Department of Surgery R ..

ident Supervisaln Chart of Clinical Privileges

Leval1: Clinical activities requiring attending staff physically present during key portion of procedure or Immediately available

Level 2: Clinical actlviti .. requiring attending IIt8ff or upper leval .... Ident phyalcally present In facility or camp. and I, Imme.ii.ely available for con.ultatlon ,.

Level 3: Clinical Activitl .. Requiring Inltlallnetruction Prior to Performing without Supervi,ion

Raqulrementll for
Certlficatlon to
R .. ldant Method of Lavel of .Lavel of Perform WiD Direct Method of Confirming Certiflcaton of
Clinical Activity Level Inltruciton lnetructor Supervision Supervision R .. ldent WID Superylalon
At the beginning of
Direct clinical PGY-1, after initial
Admission PGY-1-+- Instruction PGY-2+ Level 3 Inatructlon PGYl.evel
AI the beginning of
Direct clinical PGY-1, after initial
H&P PGY~1+ instruction PGY·2+ Level 3 il18truotion PGYLevel
Direct clinical In1tl81 direct clInical
Abdominal paracentesis PGY-1+ insttiJctlon PGY·2+ Level 2 instruction PGY Level
Direct clinical lnilflil direct clinical
Arterial catheter PGY-1+ instruction PGY-2+ Level 2 Instruction pGYLevel
Direct cl'IOlcal Inltial direct clinical
Arterial puncture PGY-1+ instrucllon PGY-2+ Level 2 instruction PGYl.evel
Direct clinical Inltlill illrect Clinical
Lumbar PJlncture PGY·1+ Instruction PGY-2+ Level 2 instruction PGYl.evel
Direct clinical Initial direct clinical
Phlebotomy _ PGY-1+ Instruction PGY-2+ Level 2 instructlon PGYl.evei
Arthrocentesis of knee, Direct clinical Initial direct clinical
elbow, hand, wrilIt PGY-1+ Inslnlction PGY-2+ Level 2 InstrucUon PGYl.evel
Bone marrow aapira!ion and Direct clinical Initial direct clinical
biopsy PGY-1+ Instruction PGY-2+ Level 2 Instruction PGYl.evel
Direct clinical Initial direct clinical
Breaslexam PGY-1+ lnBln.lction PGY-2+ Level 2 instruction PGY Level
Direct clinical Initial direct clinical
Central venous catheter PGY-,. ii\8lruC1ion PGY·2+ Level 2 instruction PGYl.ellel
Dellelop and document initial Direct clinical AHhebeginning of
PGY -1, after IniUal
plan of care PGY·1+ instruction PGY-2+ Lellel3 in8b1fCt1on PGYl.ellel
Develop differential diagnosis At the beginning of
Direct clinical PGY -1, after iniUsl
and problem lilit PGY-1+ instruction PGY-2+ Lellel3 instruction PGYl.evel Approlled; September 18, 2002, February 23,2004

Page 1 of 16

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Department of Surgery Resident Supervlsoin Chart of Clinical Privileg ..

Requirements for
Certification to
• Resident Method of Level of Level of Perform wlo Direct Method of Confinnlng Certlfic:atan ot
CliniCal Activity LevII lnatruclton lnetructor Supervision Supervleion RMldent w/o Supervl,lon
At the beginning of
Direct clinical PaY -1, lifter initial
Dictate discharge-BUmmar\l PGY-1+ Insbuction PGY·2+ Level 3 inall'uclion PGYLevei
At the beglMing of
,Direct clinical PGY-1, after initial
Digital rectal. exam PGY-1+ Instruction PGY-2+ Level 3 Instruction PGY Level
At the beginning of
Evaluate new and follow-up Direct clinical PaY-1, after initial
Il~tient& in outpatient setting PGY·1+ Instruction PGY·2+ Level 3 Insbuction PGYLevel
Evaluate patienl8 willi acute At the beginning of
m~lcal problems upon Direct clinical PGY -1, after initial
~ue.st of nurses or UPs PGY-1+ inatruction PGY-2+ Level 3 iO-lructlQn PGYLevel
Direct clinical
Flexible sigfTIoidoscoov PGY-1+ IMlNcilan FIICIiI_ly Level 1 NlA PGYLevel
AI the begInning of
Initiate/adJust mechanical DIrect clinical PaY -2, after initial
ventilation PGY-2+ insbuction PGY-2+ Level 3 I nBtructIon PGY Llive1
At the beginning of
Direct clinical PGY -1, after Initial
Initiate dillCllBrge planning PGY·1+ instruction PGY-2 .. Level 3 Ih.truction PGYLevel
Direct clinical
Insert chest tube PGY-2+ instruction Faculty Level 1 NlA PGYLevel
I'nsert pulmonary artery Direct cliniCal
catheter PGY-2+ Ihlbuction Faculty Level 1 NJA PGYLevel
Direct clinical
Insert urethral catheter pGY-1+ Instruction Faculty Level 1 NlA PGYLeliel
AI the beglMing of
Moctify_ dail_yptan of care Oirect clinical PaY-1, after Initlal
PGY-1+ Instruction PGY-2+ Lavel3 Instruction PGYLevel
Direct clinical Initial direct dinlcal
Nasal andotrachial intubation PGY·1+ inslrUclion PGY-2+ Level 2 InstrucUon PGYLalial
Direct clinical Inltlaf direct dlnical
N8sog88tric i"tubalion PGV-1+ Instruction PGY-2+ Level 2 Instruction PGYLevel Approved: September 16, 2002, February 23,2004

Page 2 ai16

Department of Surgery Raldent Supervlsoln Chart of CllnlCill Privilag ..

Raqulrementa for
Certification to
R_idant Method of Level of Lev.lof Parfonn wlo Direct M.utod of ConfInning Certlficaton of
Clinical Activity Level Inetruc:lton .netruc:tor Supervision Supervision R .. ldsnl wlo SupervIsion
At the beginning of
Obtain informed coneent for each POit-Graduate
procedures in POlt Graduate Direct clinical Year, after initial
Year scope of practice PGY-1+ instruction PGY-2_+ Level 3 Instruction PGYLevel
DIi'ect clinical Initial dIrect clinical
Oral endo_trachiaJ Intubation PGY-1+ jnslnJ.otion PGY-2+ Level 2 Instruction PGY Level
Direct clinical InlUal dli"ect clinical
Order Restraints PGY-2+ Instruction PGY-2+ leveJ2. Instructlo_n PGYLevel
Order GOnsults for diagnostic ,N. the beginning of
studies, evaluaHon by other each POit-Graduate
LIPs, therapies, specialized Direct clinical Year, after initial
care, or social services PGY-1+ instrudion PGY-2+ Level 3 instruction PGYLevel
AI the beginnIng of
Order/adjust artlftcal feeding Direct clinical PGY -2, after initial
modalities PGY-2+ i"lItruction PGY-2+ Level 3 InBtruellon PGYLevel
At the beginning of
Order/interpret routine Direct clinical PGY-1, after iniUsl
diagnostic IItudies pGY-1+ In&truction PGY-2+ Level 3 Instruction ,PGYlevel
Pelvic exam, pap smear, wet Direct ClfrilCaJ Initial cfJreCt clinical
mount PGY-1+ instruction PGY-2+ Level 2 Inlltruction PGY Level
AHA After lIuccesaful
CertifIed GOmpletion of ACLS
'Perform ACLS PGY-1+ ACLS Training Instructor Level 3 Training PGYLevel
ATLS After successful
CertIfI8d 'completion of ATLS
Perform ATLS PGY-1+ ATLS Training Instructor Level 3 Training PGYLevel
Perform and document At the begInnIng of
PII18ct clinical PGY-1, after initial
~i8tory & phySical PGY-1+ In.tructIon PGY-2+ Level 3 Instruction PGY Level
Thoracentesis Direct clinical Initial direct clinical
PGY-1+ Instruction PGY-2+ Level 2 Instruction PGYLevel
At the beginnIng of
Direct clinical PGY-1, after initial
Write daily progress notes PGY-1+ Instruction PGY-2+ Level 3 instruction PGY Level Approved: Seplember 18,2002, February 23,2004

