Hand Surgery Fellowship Training Program

Fellowship Overview

The Walter Reed Hand Surgery Fellowship is one of only two orthopaedic fellowships in the U.S. Army. It is twelve months in duration and trains two fellows per year. It is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME). The most recent visit by the Residency Review Committee was in 2013, at which time the fellowship was given a full eight-year accreditation. Both fellows begin on August 1 of the year of their academic hand surgery fellowship appointment.

Six months of training occurs at the Union Memorial Hospital Curtis National Hand Center in Baltimore, Maryland, under the direct supervision of over a dozen experienced hand surgeons with orthopaedic and plastic surgery backgrounds. During this portion of the year, the Walter Reed fellow trains with three Union Memorial hand surgery fellows. The eclectic combination of surgeons, fellows, hand therapists, and patients makes the experience truly unique and broadens the fellow’s repertoire of surgical technique and philosophy.

The hand surgery fellow spends the next five months at Walter Reed National Military Medical Center, a worldwide tertiary referral center for conditions of the upper extremity. At Walter Reed, the hand surgery fellow participates in orthopaedic resident education through direct supervision of residents and by providing didactic lectures on care of the upper extremity. The Walter Reed fellow is the focal point in the planning and performing of all hand surgery activities at Walter Reed Army Medical Center. The fellow also performs surgery with Walter Reed hand surgery faculty at the Kimbrough Ambulatory Care Center, a state of the art surgical facility at nearby Ft. Meade, Maryland.

A one month rotation is offered at Texas Scottish Rite Hospital in Dallas, TX to broaden the fellow experience in treatment of pediatric and congenital differences of the upper extremity. This experience is under the direction and mentorship of Mary Beth Ezaki, MD, world renowned upper extremity surgeon and co-director of the University of Texas Southwestern Hand Surgery Fellowship.

The Walter Reed hand surgery fellow is exposed to the full breadth of hand pathology, including complex war and industrial injuries, acute high- and low-energy trauma, post-traumatic conditions, congenital differences, disorders from repetitive motion and overuse, and arthritic deformities.

Exposure to micro vascular surgery occurs at both training locations in the form of replantation, revascularization, free-tissue transfer and nerve reconstruction. In addition, the hand surgery fellow attends a formal microsurgical course at the Uniformed Service University of the Health Sciences during the academic year. Microsurgical training is also instructed at Union Memorial’s microsurgical laboratory. Fresh cadaver specimens are readily available at both training locations for in-depth anatomy review. The research facilities at both training locations are well-developed, highly capable, and accessible to the hand surgery fellow. Journal club, preoperative conference, indications conference, and an aggressive hand surgery lecture series are activities that are ongoing throughout the year in training.

Walter Reed Army Medical Center and the National Naval Medical Center combined in 2011 to form the new Walter Reed National Military Medical Center, and moved into new and renovated facilities in Bethesda, Maryland. The basic structure of the hand surgery fellowship has not been changed by this realignment. With the consolidation of resources and a new, state-of-the-art facility, the hand surgery fellowship only continues to improve in quality and depth.

Applicant must be a graduate of an accredited Orthopaedic, Plastic or General Surgery Residency program and be ABOS Board certified or eligible. Applicant must be a citizen of the United States and willing to serve on active duty in the United States military. Graduates incur a two-year professional active duty service obligation for the fellowship. This obligation can be served concurrently with pre-professional obligation (ROTC, service school, HPSP, and USUHS).

Objectives

• To train fellows to become independent, self-sufficient hand surgery specialist able to function as the sole hand surgery specialist at a medical facility.
• To provide training in care of traumatic upper extremity injuries including: bone, nerve, vessel, and soft tissue.
• To provide training in diagnosis and care of congenital anomalies of the upper extremity.
• To provide techniques as they pertain to vascular and nerve repair as well as microvascular free-tissue transfer.
• To provide exposure to the civilian practice of hand surgery.
• To provide opportunity and encourage basic science and clinical research in relation to upper extremity surgery.
• To provide exposure to locally and nationally known experts in hand surgery through the use of visiting professors and attendance at national meetings.

