I. Purpose:  To delineate policy and procedures concerning oral and maxillofacial surgery resident supervision.

II. Policy:  Community Medical Centers’ Ambulatory Care Center Oral and Maxillofacial Surgery Service provides appropriate clinical supervision for Community’s Oral and Maxillofacial Surgery (OMFS) residents. Robert S. Julian, D.D.S., M.D., is director of the OMFS Residency. Dr. Julian is responsible for the quality of the dental/medical education provided to OMFS residents and for ensuring that the program is in compliance with ADA post-graduate education standards. Community’s OMFS Service provides faculty supervision and residents the opportunity to assume increased responsibility for patient care according to their level of education, ability and experience, as determined by their faculty supervisors.

  1. This increase in clinical responsibilities shall be determined by the following criteria:There will be increasing levels of a resident’s clinical responsibilities as he/she moves through four years of post-graduate training. The appropriate level of supervision for such residents by the OMFS attending is based on the nature of patient medical/dental problems and the experience, judgment and skill of the resident being supervised. Third- and fourth-year OMFS residents can serve in a direct supervisory role of first- and second-year residents with the attending OMFS taking ultimate responsibility for all such patient care via indirect supervision.
  2. There will be resident evaluation/promotion criteria to assist attending OMFS staff in determining advancement between levels of responsibility. Competency-Proficiency Statements are used by the OMFS Education Program to evaluate residents every four months.
  3. This OMFS residency program will provide attending supervisors with a mechanism for assessing a resident’s clinical judgment and skills to identify one who is not achieving the progression in necessary skills. This mechanism is found in the Documentation Protocol for Goals, Objectives and Competency-Proficiency Statements of Graduates of the UCSF Fresno Oral & Maxillofacial Surgery Residency Program. The evaluation document and its essential elements are provided to each resident upon entry into the four-year OMFS residency.
  4. There will be decreasing levels of attending supervision for a resident who logically progresses in skill base with increasing independence. This will be accomplished by faculty certification that a competency or proficiency statement has been met. Progressive levels of competency would allow for decreasing levels of supervision for a particular skill or procedure.

III.  The Oral and Maxillofacial Surgery Residency will provide quality patient care services through its residents, in conjunction with attending supervision that is at or above the community standard of care.
The mechanisms for achieving this are as follows:

  1. The levels of clinical responsibilities awarded to each resident are defined by resident year (PGY 1, 2, 3, and 4) in terms of specific procedural resident competencies that may be performed without supervision. For the OMFS program procedures and skills, please refer to sections 2 and 3. These resident competencies are available to inpatient/outpatient clinical staff electronically or in hard copy so the community standard of care can be assured in either setting.
  2. A supervising attending OMFS surgeon must be available to oversee the resident staff for the entire duration of patient care within the hospital, ambulatory care or emergency service site.
  3. Supervising attending OMFS surgeons may only supervise residents in areas/procedures which they themselves hold clinical privileges within the Community Medical Centers health care system.

IV. The Oral and Maxillofacial Surgery Residency ensures there will be sufficient and appropriate attending-resident communication to provide the very highest quality of patient care and enough supervision for an excellent educational experience.

This will be done in the following manner:

  1. There will be a mutual responsibility to recognize the need for increased communication and supervision under the following circumstances:
  1. A significant deterioration in clinical status
  2. Any patient with a high risk condition (critically ill, airway or bleeding concerns)
  3. Uncertainty regarding the diagnosis
  4. Uncertainty regarding the proposed clinical management of the patient
  5. Patients requiring procedures or interventions, which entail significant risk
  1. The nature of this communication between the attending OMFS surgeon and the resident would by as outlined under levels of supervision in section II, 1. Essentially, increased levels of communication would translate to increase levels of supervision required to assure the highest standards of patient care.

V.  The Oral and Maxillofacial Surgery Residency will actively monitor and document the resident-attending communication and supervision in a way that demonstrates the high quality of patient care given and also satisfies the needs of all relevant accrediting bodies.