Paae 3 of 16

Departmlnt of Surglry Reslden, Supervlsoln Chart of Clinic.J Privillg8l

Requlremlntl for
Clltlficalion to
, Resident Method of Llvelof Level of Perform WiD Direct Method of Confln1llng Clrtlficaton 0'
,Cllnlc:al Activity LlvII lnatruclton Instructor Supervision Supervision RlIsIden! wloSupervl~lon
Write orders for routine
diagnostic studies, At the beginning of
medications and other care Direct clinical PGY -1, after initial
modalities PGY-1+ instruction PGY-2+ Level 3 Iinstruction PGYLevel
Antle beginriirlg of
Direct clinical PGV -2, after initial
Abscess drainaae PGV-1+ instruction PGV-2+ Level 3 instruction PGVLevel
Direct clinical PGY ~2, after InIUal
Repair laceration PGV-1+ Instruction PGY-2+ Level 3 lostruction f>GY Level
Direct clinical PGY-2, after initial
Excision benicn leision PGY-1+ instruction PGY-2.+ Level 3 Instruction PGYLevei
At the beginning of
Direct clinical PGY.4, 8fter Initial
Excision malignant leision f>GY-1+ instruction PGY-4+ Level 2 instruction PGY Level
Aflie beginning of
Direct clinical PGY -2, after initial
Excisional breast biopsy PGY-1+ Instruction PGY-2+ Level 2 instruction PGYLevel
At the beginning of
Breast Direct clinical PGY -4, after initial
lumpectomv/Quadrantectomy PGY-1+ instruction PGY-4+ Level 2 Instruction PGVLevel
AI the beginning of
Maatectomy (modified Direct clinical PGV -4, after initial
radicallradlc8l) PGY-2+ instruction PGY-4+ Level 2 'Instruction PGYLevel
At the beginning 'of
Mastectomv itotal/slmple) Direct clinical PGY -4, after initial
PGY-2+ Instruction PGY-4+ Level 2 Instruction PGYLeve!
At the beginning of
Direct clinical PGY -4, after Initial
Lymph node dissection PGY-2+ instruction PGY-4+ Level 2 instruction PGYLevei
At thli beginning of
Direct clinical PGY-1, after initial
Skin graftlflap PGY-1+ instruction PGV-2+ lllvel2 instruction PGYLeliel
At the beginning of
Direct clinical PGY -4, after Initial
Breast reconstruction PGY-2+ Instruction PGY-4+ Levet 2 instruction PGYLevel Approved: September 18, 2002, February 23,2004

Page 4 aI 16

Departmant of Surgery Raeldant SuparvilOin Chart of Clinical Privilaga

Requlremants for
Certification to
Resident Method of Laval of Lav.lof Parfonn WiD Direct Method of Confinnlng C.rtlflcaton d'
Cllnlcal.ACllv'ttv Laval Instruclton InatNctor Supervision Supervision R .. ld.nt WiD Suparvi.ion
At the beginning of
DIrect clinical PGY -4, lifter initial
Mammoplasty PGY-2+ Instruction PGY-4+ Level 2 Instruction PGYLevel
At tho beginning of
Direct clinical PGY -3, after Ioillal
Tracheoslomy PGY-1+ instruction PGY-3+ Lavel2 Instruction PGY Level
At the beginning of
Cervical exploration for DI~ clinical PGY -3, after initial
trauma PGY-1+ instruction PGY-3+ Level 2 instruction PGYLevel
At thil beginning of
Olrect clinical PGY-4, after Initial
Carotid endarterectomY PGY-3+ instruction PGY-4+ Level 2 Instruction PGY Level
At tho beginning of
Repair Carotid Direct clinical PGY -4, after initial
oooatierectomy PGY-3+ instruction .PGY-4+ . Leval2 instruction PGYLevel
At the beginning of
Direct clinical PGY -2, after Initial
Vascular access procedure PGY-1+ Instruction PGY-2+ Level 3 instruction PGYLevel
At the beginning of
Direct clinical PGY-4, after Initial
Vascular bypass procedure PGY-2+ Instruction PGY-4+ Level 2 Instruction PGYLevel
At the beginning of
Dlr8Ql clinical PGY -3, after Initial
Thoracic duct ligation PGY-1+ Il1struct!on PGY-3+ Level 2 instruction PGYLevel
AI the beginnIng ·cir
Direct clinical PGY-4, after initial
Cervical lymphadenectomy. PGY-2+ Instruction PGY-4+ Level 2 . lnsbuctlon PGYLevel
At the beginning of
Direct clinical PGY -4, after Initial
Cervical ~phagostomy PGY-3+ instruction PGY-4+ Level.2 Instruction PGYLevel
At the beginning of
Direct clinical PGY -4, after initlai
Cricoph~ryngeal myotomy PGY-2+ Instruction PGY-4+ Level 2 Instructlon PGY Level Approved: September 18, 2002, February 23,2004

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Depal1ment of Surgery RMldent Suparvleoin Chart of Clinical Prtvileg ..

Requirements for
Certification to
R_Ident Method of Level of Levllof Pelform wlo DlrKt ~.thod of Confinnlnll Certifaton 0'
Clinical Activity "evI' In.truclton Instructor SilpeNllJlon Supervision Resident wlo SupeMslon
At the beginning of
Direct clinical PGY-4, after initial
Diverticulectomy PGY-2 ... instruction PGY-4+ Level 2 Instruction PG:V Level
At the beginnlng of
Direct clinical PGY"3, after initial
, lllyrogiossal duct cysteclom~ PGY-h instruction PGY-3+ Level 2 instruction PGY Lavel
At !tit beginning of
Direct clinical PGY -4. after initial
Th__ID)ldectomv PGY-2+ instruction PGY-4+ Level 2 Instruclloo PGYLevel
Altha beginning of
Direct clinical PGY-4. after Initial
Parlithyroidectomy PGY-1+ inatructJon PGV-4+ Level2_ lrialnlcllcn PGVLevel
At the beginning of
Direct clinical PGY-4. after Initial
CelV!callhym6CIOmv PGY-1+ instruction PGY-4+ Level2_ JnslJUcIion PGVLevel
Altha beginning of
EJ«:lslon of carotid body Direct clinical PGV -4. after Initial
tumor PGY-2 ... instruction PGY-4+ Level 2 In;truellon PGYLevel
AI the beginning of
Upper gastrointalltlnal Direct clinical PGV-2, after inilial
endoscopy PGV-1+ Jn8lnlctlo,n PGV-2+ Level 2 Inatruc1fon PGYLevel
Lower galtrointeatinal Direct clinical At the beginning of
PGY -2. after initial
endoscopy PGY-1+ instrucUon PGY-2+ Level 3 inaDuctlon PGY Level
'Dir8Gt clinical AI the bBgiIlnlng Of
paY-4. after Initial
Antlreflux Operation PGY-2+ instruction PGY-4+ Level 2 Ins!ructlon PGYLeveJ
DJrec:t clinical At ttie.~lnnln9 of
PGV-4, after Initial
Paraasophai:raal hem!a repair PGV-2+ Instruction PGY-4+ LWEII2 in&!rucUOn PGY Level
AI the bOginnfng of
Dlr&el clinical PGY-4. after initial
DiiIPhragmalic reDair PGY-2+ InS1IUcfion PGY-4+ Lll'llel2 fn&l1UctiOn PGYLevel Approved: September 18. 2002. February 23, 2004

Page I) of'5

Department of Surgery Reeident SupervilSOin Chart of Cllnk:al Privileges

Requirements for
CertiflC8tlon to
R .. I.dant Method of Lev_I of Level of Perform wlo Direct Method of Confinnlng Celtiftcaton of
Clinical Activity Levil InetNClton Instructor Supervision Supervision R .. ld."* wlo SUlNrvlt;lon
At lne lleglnnlng of
Eaophagectomy (+/- Direct clinical PGY -4. after initial
thoracotomy) PGY-3+ in .• tructlon PGY4+ Level 2 InstrucUon PGYLevel
Arthe beginning of
Direct clinical PGY-4, after initial
Esophagomyolomy PGY-3+ inalructiDn PGY4+ Level 2 Instruction PGYLevel
At the beginning of
Direct clinical PGY -4, after Initial
EsophaQOSlomy PGY-2+ instruction PGY4+ Level 2 Instruction PGYLevel
Repair esophageal At the be~inning of
Direct ctinlcal PGY-4, after initial
Iperforation PGY-2+ Instruction PGY4+ Level 2 inalructlon PGY Level
AIU1e beglnnlng of
Direct dinJcaJ PGY,2, after initial
Gastrotomy PG'l-1+ instruction PGY-2+ Level 2 instruction PGY Level
At the beginmng of
Direct ctlnical PGY -4, after Initial
Gastrotrectomy PGY-3+ instruction PGY4+ Level 2 instruction PGYLevel
At the beginning of
Direct clinical PGY-4, after Initial
Vaaotomv PGY-2+ instruction PGY4+ Level 2 Instruction PGYLevel
At the beginning of
Gastrostomy Direct clinical PGY -2, after Initial
I{percutanaou&iopenl PGY-1+ instruction PGY-2+ lI,.evel2 Instruction PGYLevel
Gastric restrictive procedure AI the begJnnlng of
Direct clinical PGY4, after Initial
11+/- bypass). PGY-3+ instruction FGY-4+ Lavel2 Instruction PGY Lavel
Repair gastric/duodenal At the baginning of
Direct clinical PGY -3, after initial
lperforallon PGY-2+ instruction PGY-3+ Level 2 instruction PGYLevel
Repair small bowel At the beginning of
Direcl clinical PGY -2, after Initial
[perforation PGY-1+ Instruction , PGY-2+ Level 2 Instruction PGYLevel Approved: September 18, 2002, February 23, 2004

Page 7 0116

Department of Surgery R .. ident 5upervi.oln Chart of Clinical Prlvlleg ..

