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Supervision and Procedures: Hanna, E. Lex (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 Orthopaedic 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.

E. Lex Hanna

E. Lex Hanna, MD  

PGY-6 Fellow 

Orthopaedic Trauma 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 PGY-6 Orthopaedic Trauma Surgery Fellow, the Fellow can perform any Orthopaedic Surgery or Orthopaedic Trauma surgeon skill or procedure deemed appropriate by his/her attending physician or specialty physician skill or procedure deemed by an attending physician in a department in which the Resident is assigned for rotation (e.g., Emergency Medicine, Trauma Surgery, Surgical Critical Care, PICU, 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-6 Orthopaedic Trauma Surgery Fellows are supervised either directly or indirectly with the supervising attending available to provide direct supervision.  PGY-6 Orthopaedic Trauma Fellows can perform the procedures listed below under Indirect Supervision or Oversight highlighted in gray.


 Differential Diagnosis, Treatment, and Patient Care Skills                        



    Clinical and Social History X
    Communicate with patients and family members X
    EKG - perform and interpret X
    Formulate diagnostic and treatment plans X
    Formulate pre-and post-operative treatment plans X
    Initial Emergency Department consults X
    Interpret basic x-rays and imaging studies (e.g., skull, spine, chest, abdomen, and extremities) X
    Interpret laboratory and diagnostic studies and tests X
    Mark surgical procedures on patients X
    Order radiologic, laboratory, or other diagnostic tests X
    Participate in and run a code (adults), including trauma X
    Participate in a code (pediatrics), including trauma
    Participate in the care of medical and surgical critical care patients X
    Physical Examination X
    Request specialty and subspecialty consults X
    See patients and write patient orders X
    Supervise Medical Students and Residents X
    Venipuncture X
    Wound debridement X
    Write admission, treatment orders, and notes in the Electronic Health Record 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) 

   Adult Resuscitation  X
 Additional Specific Skills  
   Application of external fixation devices  X
   Closed treatment of simple fractures and dislocations X
   Closed treatment of more complicated fractures and dislocations X
   Conscious and moderate sedation  X
   Emergency closed reduction techniques X
   Follow rehabilitation protocols X
   Interpret Arterial Blood Gases X
   Intravenous Lines X
   Joint injections and aspirations  X
   Local anesthesia block  X
   Minor surgical procedures X
   Perform Orthopaedic Trauma procedures X
   Resident Surgeon on more simplified major orthopaedic procedures  X
   Roll with patient to surgery when staff is notified the attending is "on the way to the OR"  X
   Splinting of fractures and dislocations and casting X
   Supervise more junior residents  X
   Suture simple wound/laceration X
   Traction Pin Insertion  X
   Triage adult and pediatric trauma patients  X


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

Last Published: Aug 21, 2020