RESIDENT RESPONSIBILITIES/SUPERVISION

 

 

Residents are responsible, under supervision, for total patient care, including admission, initial evaluation, diagnosis,

selection of therapy and management of complications for patients at the MED, Veterans Hospital, Methodist

University Hospital, and LeBonheur Hospital.  The residents encounter these patients in the out-patient clinics of

these facilities, arrange the admission, the initial evaluation and diagnosis, and select the appropriate therapy under

supervision.  Complications are managed by the residents under supervision.  They are responsible for continuity of

care of these non-private patients throughout their rotation.  This includes night and weekend responsibility (when

on call) and long-term care within the limits of the length of the rotation.  In all of the training sites, residents are

also responsible, under supervision, for the total patient care of private patients.  However, due to the diversity of

volunteer faculty office sites, they may not be associated with the decision for patient admission and similarly, they

may not be available to participate in the office follow-up and long-term continuous care of these private patients.

On the other hand, many of the private patients, especially those of the full time faculty, are initially seen as in-

patient consultations.  In these instances, the resident is responsible, under supervision, for the initial evaluation,

diagnostic studies and therapy plan. In addition, more senior residents (URO-3 and URO-4) are encouraged, time

permitting, to attend faculty private clinics.  This allows them an opportunity to participate in the post hospitalization

care of those patients they were responsible for during hospitalization, as well as to experience other office

procedures.  These include renal/transrectal ultrasonography/prostate biopsies, vasectomies, flexible/rigid cystoscopy,

complex video urodynamics, and other techniques that supplement their training.

 

 

MED Rotation:  This rotation is carried out in The Regional Medical Center of Memphis doing business as The

MED.  Overall, resident supervision during the MED rotation is provided by Dr. Chris Ledbetter.  Two residents

participate in this rotation; URO-3 and URO-2 level residents.  The teaching service averages between 4-6 patients

or approximately 2-3 patients per resident.  However, as an increasing number of diagnostic and operative

procedures are performed in an ambulatory or outpatient basis, the actual resident/patient teaching volume is higher

than would be anticipated from an in-patient census.  This reflects a busy and productive service educating urology

residents in both in-patient and outpatient care.  This does not include the urology consultations, which average two

per day.  Teaching rounds are conducted daily by the service chief, with all residents in attendance, for all patients

at The MED including trauma patients and consults.  Individual cases requiring subspecialty attention are staffed by

appropriate members of the urology faculty.  The office of the chief of service is adjacent to the MED Hospital and

less than 50 yards from the sponsoring institution.

 

 

VA Hospital:  The VA Medical Center is one of the primary sites of surgical training and education concerning in-

patient and outpatient care. The hospital serves as a regional (tertiary) referral center for Tennessee, Arkansas,

Mississippi, and Missouri as well as a multi-state spinal cord injury and stone disease facility. The teaching service

is under the overall supervision of Dr. Anthony L. Patterson, Chief of Urology at this institution.  This service is

staffed by three urology residents; one URO-4 and two URO-1’s.  Also, the clinic staff is comprised of a head

nurse who supervises 5 nurses, 4 urology technicians, 3 clerical staff and a urology liaison nurse.  In addition,

research nurses interact with the residents on a regular basis.  The VA Hospital is located one block from the

sponsoring institution. The URO-4 (chief) and the two URO-1 residents are responsible for the outpatient (clinic)

and in-patient urology service in the main VA Hospital.  The URO-4 resident serves as chief for the spinal cord

injury and stone center which are physically connected to the main hospital.  There are a great number of outpatient

procedures.  There are approximately 6 in-patients per week at the main hospital and approximately 2 per week at

the spinal cord injury part of the hospital (approximately 2 patients per resident).  Dr.Anthony L. Patterson conducts

teaching rounds in the main hospital.  Dr. Robert Wake serves as chief of the stone center and conducts rounds daily

with the URO-3 resident concerning these patients.  Other faculty, including Dr. Clyde Martin, supervise the

residents and conduct teaching rounds on patients with which they were involved.

 

 

LeBonheur Children’s Hospital: The pediatric urology rotation is located at LeBonheur Children’s Medical

Center and its outpatient and surgical center facilities. The hospital is a freestanding hospital but is now a part of

the Methodist Health Care System. The hospital provides the only full service pediatric emergency department in

the city.  In addition, there is a Newborn Intensive Care Unit located adjacent to The MED Hospital where frequent

consults are handled. A similar arrangement is made with The St Jude’s Pediatric Research Hospital for answering

consultations. A URO-3 is resident assigned to this rotation and is responsible for all urology patient care, with the

majority of care being provided in an outpatient setting.  Resident supervision occurs daily and continuously by

three (3) full time faculty members.  The pediatric hospital is located one block from the sponsoring institution.  It is

important to note that housed within this hospital are the pediatric teaching faculty, and consultative sub-specialty

medical and surgical services, required to support the training program and the hospital. 