Requlremenla for
Certification to
(( .. Ident Mtlthodof Levalof Level of Perform wlo Direct Method of Conllnning C.rtlftcaton of
CI.l.nlcal Activity Level Inatruclton InltrvctM Supervision SUptlrvlalon Raid.nt wlo Supervision
AI th.e begInning .of
Okecl clinical PGY -3, .after lnillal
Gastr~nteric anaslQmosis PGY.1+ ins!n.tcUon PGY-3+ Level 2 inslruation PGY Love!
At Uai beginning 01
Direct clinical PG Y·2, alter iniUal
Enterolysis' PGY-H Ins!n.tclion PGY-2+ Level 2 hlSlruction PGYLavel
At the beginning of
Direct clinical PGY·3, after initial
Enter.ectomy PGY-1+ instruction PGY-3+ Le'iel2 Instructlon PGYlevel
Allhebeglnnlng of
Enteroenterostomy Direct clinical PGY"3, after initial
anastomosis PGY-1+ instruction PGY-3+ Leliel2 inall'Uclkln PGYLevel
AI tI1e l:ieglnnln~ of
Direct clInical PGY·3, aftilr initial
Enlerotomy PGY-1+ inBtruction PGY-3+ Level2_ Instruction PGYLeve!
Allhe ~lnnklg of
Direct clinical PGY-3, .r Initial
Snlaros to my PGY-1+ lnatructioo PGY-3+ L8vel2 ;n&trocllon PGYLevei
Direct clinical At Ihe beg.innlng ot
PGY -2, aller initial
Appendeeton1V PGY-1+ loslrucUon PGY-2+ L.evel2 Instruction PGYLevei
AlIIle beslhniflg of
Direct clinical PGY -3, .r inllial
Colectomy PGY-1+ InslruetiOn PGY-3+ Level 2 iMtruction PGYLevei
At !he begllU1Jng of
Dlred clinIcal PGY-3, BIIer initial
Colostomv PGY·1+ Inslnlction PGY-3+ Lovel.2 Instruction PGYLevel
Allhe beginning (If
DireGt clinical PGY -3; after Initial
Enterostomy Closure PGY-1. JoslrucUon PGY·3+ Level 2 Instruction PGYLevel
Alllle beginning of
Direct clinical PGY-3, after inilial
Fistula Closure PGY-1+ inlilrucUOn PGy.a+ L.evel2 Inslruction PGYLeval Approved: September 16, 2002, February 23, 2004

.....

, ___ I

Department of Surgery Resident Supervi&oin Chart of Clinical PrivileglS

Requirements for
Centfication to
, Ra&ident Method of Level of Level of Perfonn wlo Direct Mtthod of Confinning Certificaton of
Clinical Activity Level Instnlciton Instructor Supervision Supervision R .. ldent wlo Supervision
AI the beginning of
Direct clinical PGY --4, after initial
Proctectomy PGY-2+ instruction PGY--4+ Level 2 Instruction PGYLevel
AI the beglnnlng of
Direct clinical PGY -3. after initial
Excision of rectal tumor PGY-1+ Instruction PGY-3+ Level 2 Instructlcin PGYlevel
IAI the,beginnrng of
Direct clinical PGY -2. after initial
Hemmorrhoidectomv PGY-1+ InllNction PGY-2+ .Leval2 Instruction PGYLevel
Altha beginning of
Direct clinical PGY-2, after Initial
Anal fistulectomv/fistulotomy PGY-1+ Instruction PGY-2+ Level 2 Instruction PGYLevel
Atlhe beginning o~
Direct clinical PGY -2, after Initial
Lala~ Inlamal shlnC1,arotomy PGY-1+ Instruction PGY-2+ LeYel2 instrucliQfl PGY Level
At me beginning of
Direct Clinical PGY -2, after inlUai
Excision of perinatjesion PGY-1+ instruction PGY-2+ Lellel2 instruction PGY Lavel
At the beginning of
Direct clinical PGY -3. after inlUaI
Exploratory laparotomy PGY-1+ instruction PGY-3+ Level 2 Instruction PGYLevei
At the beginning of
Direct clinical PGY-3, after Initial
Diagnostic laparoscopy PGY-1+ Instruction PGY-3+ Level 2 Instruction PGYLevel
,Atllie beginning of
Direct clinical PGY -3, after inlual
Splenectomy PGY-1+ Instruction FlGY·3+ Level 2 Instruction PGYLavel
Altha beginning of
Direct clinical PGY -3. after initial
~plenorrhaphy PGY-1+ Instruction PGY-3+ Level 2 [nstrucllon PGYLevel
At the beginning of
Direct clinical PGY --4, after InlUaI
Abdomnal lymphadenectomy PGY-2+ instruction PGY-4+ Level 2 Instruction PGY Level Approved: September 18, 2002, February 23, 2004

Paae9 of 16

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D.partmlfll of Surgery Resident Supervi80ln Chart of Clinical Privileges

~aqulremeJ)" for
,Certification to
Reald.nt Method of Level of Lev.lof Perfonn wlo Direct Method of Conftnning Certiftcllton or
Clinical Activity Level Instruciton lnatructor Supervlaion Supervlalon Reaidenl wlo Suptlnlilion
At the beginning of
Direct clinical PGY-4, after initial
Hepatectomy pGY-3+ inslru.ction PGY-4+ Level 2 instruction PGY Level
At the beginning of
lJirect clinical PGY -2, after i!liUal
Biopsy of IiverLwedge PGY-1+ In&Iruclion ,PGY-2+ Le\let2 1000lruclion PGYLevel
AI the beginning of
Direct clinical PGY -4, after Initial
Choledocholomy/CBDE PGY-2+ jnstruction PGY-4+ Level 2 Instruction PGY Level
Attha beginning of
Direct clinical PGY -3, after Initial
Cholecystectomy PGY-1+ instruction PGY-3+ Level 2 instruction PGYLevel
At the beglnnrng of
Direct clinical PGY -3, after initial
Cholecystostomy PGY.1+ Instruction PGY-3+ Level 2 Instruction PGYLevel
At the begiMing of
Cholecystoenieric Direct clinical PGY-3, after Initial
, IInastomosl& PGY-1+ lnaIrucUon PGY-3+ .Level2 InstrucUon PGYLevel
Cholecystoenteric At the beglnning uf
Direct clinical PGY -4, after initial
anastomosis PGY-2+ Instruction PGY",,+ Level 2 iOBtruction PGYLevel
At the beginning of
Direct clinical PGY -3, after Initial
Panaeatlc dabridement PGY-1+ Instruction PGY-3+ Level 2 instruction PGYLevai
At the beginning of
Direct clinical PGY-4, after initial
Whjpple procedure PGY-3+ InlllnicliolJ PGY-4+ Level 2 Instruction PGYLevel
At the beginning of
Direct clinical PGY -4, after IniUal
Pancreatic resection . PGY-3+ InstrucUon j'GY-4+ Level 2 Instruction PGYLeveJ
AI the beginning of
Pancrealicoenteric Direct clinical PGY -4, after Initial
anastomosis PGY-2+ instruction PGY-4+ Level 2 instrucHon PGYLevel Approved: September 18, 2002, February 23,2004

~.

Department of Surgery Relldant Supervlsaln Chart of Clinical Privilegee

Requlramanta for
Certification to
Resident Method of Laval of Level of P.rfonn wlo Direct M.thod of Conflnnlng CartificatDn of
Clinical Activity Level InstnIciton In.tnlelor Supervision Supervision R .. ldwt' WiD Supervision
At the beginning of
Drainage of abdominal .Dlrect clinical PGY -2, after Initial
abscess PGY-1+ InslruCUon PGY-2+ Level 2 instruction PGYLevel
At the beginning of
Direct clinical PGY -4, after Initial
Donor hepatectomv PGY-2+ instruction PGY-4+ LeJlel2 Instruction PGY L.evel
At the beginning of
TranSplenl8lion of hepatic Olrect clinical PGY -4, Sfter initial
allograft PGY-3+ instruction PGY-4+ Level 2 instruCllon PGY.Level
At the beginning of
Direct clinical PGY -4. after Initial
Donor pancreatectomy PGY-2+ instruction PGY-4+ Level 2 Instructlon PGYL.ev~!1
At the beglnnlng of
Tranapl.anfa,tlon of pancreatlc Dlrec:t clinical PGY -4, after Initial
allOQlaft PGY-3+ inel!uction PGY-4+ L.evel_2 Ins!ruction PGY Level
At the beginning of
Direct clinical PGY ·2, after initial
Herniorrhaphy PGY·1+ inslrUction PGY·2+ Level 2 Instruction PGY Level
Althe beginning of
Transplantation of renal DIAICt clinical PGY -3, after initial
allograft PGY·2+ inetruction PGY-3+ Level 2 ·instructlon PGYLevel
At the beginning of
Direct clinical PGY -3, after Initial
Nephrectomy PGY-2+ Inatruction PGY-3+ Level 2 instruction PGY Level
At the beginning of _
Direct clinical PGY ·3, after Initial
Ureteral reDalr/uretarrhaphy_ PGY-2+ instruction PGY·3+ L.eyel2 !nstnJction PGYL.evel
At the beginning of
Direct clinical PGY·1, after Initial
Central venous access PGY·1+ Instruction PGY·2+ Level 3 inaJruction PGY Level
At the beginning of
Direct cllnlcel PGY-1, after initial
Arterial line PGY-1+ Inltruction PGY·2+ Level 3 inlltruction PGYlevsl Approved: September 16,2002, February 23.2004