Facilities

• The Hand Surgery Service has full admitting privileges to Walter Reed National Military Medical Center.
• The hand surgery clinic is situated within the Orthopaedic Surgery Clinic area. This area is well equipped and includes a large cast room, a satellite x-ray department, and multiple treatment and examination rooms.
• The cast room is a direct responsibility of the Chief, Orthopaedic Surgery Service.

Clinical Material

• The number of surgeries performed on the hand service averages 500-750 cases per year.
• There are approximately 4200 outpatient visits per year

Call

• Hand Surgery Fellows takes call from home six days per week.
• The hand surgery fellow may be called in for duty at nights and on Saturdays based on mission requirements and learning opportunity. The non-call day is designated as Sunday, but can be adjusted weekly by the fellow to meet service needs.
• The fellow fields calls from in-house Orthopaedic Surgery residents regarding patient management for emergency room visits and inpatient consultations.
• The fellow will contact the on-call hand surgery attending for all patients requiring admission and/or operative treatment.
• Compliance with duty hours regulations is mandatory and monitored by the Program Director via the E*value online database.
• The fellow is expected to comply with the duty hour standards as outlined in the National Capital Consortium Administrative Handbook.

Academics

• Morning report is held Monday through Friday from 0615 to 0700 and is attended by the at least one hand surgery staff, the hand fellow, and all rotating orthopaedic residents, interns, and medical students. Preoperative, postoperative, and call cases are presented and discussed.
• Hand academics are held on Thursdays and Fridays and are attended by the hand fellow, all trainees assigned to the hand surgery service, and hand staff.
• Weekly hand academics consist of a weekly indications/pre-op conference where surgical cases are discussed, a weekly journal club or lecture/topic conference, a weekly anatomy dissection exercise attended by hand surgery faculty and trainees, and a weekly multidisciplinary conference with a therapist from the WRNMMC Occupational Therapy department based on review of current inpatient hand surgery patients.
• The hand surgery fellow is expected to be involved with the student and resident education of the hand team members as well as other trainees.
• Orthopaedic Morbidity and Mortality / Process Improvement conference is held monthly. The hand fellow attends all Morbidity and Mortality conferences and presents cases as appropriate.
• Cadavers will be available at USUHS and fresh tissue may be obtained if prior arrangements are made in advance

Conferences

• The fellow is expected to attend at least one professional meeting during the fellowship year. Funding is available.
• Attendance at the Annual Meeting of the Society of Military Orthopaedic Surgeons is highly encouraged. Hand surgery fellows are encouraged to submit research for podium or poster presentation. Often, funding separate from the fellowship is available.

Visiting Professors

• Several visiting professor conferences are held each year. The most notable is the annual Raymond M. Curtis Hand Symposium, held in conjunction with the local Washington, DC, Metropolitan Hand Society in the spring of each year.
• This generally involves a nationally recognized hand surgery authority and participation by many local and regional hand surgeons.

Microsurgery Course

• Each fellow will attend the Microsurgery Course at USUHS during the fellowship.
• This provides an uninterrupted week of microsurgical lab experience in various microsurgical techniques and is conducted in November and March of each year.

Educational Aids Available to Fellows

• The hand fellow has access to the National Library of Medicine, Walter Reed National Military Medical Center Library, Walter Reed Army Institute of Research Library, the Joint Pathology Center (formerly the Armed Forces Institute of Pathology Library), the USUHS library, and the USUHS Anatomy lab.

Research

• Ample opportunities are available for both clinical and basic science research.
• Walter Reed Army Institute of Research (WRAIR) and USUHS provide excellent facilities for this activity.
• The fellow is expected to complete one publishable project during the twelve-month fellowship. This project should be identified early on and coordinated throughout with the appropriate staff member.