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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.

Morgan Fretwell Kato

Kato, Morgan Fretwell - PGY - 2

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

Dec 1, 2023