Page 11 of 16

Department of Surgery R .. ldent SupeNlsoin Chart of Clinical Prlvlleg"

Requlrementa for
CertlfiClltion to
R .. ident Method of Lev. of Level of Perform WiD Direct Method of Confinnlng Certiflcaton of
Clinical Activity Level In.truclton Instructor Supervision SUP8Nlslon A_Idem WiD Supervision
At the beginning of
Direct clinical PGY -3, lifter initial
Excision cervical rib PGY-1+ instruction PGY-3+ Level 2 In&truction PGYLevel
At the beginning Of
DIracI clinical PGY-2, after Initial
Arteriotomy repair PGY-1+ instruction PGY-3+ Level 2 Instruction PGY Level
At the beginning of
Direct clinical PGY-4, after initial
Sympathectomy PGY-2+ inl$truction PGY-4+ Level 2 instruction PGYLevel
At the beginning of
Direct clinical PGY -4, after initial
Embolectomylthrombectomy PGY-1+ instruction IPGY-4+ Level 2 instruction PGY Level
AHhebeginning of
Direct clinical PGY -4, altar initial
Endovalcular repair of AM PGY-3+ jnstruction PGY-4+ Lavel 2 instrucHon PGYLevel
AUhe beginning of
Direct clinical Pay -4, after Initial
Placement of aortic graft PGY-3+ instruction PGY-4+ Lavel2 Instruction PGYLevei
AI the beginning of
Direct clinical PGY -4, after initial
Arteriovenous fistual PGY-1+ Inltruction PGY-4+ Level 2 instruclion PGY Level
At the beginning of
Peripheral bypass Direct clinical PGY -4, after Initial
procedures PGY-3+ InslNctlon PGY-4+ . Level 2 instruction PGYLevel
At the beginning of
Aortofemoral bypass Direct clinical PGY -4, after initial ,
~ocedures PGY-3+ instruction PGY-4+ Level 2 Instruction . PGYLeveJ
At the beginning Of
Vascular transposition Direct clinical PGY -4, after Initial
Iprocedures PGY-3+ instruction PGY-4+ Level 2 InstrucUon PGYLevel
At the beginning of
Direct clinical PGY -4, after initial
Visceral bypass procedures PGY-3+ lns.truction PGY-4+ Lavel2 inslruclion PGYLeveJ Approved: September 18,2002, February 23,2004

Department of Surgery Reeldent Superviaoln Chart of Clinical Prfvi'eg ..

Requirements for
Certification to
Ruldenl lIethodof Lev.,of Lev.'of Perform wlo Direct Method of Confinning CertiftGaton of
Clinical Activity Level 'nelruclton instrUctor Suparvlslon Supervision Resident w/o Superv'slon
AIIt\e beginning Dr
Re palr(resctkln visceral Olrect clinical PGY -4, after initial
anel!!}'sms PGY-3+ tnstrucHon PGY-4+ Le"'eJ'2 Instruction PGYL&.val
Atlt\e beginning of
Direct clinical pay -4. after initial
Elldartjlrectomy PGY-3+ Ins1ruclJon PGY-4+ Level 2 Instrucllon PGYLeve'
AI the beginning of
DireCt clinical PGY-4. after initial
Thr.omboendarlerectomy PGY-3+ Jo.truct'on PGY-4+ Lel/el2 instruc110n PGY Level
Vascular exploration for At the beginning of
Direct clinical PGY -4, after '~ltlaI
Irauma PGY-2+ Instruction PGY-4+ Lellel2 lnslructlon PGYLevel
At the beglhnl,,9 of
Procedures for portal Direct clinical PGY-4, after Initial
hy.Q_erten&ion PGY-3+ Instruction PGY-4+ Lel/el2 lostrucllon PGYLovol
At the beginning of
Vascular resection/bypass tpr Direct clinical PGY -4, after iliitial
ne:ojlla:sm PGY-3+ lostrucHon PGV-4+ Level 2 Inslructlon PGYLevel
At the beginning of
Direct clinical PGV -4, after initial
ExcisIon Orjlancre~lIc 'elson PGY-3+ instruction PGY-4+ Level 2 fr\slrut:lIon PGYLevel
Altha beginning of
Direct clinical PGY -4, after initial
AdrenalectomY PGY-3+ instruction PGY-4+ Level 2 instruction PGYLevel
Alb beginning of
Direct clinical PGY-2. after Initial
Bronchoscopy PGY-1+ histruct!pn PGY-2+ Level 2· InslruGtlon PGYLevel
At !he begInning of
Direct clinical PGY -2. after initial
Thor1lCC&lomy PGY-1+ ("lItructlon, PGY·2+ Level 2 Il19tructlon PGYLeve!
At the beginning of
Direct clinical PGY-3, after initial
Tho(acolomy PGY·2+ instrucllon PGy·a+ Level 2 Insiru~ PGYLevei Approved; September 18, 2002, February 23, 2004

Pagil1'lof 16

Department ot Surgery Raidem ~upervieoln Chart of Clinical Prfvil8lll"

Requirements for
Certification to
Resident Method of Level of levelot Perfonn wlo Direct Method of Conftnning Certlflcatan of
Clinical Actlvitv level lnatruciton Instructor Supervision Supervision Raldent wlo SUpill'YJ.lon
At the beginning. of
Direct clinical ~Y -4. ·lifter iniilal
Sternotomy PGY-3+ instruction PGY-4+ leYel2 InslnJCtJon PGYlave'
Attnabeglnning of
Direct clinical PGY -3, after Initial
Rib excision PGY-1+ l!lIJ1I1IcIion PGY-3+ Level 2 InslIUcUon PGYlevel
AUlie beginning of
Direct clinical PGY -4, after Inlllal
Decortication PGY-1+ instruction PGY-4+ level 2 InstructIon PGYl..eVI!I
Atlhe'beglnnlng of
Direct c:llnical PGY-4. afterlnitJal
Pleurodesis PGY-1+ lnlllrucllon PGY-4+ leyel2 Ins!I:UcUon PGY Level
At tile beginnIng of
Direct clinical PGY -4. after inilial
Pleural biopsy PGY-1+ instruction PGY-4+ Level 2 InslrucUan PGYleyei
At the beginning of
Direct clinical PGY-4, after initial
lung biopsy PGY-2+ InBtructlon PGY-4+ Level 2 Instruction PGYLevel
At !he beginning of
Direct clinical PGV-4. after initlal
Pneumonectomy PGY-3+ InBtruction PGY-4+ level 2 Ins1rucllon PGYLeYei
At the beginning of
Direct clinical PGY-4, after Initial
Lobectomv PGY-3+ instrucllon PGY-4+ Level 2 Instruction PGYleyel
At !he beginning of
Direct clinical PGY -3, after initial
Thoracoscopv PGY-l+ InslrucUon PGY-3" Level 2 Instruction PG:fLeyel
At the beginning of
Direct clinical PGY-3, after initial
Closurll o.f Ch851 wBil defect PGY-l+ Instruction PGY-3+ lLelleL2 Instruction PGYLevel
At the beginning of
Direct clinical PGY -3, after Initial
Perlocariocenlesls PGY-l+ Insl(u.ollon PGY-3+ level 3 Inslruction PGYleyel Approved: September 18,2002, February 23,2004

