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.
Snyder, Kendall - 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.
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
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
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
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
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