This will be accomplished in the following manner:

  1. There will be an OMFS residency specific policy-procedure for an active monitoring-feedback process to the Program Director or designee, at each appropriate affiliated site, in conjunction with the performance improvement staff at that facility. This would include, but not be limited to the following elements:
  1. Admitting orders must specify the attending OMFS surgeon of record.
  2. Evidence of daily communication between resident and attending staff should be documented in the patient’s medical record by the attending or, at his or her request, by the resident referencing the communication.
  3. The attending faculty on the requesting service should approve consultation requests.
  4. Completed consultations should include evidence of faculty participation and supervision within 24 hours of completion by the resident staff.
  1. The Program-Specific monitoring-feedback process with the Performance Improvement (PI) Staff to the OMFS Program Director or designee at the facility will be as follows:

The PI staff will review records for proper documentation as well as progress in developing the documentation for the required competency-proficiency statements under each OMFS Residency goal.


Extraction, erupted teethXXXX
Extraction, impacted teethXXXX
Biopsy, soft tissueXXXX
Biopsy, boneXXXX
Repair laceration, simpleXXXX
Repair laceration, complexXXXX
Arthrocentesis, TMJ  XX
Steroid Injection, TMJ  XX
Arch bar, applicationXXXX
Arch bar, removalXXXX
History and PhysicalXXXX
Airway management, intubation XXX
Application of local anesthesiaXXXX
Arterial Blood Gases XXX
Arterial Line, application/removal (A/R)XXXX
CPR, closedXXXX
Closed Reduction, Facial Fracture(maxilla, mandible, nasal) XXX
Cast/splint (A/R)(for fracture, protection, immobilizationXXXX
Central Line (femoral, jugular, subclavian), Insert   X
Central Line (femoral, jugular, subclavian), RemoveXXXX
Chest Tube, insert   X
Chest Tube, remove XXX
Conscious Sedation  XX
Cricothyroidotomy, emergency  XX
Cultures (wound, urine, sputum, blood)XXXX
Defibrillation, emergency (ACLS protocol)XXXX
Drainage tube (not chest or mediastinal), insertXXXX
Removal of drainage tube (all)XXXX
Drug administration, IMXXXX
Drug administration, IVXXXX
Endotracheal SuctioningXXXX
Endotracheal/nasotracheal intubationsXXXX
Foley Catheter (I/R)XXXX
Incision and Drainage, abscess, cyst, seroma, hematomaXXXX
Laryngoscopy XXX
Fiber optic Nasopharyngoscopy  XX
Nasal Packing, anterior and posterior (I/R)XXXX
Nasogastric tube(I/R)XXXX
Other resuscitationXXXX
Other wound care, change/replace dressing, cleanXXXX
Percutatneous needle aspiration (biopsy or drainage)XXXX
Perform/interpret lab tests (hct, ua, EKG, gram stain)XXXX
Remove foreign bodyXXXX
Sutures/staples (I/R)XXXX
Swan Ganz Catheter, insert   X
Swan Ganz Catheter, removeXXXX
Thoracentesis   X
Tracheotomy, emergency  XX
Venous line (I/R) XXX
Wound DebridementXXXX
Scar Revision XXX
Excision of Cyst, Tumors of the maxillofacial area XXX
Dental Implant (I/R) XXX
Repair of Dentalveolar injuriesXXXX
Endodontic surgery (apicoectomy) XXX
Maxillary Sinus Aspiration and Lavage with culturesXXXX
Office Visit, simpleXXXX
Office Visit, intermediateXXXX
Office Visit, ComplexXXXX
Post-operative office visitXXXX
RFTA palate (radio frequency tissue ablation)   X
Uvulectomy  XX
Excision of Mandibular/Maxillary tori (exostosis)XXXX
Caldwell-Luc with nasal antrostomy  XX
Surgical Drain (I/R)XXXX

Program Director Message

Robert Julian

Robert Juilian III, DDS, MD, FACS

Chief and Program Director

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