D.partmlllt or SUrgery Reeldent Supervisoin Chart of CUnica! Privilegee

Requlrwmenw for
CartJfloatlon to
R .. rdent Methodaf Levalor Level or lI.nonn wlo Direct Metnod of Conftnnlng CertiIIcetan of
Clinical Activity Level Inattuciton lnatruc:tor Supervision Supervision Realdent w/oSupervl.iqn
Alltle beginning of
Direct clinical PGY -a, after initial
.Percardjectomv PGY-1+ in$lruC1iDn PGY-3+ Level 2 .IIlSI!:uClion PGY Level
At !he beginning Of
Direct clinical PGY -3, after initial
Ligate/repair bleedillQ vease! PGY-1+ iDSlruciion PGY-3+ Level 2 In&irucUOn PGYLevel
Alltle beginning of
Pacemaker, Direct clinical PGY -3, after inillal
IpJecementlremoval PGY-1+ InBlruclion PG),-3+ Level 2 Instruction PGYLevel
At the begfnnlng of
Direct clinical PGY -4, after Initial
Excision of m~astioal tumor PGY-2+ Instruction PGY-4+ Level 2 instruction PGYLevel
AI !he beginning of
Excision of media&tlnallymph Direct clinical PGY -4, after Initial
nad85 PGY-2+ inltructlon PGY-4+ Level 2 Inetruction PGYl:l!lvei
At the liegrnnlng Of
Direct clinical PGY -2. after initial
Laceralion repair PGY-1+ insllUclion PGY-2+ Level. 3 Instruclion PGY Level
Direct clinical At the beginning of
PGY -2, after inillal
Diagnolltic periloneallavage PGY-1+ Instruction PGY-2+ Level 3 ioetruction PGYLevei
At !he beginning of
Direct clinical PGY -2, aIIar InlIiaI
Trauma U(lresonograOhv PGY·1+ inalNCUOn PGY·2+ Level 3 Instruction PGYLevel
I\l the begInning of
Direct clinical PGY -2, after initial
Wound eXj.lloralfon PGY·1+ insIItICIlon PGY-2+ Level 3 instruction PGYLevel
f\tlhe beginning of
Dlrecl clinical PGY -2. after iniUal
Closed reduction of fractures' PGV·1+ Inslruclion PGY-2+ Level 3 Instruction PGVLevel
AlIIle b8Q1nnfng of
Open reductionlflxatlon of Direct clinical PGY -3, after lnillal
fractures PGY-1+ Instruction PGY-a+ Level 2 Ilnstructlon PGYLevel Approved: Seplember 18, 2002, February 23, 2004

Page 1:l of 16

'.

Department or Surgery RMldent Supervieoin Chart of Clinical Privileges

Requlramenta for
CeItJfiaItIon to
R_ldent MIIthocI or Lev.lot LeHlof PMarm wlo DINCt ~ of ConfInnIng CeItifIc:aN1 of
Clinical Activity Level Instruclton InatNctor SuptllVielon SuperWllon R_lcSent w/o'Supervhllon
At the beglnrMg of
DIrect clinil;al PGY -2. after initial
Decompression faeciotomv PGY-1+ Instruction PGY-2+ Level 3 I(,s!ruction PGYLevei
- At !he beginning of
Piract clinical PGY-2. after l!lilial
Treatment of dislocation PGY-1+ 1DIitI'UCIIon- PGY-2t Lavell Instruction PGYLevel
AI·the beglnnl~ of
Direct cllnil;al PGV-4-. afterlnltJal
INephrorrhaphy PGY-.2+ io.!ructlon PGY4+ Level 2 inalrucUon PGYLovel.
1J.!he beglilning of
Direct clinical PGY -3. after initial
CVlilDrrhaohvlDiadder ~ PGY-1+ Instruction PGY-3+ Level 2 Instruction PGYLevel
At the beginning or
Direct clinical PGY-4, after initial
Craniotomy PGY-2+ instruction PGY-4+ Levill2 inslNclion PGY Le~el
DIracl clinical ~ VI8~nrung or
PGY4, after InIUaI
Placement of ICP monitor PGY-2+ Instruction PGY-4+ Level 2 1n&1ruCIIon PGY Level Approved: Seplember 18, 2002, February 23, 2004

Paae1601111

Clinical Activity

. _. . • _P,,!p':a!'!lT!l!l"!t o!!ial-!ro.h?g.l~I.~~rse!y _.

_. __ !te~I!!!"..! ~!!~I~~ c.~.~!!~!,~I!nli~1 Pr!~"!Q1IS ,

, i ' , -

.. - .,- -r-'- 1 ·-------l~:~~:.~:::f6r· .. 'I- - .

:Resldent ! Method of Level of Level of Perform w/o Method of Confirming Certlflcaton of

'Level IIMtn1clton In.tructor Supervision Supervision iResidentw/o SupIJVI,lon

I Altha beginning of' I

,DI/$ctcllnical PGY-1, aftBl'lnitial

_!~c;Y.:!:!_ lln.!~EI!on __ PGY:!!:._r!:-ey~_L_ ~structlo.!!__ ,_ ,. ~~ Level_

AI the beginning of

iDirect clinical PGY-1, after Inillal '

._ :PGY-_l~. _i~~tructlofl__ PGY-2+ Level 3 InsltUallon ...• _J~G"!'. Level At ttla begfnning of _

'Direct eUn leal PGY -1. after initial i

~PGY..:1: "ji;i'P-C'1ol). PGY-2+ leyeI3.. . • ..:l~!!!IP~ _ .. _. !F'qv Level

I At. the beginning of I

Olrectclinlcal PGY-1, afterinlUal

I PGY-l + :lnstrucUon PGY·2+ Level 3 instruction IpGY Level

- :' - - -Ji5irectdlnlrii,.ii-- --- ~- r-' .... _- -fnitlel dlrec! cllnleal rSu'perliiBing faculty judgment of

SubsequentlCU evaluation ;PGY-2~. 1!!J!!~~'l. __ FacuJ!L_.!:!V!l_ ~ __ 1~8truotJo_n •• ~r~I~~ars capability

I Direct clinical Inltil1ldlrlNlt cllnlC81 SUp8NJslng faculty judgment of

!PGY~~: IIn_!tru~_ ._.IFa~ Level2 \~Ii\Icl~_ ...... !~dlVh:ll!al's capabNlty

lOlreal olInlca1 ! ,Inftlal direct clinical·· Supervising faculty Judgment of

!P~Y.~!. _"IJ!'IP~UE.!". iFacul!L... !:!.~~ in8~cIIon __ ... lndl~ldual's Capability

, ,Direct ollni'iifl Initial direct clinical ISuPervlsmg faculty judgment of

!f'GY~2+ .·!ns~£!!.o~. ~_~F!~ !:.~el2_ _ I~~~~~.n_ _ _ In~MdiJaI'scapability

; r~lrecl ~(nlcal ,lniUal dIrect clbilcal lSuparvlslng facully judgment of

,;PGY.~+ . !In.sln!cti~n _ . __ !~~u!!t_ ~e~12In8~!l!fpn .. __ . i!ndlvldUal'8,capablllty

!Oirect cI,inicaJ ~ .. . IniUal dJrect clinical Supervising 'aGIlity judgment Qf

,PGY-2+ lllnlt~o,'p. ('I _ !'.!!!'-'.1!L_ l:-!!! L_,-., ln8wc_!lCl!!.. " lindl,vldual's capability

I Dlrecl clinical

'PGY-4+ ;In_s_l!'U,?!I~n _ I.F~..!!l_ ~11_. - .. l~- . __ ... __ . 'N/A

,Direct clinical 1 '

PGY-4+ Instruction iF_e.c~L. LII:!11. .N!A ,__ N/A

Direct clinical I

.PGY-4+ instruclJon ,Facul\Y Lavel1 'N/A N/A

Evaluation of ER patient

Admission H & P

Evaluation of Floor patient

Inillal evaluation of ICU patient

A5sesment of inpatient

Lumbar Puncture

\I.p Shunt Tap

Insertion lumbar drain

Review CT Scan

V'P shunt placement

Craniotomy for tumor

CraniotomY for nematoma

Approved: September 18. 2002, February 23,2004

Page 1 of2 (5129/07)

Craniotomy for aneurysm

Direct clinical ~

_.!PGY-4+ __ l!l~~~!o!! __ E.a~.1 __ r!:-e~e!.!..... __ NLA_. _~_~ __ '~.'~' Dlrecl clln.lcal

_ _!)!I~Y:4!_ !_n~~ F8CI.!1!l_ _ L.ey8I _!__,. N/A _ _ ~IA _ ..

DItKt oIlnlOliI

IPGY-4+ Ioiiructlon Faculty level t NiA N/A

. - . -nlrej£Jin~-~~ -------------1---"

IPGY-4+ InslnJc!IOIl, Faculty Level 1 NIA IN/A

i~-~~~ ~~11 _WA ~~~_

I

Spinal decompression

Nerve decompressiol)

N8MJ transposition _

Lav.l1: Clinical activities requiring attending ltaff physil:llily present lind directly IUparviIU the procedure

Level2: Clinical KtMties requlrt~g attending staff phyllcaJJy pn.ent In iaclllay or campul and i. I -_ ...

