Supervision & Procedures: Quatrino, Gregory Mark (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 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 (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 the UT GME Policy 400 Resident Supervision 2018.

 

Click here to view the UT GME Policy 405 Patient Care Settings - Resident Supervision Standards 2018.

                                                   

Gregory Mark Quatrino, MD

Gregory Mark Quatrino, MD  

PGY-6 Fellow 

Colon and Rectal 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 Colon and Rectal Surgery Fellow, the Fellow can perform any Colon and Rectal Surgery or general surgery 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 Colon and Rectal Surgery Fellows are supervised either directly or indirectly with the supervising attending available to provide direct supervision.  PGY-6 Surgery Fellows can perform the procedures listed below under Indirect Supervision or Oversight highlighted in gray. and do not require the physical presence of a supervising physician:

         

 

 Differential Diagnosis, Treatment, and Patient Care Skills                        

PGY-6

Fellow

    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, spinie, 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 supervise a patient code (adults)  X
    Participate in and superise in trauma patient care  X 
    Perform procedures in the OR and assist residents with procedures in the OR  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) 

 X
   Adult Resuscitation  X
   
 Additional surgical related skills not requiring the physical presence of a supervision physician:
 
   Amputation of extremity or digit
 X
   Appendectomy X
   Arterial Puncture
X
   Breast Biopsy
 X
   Bronchoscopy X
   Central Venous Pressure Lines
X
   Diverting Loop Colostomy
X
   Drainage of Extremity X
   Drainage of Subcutaneous Abscess X
   Epigastric, umbilical, or inguinal hernai X
   Excision of subcutaneous or dermal lesion X
   Intravenous Lines  X
   Knot tying
 X
   Minor surgical procedures  X
   Nasatracheal intubation
X
   Oratracheal intubation  X
   Perforated duodenal ulcer  X
   Peritoneal lavage X
   Portacath, venous access X
   Roll with patient to surgery when staff is notified the attending is "on the way to the OR"   X
   Skin graft
 X
   Small bowel obstruction X
   Suture simple wound/laceration  X
   Swan Ganz Catheterization
 X
   Thoracentesis
 X
   Triage adult and pediatric trauma patients   X
   Tube Thorocostomy X
   
Colon and Rectal Surgery Procedures that the Fellow will be able to perform with Direct Supervision or Indirect Supervision with Direct Supervision Available (Categories -- Anorectal; Sigmoidosopy; Fiberoptic Endoscopy; and Abdominal (Open and Laparoscopy):  

I.    Anorectal

 
      Excisional hemorrhoidectomy  X
      Non-excisional hemorrhoidectomy (ligation, injection, cryotherapy, laser)  X
      Excision thrombosed external hemorrhoid  X
      Incision and drainage of abscess (other than Crohn's disease)  X
      Anal fistulotomy or fistulectomy  X
      Lateral internal sphincterotomy  X
      Anoplasty for stricture or ectropion  X
      Excision or exteriorization, pilonidal disease  X
      Excision or exteriorization, hidradenitis suppurativa  X
      Excision or fulguration, condylomata acuminata  X
      Drainage or fistulotomy, perineal Crohn's disease  X
      Exam under anesthesia, with or without biopsy  X
      Transanal excision or fulguration of rectal tumor  X
      Repair incontinent anal sphincter  X
      Endorectal flap procedure for ano-vaginal or ano-perineal fluids  X
      Repair recto-vaginal fistula (other than with flap)  X
      Perineal proceure for prolapse (resection, banding, etc.)  X
      Removal of rectal foreign body  X
II.   Signoidoscopy (Rigid)  
      Diagnostic screening  X
      Therapeutic (Fulgeration, Snare)  X
      Detorsion of Volvulus  X
III.  Fiberoptic Endoscopy  
      Flexible Sigmoidoscopy  X
      Diagnostic Colonoscopy (Inflammatory Bowel Disease)  X
      Disgnostic Colonoscopy (Other  X
      Colonoscopc Polypectomy  X
      Decompression of Volvulus or Pseudo-obstruction  X
      Endoscopc Laser Therapy  X
      Dilation of Strictures  X
      Other (summary)  X
IV.  Abdominal  
      Partial colectomy for cancer (left, right, segmental)
 X
      Low anterior or abdominal transsacral resection for cancer  X
           (A)  Stapled anastamosis  X
           (B)  Sutured anastamosis  X
      Abdominoperineal resection for cancer  X
      Resection for Crohn's disease  X
           (A)  Small bowel
 X
           (B)  Ileocolic resection
 X
           (C)  Colectomy with proctectomy
 X
           (D)  Colectomy without proctectomy  X
      Resection for ulcerative colitis  X
           (A)  With proctectomy  X
           (B)  Without proctectomy  X
      Resection for polyposis syndrome
 X
           Colectomy with proctectomy  X
          Colectomy without proctectomy  X
      Ileonanal procedure (ulcerative colitis or polyposis)  X
      Coloanal procedure  X
      Continent ileostomy  X
      Resection for diverticular disease  X
      Resection for other reasons  X
      Small bowel resection  X
      Creation, revision, relocation or closure of colostomy or cecostomy  X
      Creation, revision, relocation or closure of ileostomy  X
      Exploratory laparotomy with or without adhesiolysis  X
      Resection or fixation of rectal prolapse or intussusception  X
      Colotomy for polypectomy or foreig body  X
      Volvulus (detorsion, fixation, or resection)  X
      Drainage of intraabdominal abscess  X
      Perineal proctectomy  X
      Repair abdominal wall or incisional hernia  X
      Resection presacral tumor or cyst  X
      Hepatic resection - wedge - lobe  X
   

  

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

 

Updated 5/1/2018

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