Supervision and Procedures: Shelton, Will (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 Family Medicine.  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

Will Shelton, MD       

PGY-3 Chief Resident

Family Medicine

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)

Pediatric Advanced Life Support (PALS)

Advanced Life Support in Obstetrics (ALSO)

Neonatal Resuscitation Program (NRP)

As a 3rd Year Family Medicine Chief Resident (PGY-3 level), the Resident can perform any Family Medicine physician skill or procedure deemed appropriate by his/her attending physician or specialty physician skill or procedure deemed appropriate by an attending physician in a department in which the Resident is assigned for rotation (e.g., Emergency Medicine, Surgical Critical Care, etc.).  Residents 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. 

PGY-1 Family Medicine Residents are supervised either directly or indirectly with the supervising attending or more senior resident available to provide direct supervision.

PGY-2 Family Medicine residents can perform the procedures under Indirect Supervision or Oversight highlighted in red.

PGY-3 Family Medicine residents can perform the procedures under Indirect Supervision or Oversight highlighted in green.

The procedures listed below do not require the immediate physical presence of a supervising physician:

Differential Diagnosis, Treatment, and Patient Care Skills	PGY-1	PGY-2	PGY-3
Arterial puncture		X	X
Arthrocentesis			X
Chief Resident and administrative supervision responsibilities			X
Clinical and Social History	X	X	X
Communicate with patients and family members	X	X	X
EKG - perform and interpret	X	X	X
Emergency treatment of 1st, 2nd, and 3rd degree burns		X	X
Excision biopsy		X	X
Formulate diagnostic and treatment plans	X	X	X
Formulate pre-and post-operative treatment plans	X	X	X
Incision & Drainage of skin abscess		X	X
Initial Emergency Department consults	X	X	X
Interpret basic x-rays and imaging studies	X	X	X
Interpret laboratory and diagnostic studies and tests (including arterial blood gases)	X	X	X
Joint injections			X
Mark surgical procedures on patients	X	X	X
Non-stress test (fetal)		X	X
Obstetrical ultrasound (limited abdominal)		X	X
Order radiologic, laboratory, or other diagnostic tests	X	X	X
Paracentesis			X
Participate in and supervise a code (adults)	X	X	X
Participate in and a pediatric code	X	X	X
Participate in neonatal resuscitation	X	X	X
Participate in and supervise medical critical care patients		X	X
Pelvic Examination and Pap Smear		X	X
Peripheral intravenous access	X	X	X
Physical Examination	X	X	X
Punch biopsy (skin)		X	X
Request specialty and subspecialty consults	X	X	X
See patients and write patient orders	X	X	X
Splinting of fractures and dislocations		X	X
Supervise Family Medicine inpatient team		X	X
Supervise Medical Students	X	X	X
Supervise more junior Residents		X	X
Suture simple wounds and lacerations	X	X	X
Venipuncture	X	X	X
Wound debridement	X	X	X
Write admission, treatment orders, and notes in the Electronic Health  Record	X	X	X
Cardiopulmonary Resuscitation
Perform Basic CPR and related procedures (airway management, emergency drug therapy, rhythm strip interpretation, intravenous catheterization, closed chest massage, adult resuscitation, electrocardioversion & defibrillation, and venous cut-down)	X	X	X

 

All other procedures are performed under direct supervision of a faculty member or more senior resident.