Immediately Ivallable for conaultatlon t

Level 3: Clinical AclMtI .. Requlrlngtnltlillnslruotlon Prior to Parformlll1l without Suporvhllon-- --

Approved: September 18, 2002, Febru;uy 23, 2004

Page 2 of2 (5129/071

Department of Otoleryngology Realdent Supervisoln Chart of Clinical Prlvllegea

Level 1: Clinical actlvltias requiring aHendlng staff physically present during key portion of procedure or Immediately Ivallable Level 2: ClinicalllCtlvltl .. requlrtng attending eta" or upper I.vel re.ldenl phplNII), pre.enl In f .. 1II1)' or •• mpu. enel Ie Immediately even.ble for _naultetlon

Level 3: Clinical Adlvities Requiring Initial Instruction Prior to P.rfonning without Supervision

Requirements for Certification MethOd of Conflnning
I.evelof Lavelof to Perfonn wlo Direct Certiflcaton of Resident
Clinical Activity Method of In&tl'uclton Instructor SupervlsJon Supervision . w/o Supervision
Senior At the beginning of residency,
Admission Direct clinical instruction Resident L.evel3 after Initial instructlon PGYL.evel
senior At the beginning of residency,
H&P Direct clinical Instruction Resident l.avel3 after initial Instruction PGYLevel
Simple and complex facial Senior
laceratlons- Direct clinical Instrucllon Resident l.evel3 Initial dlrecl clinical instruction PGYLevel
Senior
Fine needle !OIsplrl!lllon Direct clinical instruction ~esident l.evel3 Initial direct clinical Instruction PGYLavel
Placement of teeqlng_ SeniOr
lub_es Direct clinical instruction Resident l.evel2 Initial direct clinical instruction PGYl.evel
Tracheostomy lubEo Senior
tIlange Direct clinicallnatruclion Resident L.evel2 Initial direct clinical instruction PGYLevel
Close(freductlon 9f IlI,isaJ Senior
fractures Direct clinical Instruction Resident Level 2 Initiel direct clinical instruction PGYLevel
Drainage of perioionslllar Senior
absceases Direct clinical ins_truction Resident Level 2 Initial direct clinical instruclion PGYLevel
Incision and qralnage of
5iJperllciai face and neck Senior
abscess liS Direct clinical instruction Resident L.evel2 Initial direct c1inicallnstruction PGYLevel
Senior
Conlral of epistaxis Dlreol clinical inslructioo Resident Level 2 Initial direct clinical instruction PGY!.evel
Senior
FiberapUc laryngoscopy Direct Clinical Instruction Resld.ent L.evel2 Initial direct clinical instruction PGYLevel
Removal of foreign bodies
01 the external audlotry 8.enlor At the beginning of PGY-1, after
can8lorn~ Direct clinical insh1Jcticfl Reslden! Level 2 initlallnstrucllon PG¥ L.evel
Mll}cir blopsls·e of lI\e head Senior At the beginning of PGY -1, after
and neck Direct dinlcalln~1;l1cn Resident Level 2 Initial instruction PGYlevel
ORIF mandihle or mklls.oo Senior AI the bilglnnlng of PGY·1, efill(
fractlJres Dlr:act clinical InstrucUon Resident Lsvel2 infllalinstructicm PGYLsllel Approved: September 18, 2002, February 23,2004

Page 1 of 2

Department of Otolaryngology Realdent Supervilloin Chart of Clinical Privileges

Requirements for Certification Method of Confirming
Level of Level of to Perform WiD Direct Certlflcaton of Resident
CUnlell! Actlvtty Method of Inltruclton tnstruotor Supervl.lon 8upervl.lon w/o Supervl.lon
Trad1l1OslO(Tly/EmergDllt Altha begltlnll'lg Or"PGY"1, after
CrlocolhWolllolomy Dltelll. clinical inslrucUon" Faculty_ Level'2 InltlaJlnslrucllon PGVLevel
Senior At the beginning of PGV-1, after
PET's Dlred cUnlcal ii'lslnrcrlJon Resident Level 2 Inltlallnatructlon PGVLevei
Senior At the beginning of PGY-1, after
Paper patch myringopla&ty Dlfec! dll)lcallnatrucUon Rilaldant Level 2 Initial instruction PGVLevel
SterOId Injection of Senior
rurtilnates DlI1!ct clinical Instrucllon Resident Level 2 NJA PGYLevei
Iti8IllDr IAt tne I18glnmng on'I;jY~:l, anar
Kenalog injection Direct clinicallnslructlon Resident Level 2 Inillallnatructlon PGVLevel Approved: September 18. 2002, February 23,2004

Page2of2 (g,ar,\tiODrI: .:1.tJnln.."

Orthopaedic Surgery Resident Supervl80in Chart of Clinical Privileges

Level 1 : Clinical activities '*Iulrin9 attending .LIIt phV.lcally present during key' portion of procedure 01 immediately available Level 2: Clinical actlvlUell requlltng attending ataff 01 upper level resident physically present in faeility or eampua and Ie Immediataly available for conaultatlon

Level 3: Clinical ActJvitle8 Requiring Initiallnatructlon Prior to Performing without Supervision

ReqUirements for
Certlflcallon to
R .. lde.ril Melhodof Ltve] of Level of P&I1orm w/o Dlreet Method of Conflnning Certlflcaton of
Clinical AGtlvlty Level IJlIJtruciton Instructor Supervlalon Supervision R.'.dent w/o Supervision
Direct Clinical InUlal dlrecl clinIcal
Abdominal paracentesis PGY-1+ Instrucllon PGY-2+ Lsvel2 instruallOl1 PGY Level
AI the beglnn~ of
Direct clinical PGY-2, aiter initial
Abscess drainage PGY-1+ Instrucllon PGY-2+ level 3 Inf;ltructlon PGYLevef
AI the beglnnfng or
Direct clinical PGV-1, after initial
AdmISsion PG'y-1+ jnstrucllQn PGY~2 ... Level 3 lmiinlCtltin PGYlevel
AMPUTATIONS - AI the beginning of
DISARTICULATION Direct clinical PG Y -4. after initial
PGY-2,.. instruction PGY-4+ Level 2 InslMlUon PGYLeve1
APPLICATION OF PlASTER At the beginning 01
OF PARIS SPLINTS AND Direct clinical PGY -2,alter initial
CASTS PGY-l+ Instruction PGY-2+ level 3 f(lslrucllon PGY If;IlI8l
Direct clinical Initial dirl!Ct clinical
Artedal calheter PGY·1+ Inal.ructlon PGY,2+ level 2 Instruction PGYLewil
DIrect clinical IhUIal dlr&CI cllnlcal
Arterial punClure PGY-1+ Ins !ruction PGY-2+ leve12 instruction PGYLevel
Arthr~nlesls of knee, Direct clinical Ini1Ja1 dlrecI clinical
elbow. hand. wrist PGY-1+ instruction paY-2+ Level 2 inslrucllon PGYJ,.evel
ARTHRODESIS - VARIOUS AI the beginning of
JCINTS • INCLUDING
SPINAl FUSIONS Direct elinicaJ PGY -4, alter Initial
PGY-2+ InslrucUon PGY..4+ level 2 Instruction PGYlevel
Altha beginning of
ARTHROGRAPHY Direct clinical PGY-4, after Initial
PGY-2+ instruction PGY-4+ Level 2 Instruclfon PGVLev'l
ARTHROPLASTY - At the begInning 01
MULTIPLE JOINTS DJr'eCt clinical PGY-4, attar initial
PGY-2+ instrucUon PGY-4+ level 2 rnstrucliOn PGYlevel "'-_ ... _.-..1. "' __ & ... _L- __ .. ". .... A.AII 110 •• _,._ .. n," "".." .... '"

Orthopaedic Surgery R_ldent Supervlaoin Chart of CllnlcaI Prlvlleg"

