation of subdural hematoma
o Craniotomy for evacuation of epidural hematoma
o Craniotomy for evacuation of intraparenchymal hematoma
o Craniotomy/Exenteration of Frontal Sinus
o Ventriculoperitoneal Shunt Placement
o Uncomplicated spinal fusion/instrumentation

PGY-6

All residents at this level may perform independently:

Some more complicated operative procedures, e.g.,

o Craniotomy for evacuation of subdural hematoma
o Craniotomy for evacuation of epidural hematoma
o Craniotomy for evacuation of intraparenchymal hematoma
o Craniotomy/Exenteration of Frontal Sinus
o Ventriculoperitoneal Shunt Placement
o Uncomplicated spinal fusion/instrumentation

Some residents at this level may perform independently:

More complicated operative procedures, e.g.,

o Complex spinal instrumentation
o Craniotomy for Brain Tumor Resection