Supervision and Procedures: Sapp, Alex (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

Alex Sapp, MD 
1st Year Fellow  (PGY-6)
Vascular Surgery

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 2nd year Vascular Surgery Fellow (usually a PGY-7 or PGY-8), 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. 

1st and 2nd Year Vascular Surgery Fellows are supervised either directly or indirectly with the supervising attending available to provide direct supervision.

1st Year Vascular Surgery Fellows (typically PGY-6 or PGY-7 level) can perform the procedures listed below under Indirect Supervision or Oversight -- highlighted in Gray.

2n Year Vascular Surgery Fellows (typically PGY-7 or PGY-8 level) can perform the procedures listed below under Indirect Supervision or Oversight -- highlighted in Cyan.

Patient  Care Skills or Procedures that do not require the physical presence of a supervising physician (Indirect or General Supervision):

Differential Diagnosis, Treatment, Patient Care Skills  or Procedures	1st Yr Fellow (PGY-6 or PGY-7)	2nd Yr Fellow (PGY-7 or PGY-8)
Amputation of extremity or digit	X	X
Appendectomy	X	X
Arterial Puncture	X	X
Bladder Catheterization	X	X
Breast Biopsy	X	X
Bronchoscopy	X	X
Central Venous Pressure Lines	X	X
Clinical and Social History	X	X
Communicate with patients and family members	X	X
Diverting Loop Colostomy	X	X
Drainage of Extremity	X	X
Drainage of Subcutaneous Abscess	X	X
EKG - perform and interpret	X	X
Emergency Treatment of 1st, 2nd, and 3rd Degree Burns	X	X
Epigastric, umbilical, or inguinal hernia	X	X
Excision of subcutaneous or dermal lesion	X	X
Foreign body removal techniques	X	X
Formulate diagnostic and treatment plans	X	X
Formulate pre-and post-operative treatment plans	X	X
Initial Emergency Department consults	X	X
Interpret basic x-rays and imaging studies (e.g., skull, spine, chest, abdomen, and        extremities)	X	X
Interpret laboratory and diagnostic studies and tests	X	X
Intra-arterial Puncture or Catheterization	X	X
Intravenous Line	X	X
Introduction of NG Tubes	X	X
I & D of superficial abscesses and hematomas	X	X
Knot tying	X	X
Mark surgical procedures on patients	X	X
Minor surgical procures	X	X
Nasotracheal intubation	X	X
Order radiologic, laboratory, or other diagnostic tests	X	X
Orotracheal intubation	X	X
Participate in and supervise a patient code (adults)	X	X
Participate in and superise in trauma patient care	X	X
Perform procedures in the OR and assist residents with procedures in the OR	X	X
Perforated duodenal ulcer	X	X
Peritoneal lavage	X	X
Physical Examination	X	X
Portacath, venous action	X	X
Request specialty and subspecialty consults	X	X
Roll with patient to surgery when staff is notified the attending is "on the way to the OR"	X	X
See patients and write patient orders	X	X
Skin graft	X	X
Small bowel obstruction	X	X
Supervise Medical Students and Residents	X	X
Supervise more junior Fellows	X	X
Suture simple wound or laceration	X	X
Swan Ganz catheterization	X	X
Thoracentesis	X	X
Triage adult and pediatric trauma patients	X	X
Tube thoracostomy	X	X
Use of water seal drainage devices	X	X
Venipuncture	X	X
Wound débridement	X	X
Write admission, treatment orders, and notes in the Electronic Health Record	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
Adult Resuscitation	X	X

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