Requirement. for
Certification to
Reeldenl Method of Level of Level of Perform wlo Direct Method 0' Confirming Certlficaton 0'
CUnlcal Mllvlty Level Inlltruclton InstructOr Sl_!fItIf"i'Ielcm Supervlel.on Resldent w/o SUJI8IVlllion
ARTHROTOMIES OF ALL Atthe beg!nnlng of
JOINTS Direct clinical PGY -4, alter initial
PGY-2+ In&lrucll,on PGY-4+ Level 2 instruction PGYl.:.ellsl
At the beginning 01
ASPIRATION OF JOINTS Direct clinical PGY-2. alter initial
PGY-1+ Instruction PGY-2+ .Levol3 Jns1ruCllon PGY level
BONE AND SOFT TISSUE
BIOPSY OF At the beginning of
MUSCUL.OSKELETAL. DlrllCl cllnloal PGY -4, after initial
SYSTEM (ALSO PUNCH) PGY-2+ In~lfuction PGY-4+ Level 2 instruction PGYLevel
BONE DRILLING
OPEf{ATlON.INCLUDING AI the beginning of
APPLICATION. OF Ciirect clinical PGY-4. after initial
EXTERNAl PGY-2+ Insl1uClioo PGY-4+ Level 2 InstruatlOfl PGYlellel
BONE GRAFTlNG
PROCEDURES FOR
VARIOUS INDICATIONS, At the beginning of
WITH AND WITHOUT Direct clinical PGY -4. after Initial
FIXATION PG.Y"2+ instruction PGY-4+ Level 2 instruction PGYlevel
Bone marrow aspirallon and Dlrecl olinioaJ Initial dlrecl clinical
biOpsy PGY-1+ l.nslNotion PGY-2+ l-evel2 instructiah PGY Level
Olr6<;1 clinical IniliBldlrect cllnigjl,
Cenl1a! venous catheter PGY·1+ instruction PGY-2+ Level 2 InslrucUon PGYlevel
CLOSED REDUCTION OF
ALL FRACTURES AND
DISLOCATIONS
INDICATED. WITH OR At-the beginning of
WITHOUT INTERNAL Direct clinical PGY"4. after initial
FIXATION PGY-2+ Instruction PGY-4+ Level 2 instruction PGY level
At the ilegln.hlng 01:
Direct clinical PGY·2. after Initial
Closed reduction of lra.Cluro8 PGY-1+ instruction PGY-2+ levol,S inslrucllon PGYLevel
Atlllf;) Ileglnning ot
Direct clinical PGY -4. after Initial
Cranl0tomy PGY-2:+ lnslruclidn PGY-4+ Level 2 Inslrucllon PGY Level Page2of9 IR .. vjqp.n411::tln?\

Orthopaedic Surgery Resident Supervlsoln Chart of Clinical Privileges

Requirements for
Certification to
Raldent Method of Lev.lot j.ev.lof Pertonn wlo Direct Method of Confinning Certificaton of
ClinIcal AcllvllV Level lnatruclton Instructor SUPIII'Vision SUJ)erVia.ion Resident wlo Su~rvl.lon
DEBRIDEM.ENT OF At the beginning of
WOUNOS, OF BACK, HEAD, Oirect clinical PGY-2, after initial
NECK AND EXTREMITIES PGY-1+ instruction PGY-2+ Level 3 instruction PGVlovel
AI the beg!nnlng of
Direct clinical PGY -2, after Inilial
De.oompresslon '(!StllolOmv PGY-1+ instruction PGY-2+ level 3 InslttJ.ctlan PGY level
AI·lhe beginning 01
Develop and document initial Direct clinical PGY-" alter initial
IPlan 01 care PGY-1+ InstructiOn PGY-2+ lel/et3 Instruction PGY!.Bllel
At Ihebeglnnlng 01
Develop differential diagnOSig Direct clinical PGY -', after initial
and problem list PGY-1+ instruction PGY-2+ level 3 ioslruclio,n PGYlevel
AI the beglnning of
Dlracl clinical PGY~1, alter initial
OlQlilte discharge summl!l'V PGY-1+ Inslructlon PGY-2+ lsvel3. Instruction PGYLevel
EPIPHYSEAL ARRESTING Allhe beginnIng of
AND STIMULATIVE Direct clinical PGY-4, after initial
PROCEDURES PGY-2+ instruction PGY-4+ Level 2 instruction PGYLevel
AI the beginning of
Evaluate new and follow-up Direct clinical PGY-" after f.nltial
patients In oulpalienf sel1lng PGY·1+ Instruction PGY-2+ Laval 3 Instruction PGYlevel
Evaluate patients with acute .At the beginning of
medical problems upon Direct clinical PGY-1, after initial
IreQuest of nurs8$ or UPs PGY·1+ instruction PGY-2+ Level 3 Instruction PGYlevel
Atlhe beginning of
Direct clinical PGY-2, after initial
excision benlQnleision PGY.1+ Instruction PGY-2+ Level 3 instruction PGYlevel
At Ille biI.ginning of
Direct clinical PGY-4, after Inlllal
excision mali~nanlleision PGY-1+ iRStrUOtion PGY-4+ level 2 Inslruclion· PGYLevel AnnrnvRrt·l=\p.nlp.mhp.r 1A ?nn? Allnll~t?A ?nn::l

Page 3 of 9 rRevisArt 411 ::1/07)

Orthopaedic Surgery Reeident Supervlsoln Chart of Clinical Privileges

fteqUIN11H1ft18 ,.,
Certification to
Rllllldent Method of Level of Level of Perform wlo Direct Method of Confirming Certiflcaton of
Clinical ActivIty Lev .• ! IMb'Uc!tOn Instruotor Supervlalon Supervision Resident w/o ·5upervJeJon
EXCISION OF BONES
(CARPELS, TARSAL.) AND
PORTIONS OF VARIOUS At the beginning of
BONES (OUTER CLAVICE, Direct clinical PGY-4, after initial
OIST AL., ULNA, ETC.) PGY-2 + lnsttuclion PGY-4+ L.eJle12 Instruction PGYLev&1
EXCISION OF BURSAE Direct clinical PGY -4, after Inltlal
PGY·2+ Instruction PGY-4-t Level 2 InstruCllon PGY Level
EXCISION OF RUPTURES Direct cUnlcai PGY -4, after Initial
INTERVERTEBRAL DISCS PGY-2+ inslructlon PGY-4+ Level 2 instruction PGYLevel
EXCISIONS OF TUMORS,
SOFT TISSUE AND BONE, At the beginning of
FROM EXTREMITIES, Dlrecl clinical PGY-4, after initial
BACK AND NECK PGY-2+ Instruction PGY-4+ Level 2 Instruction PGY Level
FASC!OTOMY AND AI the begUinlhg 01
FASCIECTOMY Direct clinical PGY -4, alter initial
PG-Y-2+ instruction PGY·4+ Level 2 !oslrucl/on PGY'Level
At the begl,nnlng Of
Direct clinical PGY~1, aftllT initial
H&P PGY·l+ instruction PGY-2+ Level 3 Instruction PGYLeIieI
INCISION AND DRAINAGE
OF ACUTE OR CHRONIC
INFECTIONS PROCESSES At the beginning 01
IN NECK, BACK, AND
EXTREMETIES Direct clinical PGY -4, aft.r Initial
PGY-2;, jnstruction PGY-4+ Level 2 instruction PGYLevel
At the beglnillng 01
Direct clink:al PGY·" after Initial
Inillate dlscf:large planning PG'r(·1+ lnslrucllon PGY·2+ Lavel3 InalllJcilon PGYLevll1
INJECTIONS OF JOINTS,
BURSAE, CYSTS· At the beginning of
UDOCAINE, STEROIDS, Direct clinical PGY -4, after initial
ETC. PGY-2+ InsJtUO!lon PGY-4+ level 2 instructlon PGYleve!
Direct Clinical
Insert chest tube PGY-2+ instruction Facultv Level 1 NlA PGY level Approved: September 18, 2002, August 26, 2003

Page4of9 (Revised 4/13/07)

Orthopudic Surgery Residant SupervllOln Chart of Clinical Prlvilege&

.s
Requirementa for
Certifk:atlonto
Reeldent Melhodof Level of Level at Perform wlo Direct Method of Confirming Certificaton of
Clinical Acllvltv leva! lnalru.clton I Mtruofor SIlpenI_Je{on SUf29lVl.fon .Realdent wlo Supervlalon
Insert pulmonary artery DlrBCt clinical
catheter PGY·2+ Il')slrucllon FacUlty Levell NlA PGYLa.vol
Dltect clll)lcal
Insert ur911nal csfhel.er PGY·,+ Instruction Faculty level' NJA PGYleveJ
INSERTION OF ARTIFICiAl AI the beginning of
JOINTS· (METAlLIC Direct clinical PGY·4, after Initial
PROSTHESIS, ETC.) PGY·2+ insltuctlon PGY-4+ Level 2 Instruction PGVLevel
INSERTION OF SKELETAL At the beginning of
TRACTION KIRSCHNER Direct' clinical PGY -4, after initial
WIRES ANO STEIMAN PINS PGY-2+ Instruction PGY-4+ Level 2 Insuu.ctIon PGY Level
Al1he beginning ot
LAMINECTOMIES Dltect clinical PGY -4, after Initial
PGY·2+ Instruction PGY·4t Level 2 Instr,ucUon PGYLevel
Direct clinical Inll1al dlracl clln 1081
Lumbar puncture PGV·1+ instrucllon PGY-2+ Level 2 Instruction PGYLevel
DIreOt clinical At the begInning·ol
PGY-4, after Initial
lymph node dissection PGY·2+ instruction PGY-4+ Level 2 Instrucllon PGYleve)
AI the begInning ot
Direct clinical PGY·1 ,after initial
MOOity dally ptan 01 care PGY-1+ Instruction PGY·2+ Levala Ir\9lrucllon PGYLevel
Allhebeglnnfng of
MVE'-OGRAPHY Olrect clinical PGY-4, litter initial
PGY·2+ Jn81lUl:llon PGY-4+ Levet2 Inslruction PGYLevoJ
NERVE TRANSPLANTS AUhe .~jnnlng 01
AND NEUROl VSIS Direct clinical PGY-4, after initial
PGY·2+ Instruatkln PGY-4+ lel/BI2 fnstruclJon P.G.YLevel
AI the begInning 01
NEUAOARHAPHY Direct clinical PGY -4. after Initial
PGY·2+ Insltuatlon PGY,,* Level 2 Inslruct10n PGYLeval .......................... ...,. ...... ,..'" o"'II"'''_~

