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4. Emphasis on gaining experience with full spectrum of procedures, honing proficiency, and balancing quality of patient evaluation and care with improved overall efficiency. Demonstrate ability to suture and operate on cutaneous and subcutaneous tissues independently. All surgical procedures deep to the subcutaneous tissue require supervision by senior residents or attending staff. 5. May start IVs, and draw arterial and venous blood gases independently. Placement of central lines, arterial catheters, and chest tubes are to be done under direct supervision until expertise has been demonstrated. 6. No responsibility for supervision or direction of decisions of other residents. 7. Responsible for day-to-day care of assigned inpatients and consults and serving as a resource for day-by-day patient data to upper level residents and attending staff. 8. Decisions regarding invasive procedures, change in plans, discharge or problems are discussed in-depth with the attending. Specialized diagnostic studies, uncommon therapeutic interventions, and use of consultants, must be discussed with the attending prior to initiation. 9. Responsible for maintaining medical records. PGY-III In addition to the roles and responsibilities of PGY-I through PGY-II: 1. Increased teaching, consultative and research activities. 2. In addition to the technical procedures for PGY-II, may insert chest tubes when necessary without direct supervision. May perform bedside surgical and diagnostic procedures without supervision as approved by attending staff. 3. May attempt or initiate all bedside procedures, with attending approval. 4. May assist with the attempt, or initiation of, procedures by more junior level housestaff, with attending approval (and if so certified by the residency training program, as appropriate.) 5. Responsible for day-to-day care of assigned inpatients and consults and serving as the principal resource for day-by-day patient data to upper level residents and attending staff. 6. Responsible for running evening rounds at evening change of shift and for providing a teaching discussion presentation at morning board rounds. 7. Responsible for maintaining medical records. PGY-IV In addition to the roles and responsibilities of PGY-I through PGY-III: 1. Supervisory role over junior level residents, with increased teaching and consultative responsibilities as second call. 2. May carry out and supervise bedside surgical and diagnostic procedures without supervision as approved by attending staff. 3. May initiate all operative procedures, with attending approval.
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