Formal training in hand and upper extremity is an integral component of the current orthopaedic training program.
In addition to the existing weekly Hand Conference schedule, the hand fellows participate in Tumor Conference, and basic science and upper extremity topics covered in the Pediatric Conference. The existing monthly journal club will continue to include upper extremity topics. The hand fellows are expected to attend and participate. Upper extremity articles are assigned to the fellow by the chief resident for presentation and discussion. This conference (optional for resident staff) emphasizes selected articles from the Journal of Hand Surgery (American and British volumes) and the Journal of Microsurgery. Articles for discussion are selected by Dr. Koman and the fellow and discussed by the fellow, residents, and hand faculty. Coordination of the Hand Journal Club will be the primary responsibility of the fellow.
Formal pre-operative conferences are held once per week on Monday from 7 am to 9 am. Cases for the week are reviewed. The fellow and resident attending each present one or 2 cases that have been posted for at least one week and describe the clinical history, physical exam, and radiographic findings, the differential diagnosis, and alternative management options, indications for surgery, surgical options, post-operative care, and expected outcome. The remainder of the cases will be presented by the attending or staff and follow similar guidelines.
The fellows attend orthopaedic complications conference (Morbidity and Mortality) once per month and are expected to discuss upper extremity morbidity or complications. The hand fellows attend Orthopaedic Grand Rounds and present upper extremity cases when assigned by the administrative chief resident.
The fellows attend bi-weekly Musculoskeletal Pathology Conference and are expected to present one or 2 conferences per year as assigned by the administrative chief and our musculoskeletal oncology faculty. The fellows attend trauma conference as appropriate.
The weekly Hand Conference is the central educational component of the fellowship and the primary upper extremity resident conference. It is held 46 times per year. The Hand Conference is divided into 3 components: 14 hours of didactic lectures, 22 hours of Socratic case discussions, and 10 hours of anatomy. Fourteen (Core) one-hour didactic lectures will be given by the faculty. Other dissection/prosections utilizing embalmed and fresh-frozen extremities will highlight the anatomy component of this conference. These dissections are performed prior to the conference by the basic science residents who, with a faculty supervisor, then present the prosection to the group. This anatomy experience has been greatly enhanced by access to fresh-frozen cadavers which are obtained through the Anatomy Department through a special cooperative effort with the Department of Orthopaedic Surgery. The hand fellow is expected to assist the basic science residents with their dissections. Additional cadaveric and fresh-frozen specimens are provided for the hand fellow who shares this additional experience with the resident staff. The remaining Socratic case discussion continues to be headed by the faculty. The fellow and resident staff are responsible for briefly presenting upper extremity cases seen through the emergency room and bringing x-rays if appropriate.
Hand conference format consists of a 30 to 40 minute presentation as described in the conference schedule. Each fellow typically presents 2 to 3 topics during each calendar year, and is responsible for overseeing the anatomy dissection with the basic science resident. Following the presentation, there is a 20 to 30 minute discussion of OITE or OSAE questions pertinent to the topic of the week. The fellows are responsible for organizing and presenting the questions. Also included are brief journal articles from the prepared syllabus that the fellows are responsible for assigning to hand service residents and themselves to present.