Page 5 019

'n_ .. : .'''''Iln,\

Orthopaedic Surgery Reeldent SUpelVisoln Chari 0' Clinical PrivJJegll&

Requirements tor
CertHlcation to
Reardent Millhodot !.eve! of LeYelof perronn wlo DIreCt Method of Conflnnlng Certlficaton of
Clinical Actlvj!y Level 'I18truGlton Inatructor Supervlalon Supervlalon Resident wlo Supervision
At the beginning 01
Obtain informed consent far eaCh Past-Graduate
procedures in Post Graduate Direct clinical Year. after initial
Year SCOpe of_practice PGV+t- instruction PGV-2+ Leval3 insln(ctlon PGYLevel
At [be bilQlnnlng 01
Open reduClionlfixalion of Direct clinical PGV -3. after initial
fractures PGY-l+ instruction PGY-3+ Level 2 inslrucliof1 PGV level
DlrllCl ollniclll Initial direc! clinical
Oral endotrachial intubation PGV-l+ Instruction PGV-2+ level 2 Instruction PGYLeviil
Order consults for diagnostic At the beginning of
studies. evaluation by other each Post-Graduate
LIP •• th.raple ••• peeiallzed Direct clinical V ..... after Inillal
care. or social services PGY-1+ instruction PGV-2+ lavel3 ins1ructlon PGVlevel
Direct cllnlcs.1 Inilial dliect elln leal
Order Restraints PGY-2+ Instruction PGV-2+ level 2 Instruction . PGYLevul
AI [he bilQlnning 01
Orderlinterpret routine Oireot clink:41 PGY -1. after Initial
diagnostic studies PGY-l+ Instruction PGY-2+ Level 3 instruction PGYLevel
OSTEOTOMIES - MULTIPLE
BONES - CORRECTION OF At the beginning of
DEFORMITIES.
SHORTENING. ETC. Direct ctink:ai PGV-4. after initial
PGV-2+ Instruction PGY-4+ Level 2 InslJuctlon PGYLevel
AHA After successful
Certified completion of ACLS
Perform ACLS PG_V-l+ AClS Training Instructor La_vel 3 TraIning PGYlevel
At the beginnIng or
Perlorm and document Direct clinical PGV -1. alter initial
history & physical PGY-1+ in.struction PGY-2+ Level 3 Instruction PGYLevel
ATLS After successful
Certified completion of ATLS
Perform ATlS PGY-l+ ATlS Training Instructor Level 3 Training PGYlevei Page60f 9

Orthopaedic SUfgmy Aesident Supervlaoln Chart of Clinical Privileges

" Aequilementa for
CeltiticaUon to
R .. ldent Method of Levelot Level of Perfonn wlo DIrect Method of Contlnnlng Certlflcaton of
Clinlca, Activity Level Insltulliton Instructor SuDtiVlalon Supervision Resident w/o Su~laIon
PERIPHERAL NERVE At the beginning of
REPAIR Direct clinIcal PGY-4, after Initial
PGY-2+ jnstwction PGY-4+ Level 2 inetru~iQn PGYLevel
Direct clinical I niliall1irect c.linicaJ
Phlebotomy PGY-1+ Instruction PGY-2+ Level 2 Illstnk:!lon PGY,Level'
AI the beginning of
Direct clinical PGY -4, after Initlal
Placement of ICP monitor PGY-2+ InstructIon PGY-4+. Level 2 In-strlJction PGY Level ,
RECONSTRUCTION At the beginning of
PROCEDURES· VARIOUS Direct clinical PGY-4, after initial
JOINTS· HIP, SPINE PGY·2+ In.structlon PGY-4+ Lsvel2 jnslrucllon PGYlevel
REMOVAl OF FOREIGN
AND LOOSE BODIES IN At the beginning of
EXTREMITIES, BACK AND Direct clinical pGY·2, after initial
NECK PGY·l+ Instruotlon PGY-2+ Level 3 Instruclion PGYLevel
Anhe beglnrtlng 01
Direct clinical PGY·2, atter initial
Repair laceration PGY·l+ instwctlon PGY·2+ Level 3 InstructiOn PGYLevel
REPAIR OF ACUTE OF OLD At the begInning of
RUPTURE OF LIGAMENTS Direct clinical PGY-4, alter,lnlllai
ABOUT JOINTS PGY-2+ lnslructloll PGV-4+ Level 2 Instruction PGYLevel
AI the beginning of
Direct clinical PGY-S, alter initial
Alb ellclslon PGY-l+ inslr:uctLon PGY·3+ Level 2 InslfUcUon PGYlevel
SEQUESTRECTOMY AND At the beginning 01
SAUCEAIZA nON OF Direct clinical PGY·4, after initial
INFECiEO SONES PGY-2+ instructfon PGY-4+ Level 2 ;nslrucUon PGV Level
AI the beginning at
Direct clinical PGY~ 1" after initial
Skin graftllllijJ PGY·1+ ioslruction PGY·2+ level 2 Inill~ctlon PGYLevel " ....... _ .......... 0 __ + __ h ..... '1 a '1(\1", A •• ,., ."". ')Q "nn'l

Page7of9

n::a.uill!cu1 A/1":l/m\

Orthopaedic Surgery Resident Superviaoln Chart of Clinical Privileges

RequlremenhJ for
CertHIWlon to
R_ldlnt MethotI of Level of Lev.'o' Perform wlo Direct Method ot Continnlng Certlficaton o.
Clinical AcUvity Level Instrualton Insttu.C1or Supervision Supervision R .. ldent wlo Supervision
SKIN GRAFTS· SPLIT
THICKNESS - PINCH,
PEDICLE, ETC., AS
RELATEOTO At the beginning of
ORTHOPAEDIC Direct clinical PGY -4, after initial
PROe.LEMS PGY·2+ InstructIOn PGV-4+ Level 2 instructlon PGVLevel
At the beginning 01
,Dlrecl clinical PGY -4, after initial
Ste.molomy_ PGV·3+ Inslructlan PGY-4+ Level 2 InslnK:lion PGV'Level
SYNOVECTOMY • AI.the beginning or
Direct clinical PGY -4, after initial
MULTIPLE JOINTS PGY-2+ inslruction PGY·4+ Level 2 in.strucllcn PGYLeWl
TENDON FIXATION AND
SUTUFIEAND Allh. bqhning of
TRANSPLANTS AND Direct clinical PGY-4. after Initial
TRANSFERS PGY-2+ IlTstruclion PGY-4+ level 2 Inslfuetion PGY leiIal
DIrect clinical In1tl.sl dlrecl'cllriicai
Thoracentesis PGY-1+ Instruction PGY~2+ Lavel2 Instrucllon PGY LBve.1
AI the begJnnfng 01
Direct cUnicai PGY·3. after initial
Tracheostomy PGV-1+ instruction PGY-3:t- Level 2 instruction PGYLellel
At the beginning of
Direct clinical PGY ·2', alter InitlaJ
Trauma Ulirssonography PGY·1+ inst(Uction PGY-2+ LevEil3 Instruction PGYLevel
AI the beginning of
Direct clinical PGY-2, alter lni1laJ
Trealment of dislocation PGY-1+ instruction PGY-2+ Level 3 Instruction PGYLe'olel
A_t the be9innlt19 01
Direct clinical PGY·2, after lriitial
Wound exploration PGY-1+ Instruction PGY·2+ levelS [nstructlon PGYLe~el
AI the beginning 01
Direct clinical PGY·.1. after Initial
Write daily progress noles' PGY·1+ Jnsltuctlon PGY-2+ leI/ala Instruction PGYLellel Page 8 of 9 (Revised 4113107)

Orthopaadlo Surgery ResIdent Supervleoln Chart ot Clinical Privileges

Requlrementll tor
certification to
RNltlent Melhodot Lev.lof Level of Perto~ w/o Direct Method of Confirming Ccwtitic:aton ot
Clinical ActIvity Level Irwtruclton Instructor SUiH!fYlalon SuwvlsJon R8IIId •. nt wlo Superv~lon
Write orderlilor roullne
dlagnostlo studies, Altha beginning of
medications and other care Direct clinical PGY -1, after InIiiaJ
moclalWes PGY-l+ Instruction PGY·2+ Level· 3 Inslruc!Jon. PGYlevel Page 90! 9 I Revised 4113101)