All residents have in-house coverage by an attending physician at all times, 24 hours a day. Specific procedures may be indicated, however, without the attending actually present in the delivery room, the operating room, the emergency department, the clinic, or a patient treatment area. The following categories of residents have been authorized to perform the following procedures without the attending physician in the respective room at the time of the procedure.

FOURTH YEAR RESIDENTS:

(ON SECOND CALL AT HOME – WITHIN 15 MINUTES FROM THE HOSPITAL)

OBSTETRICS

• Spontaneous vaginal delivery – vertex
  
• Episiotomy and repair, repair of all lacerations
  
• Low forceps and vacuum deliveries
  
• Mid forceps (non-rotational) and vacuums
  
• Breech delivery with attending summoned
  
• May start cesarean section in an emergency situation with the attending summoned
  
• Amniocentesis
  
• Second trimester abortion using Prostaglandin E2
  
• D & C for postpartum hemorrhage/retained placenta
  
• Postpartum tubal ligation
  
• External cephalic versions

OPERATING ROOM

• D & C, conization, D & E
  

• Tubal ligation (open, laparoscopic, postpartum)
  
• Diagnostic laparoscopy and hysterescopy
  
• Cesarean section with the attending summoned
  
• Emergency laparotomy with the attending summoned

OBSTETRICS
• Identical to fourth year resident
  
  
OPERATING ROOM
• Identical to fourth year resident

SECOND YEAR RESIDENTS:

OBSTETRICS

• Spontaneous vaginal delivery – vertex
  

• Low forceps and vacuum deliveries
  
• Episiotomy and repair of lacerations
  
• Amniocentesis
  
• May start cesarean in an emergency with the attending summoned

OPERATING ROOM

• D & C

In general, direct supervision in the respective suites is required of all first year residents. During the 1^st. year, however, the resident is cleared on an individual basis to perform basic and minor procedures by the teaching attendings and senior residents. Upon verbal clearance to the respective nursing staff, the first year residents are authorized to perform circumcisions, pelvic exams, insertion of intrauterine pressure catheters, and spontaneous vaginal deliveries – vertex. The nursing staff is encouraged to contact the senior resident, attending or Chairman with any questions concerning resident authorization.

By the end of the first year, when the 1^st year resident begins his/her "night float call", they are additionally cleared to start emergency cesareans and have the same authorization as do the 2^nd year residents, unless otherwise so informed.