 

Methodist University Hospital:  The Methodist University Hospital is the largest private downtown hospital in

Memphis, Tennessee.  It functions as a tertiary care and regional referral center for western Tennessee, Arkansas

and Mississippi.  This facility is approximately 5 blocks from the sponsoring institution.  The teaching service at

the Methodist University Hospital is under the supervision of Dr. Michael Aleman and Dr. Chris Ledbetter.  A

URO-4 and URO-2 resident are assigned to this institution.  The residents are responsible for the non-private

in-patient teaching service as well as the private patients of the full time faculty.  Volunteer faculty admit to this

institution as well and they will supervise the residents when it concerns their private patients. All clerical support,

subspecialty medical and surgical services, radiology and library with internet access, are available to support the

institution and the training program.

 

The program policy regarding supervision is that residents are supervised at all times and in all locations, both

in-patient and outpatient, in which they carry out their functions as a urology resident.  This policy is implemented

by The University of Tennessee GME office and the Urology Program Director, and it is the responsibility of the

Program Director and the faculty to ensure compliance at all times.  Our institutional and departmental policy on

resident supervision is as follows:

 

 

 

 

Resident Activity

Resident Activity Description of Supervision

Documentation of    Supervision

 

INPATIENT	New Admission	Residents will notify departmental attending physicians upon patient admission.  The urgency of notification is based upon severity and acuity of patient.  The departmental attending physician must see and evaluate the patient within one calendar day of admission.	Level #1 or #2 Co-signature not sufficient
	Continuing Care	Departmental attending physician is personally involved in ongoing care.	Level #1, #2, #3, or #4
	Intensive Care	Because of the unstable nature of patients in ICUs, involvement of departmental attending physician is expected on admission and at least on a daily basis.	Level #1, #2, #3, or #4
	Hospital Discharge/ Transfer	The departmental attending physician must be involved in decision to discharge or transfer patient.	Level #1 or #2

 

OUTPATIENT	New Patient Visit	The departmental attending physician must be present in the clinic.  Every new patient must be seen by and/or discussed with the departmental attending physician	Level #1, #2, or #4 Co-signature not sufficient.
	Return Patient Visit	The departmental attending physician must be present in the clinic.	Level #1, #2, #3 or #4
	Clinic Discharge	The departmental attending physician will assure clinic discharge is appropriate.	Level #1, #2, #3 or #4
SURGERY/ OPERATING ROOM	The departmental attending physician must be notified prior to the scheduling                  .	The departmental attending physician must physically be present, within the facility the procedure occurs, for the major components of the procedure.	Level A:  Attending physician performing the procedure, assisted by resident.   Level B:  Resident performing the procedure and the departmental attending physician is scrubbed.   Level C:  Resident performing the procedure with the departmental attending physician not scrubbed, but present in operating room.   Level D:  Resident performing the procedure with the departmental attending physician not scrubbed, but present in suite or facility.   Level E:  Emergency Care- Immediate care is initiated to preserve life or prevent impairment.  The procedure is initiated with the departmental attending physician contacted and in route.

 

Consultations (Inpatient, Outpatient, and Emergency Department)

Departmental attending physician must supervise all consults

#1, #2, #3 or #4 consistent with the patient’s condition and principles of graduated responsibility.

 

 

Radiology/ Pathology

All reports verified by departmental attending physician prior to release

 

 

Emergency Department

Assigned Departmental attending physician must be present in the emergency department and is the attending of record.  Assigned Departmental attending physician must be involved in the disposition of all patients.

Level #1, #2, #3 or #4 consistent with the patient’s condition and principles of graduated responsibility.

 

Routine Bedside and Clinic Procedures

Level #1, #2, #3 or #4 consistent with the patient’s condition and principles of graduated responsibility as outlined on GME supervision web site http://www.utmem.edu/GME/supervision.htm

 

 

Non-Routine, Non-Bedside, Non-OR Procedures

(e.g., Endoscopy)

Departmental attending physician must physically be present within the facility where the procedure occurs, for the major components of the procedure and degree of involvement documented.

Level #1, #2, #3 or #4 consistent with the patient’s condition and principles of graduated responsibility.

 

 

                                                     Level of Supervision Documentation

 

(1)     Departmental attending physician note

(2)     Departmental attending physician addendum to the resident’s note (not a co-signature)

(3)     Departmental attending physician co-signature implies that the departmental attending physician has reviewed

         the resident’s note, and absent in addendum to the contrary, concurs with the content of the resident’s note.

(4)     Resident documentation of departmental attending physician supervision. (e.g.: “I have seen and discussed the

         patient with my departmental attending physician, Dr. ‘X,’ who agrees with my assessment and plan.”