2009-2010
Harvard Hand/Upper Extremity Surgery Fellowship
General Description
The Harvard Hand/Upper Extremity Surgery Fellowship is under the supervision of Barry P. Simmons, M.D. and includes several institutions and staff members. The major fellowship time is spent at Brigham and Women’s Hospital and Children’s Hospital. In addition, out-patient care and/or operative experience, is provided at the West Roxbury VA, and Faulkner Hospital, a community hospital nearby. There is a two-month cross-rotation with the fellowship at Massachusetts General Hospital.
The fellowship period is twelve months commencing August 1st. Three positions are offered. The fellowship is oriented toward those wishing to make a significant commitment to treatment of problems of the hand and upper extremity.
The staff believes that a good fellowship experience requires both supervision and independence. Initially, the fellows are closely supervised, with faculty assistance in all operative situations. As the fellows’ experience and knowledge increases they are given greater independence, but with a faculty member available for consultation at all times. This approach has resulted in excellent patient care, an outstanding educational experience, and camaraderie among all members of the service.
Hand Surgery Service
The Hand Surgery Service consists of the fellows and the two orthopaedic residents doing their hand surgery rotation. Occasionally there may be residents from other institutions or the plastic surgery service that may participate as well. Often medical school students will rotate through the service. The attending staff is Barry P. Simmons, Philip E. Blazar, Brandon E. Earp and George S. Dyer, at Brigham and Women’s Hospital; Dr. Peter Waters and Dr. Donald Bae at Children’s Hospital and Drs. Jesse B. Jupiter, Sang-Gil Lee, David Ring, and Chaitanya Mudgal at Massachusetts General Hospital.
Hand Surgery Fellows’ Responsibilities
The Hand Surgery Fellow is, with the assistance of the resident, responsible for running his/her own service. He/she is given junior staff privileges at the participating institutions and can be given independent responsibility, with the advice of the faculty, depending on her/his experience.
The Hand Surgery Service covers the emergency room at the Brigham and Women’s, Children’s Hospital Medical Center and the West Roxbury V.A. Hospital simultaneously, alternating on a weekly basis with the Plastic Surgery Service on all but the V.A. Hospital. One of three fellows is at Children's Hospital and two of the fellows are at Brigham and Women's Hospital during any given day.
Patient Sources
As mentioned, the Hand Surgery Service is responsible for emergency room coverage and this is the source of most of the trauma and microsurgery. This coverage also includes Harvard Vanguard Health Plan and Harvard University. The clinics and fellow’s office are sources for elective referrals and follow-up care. This is a significant source of long-term exposure to patient problems.
At Children’s Hospital the fellows see the spectrum of disorders in the pediatric upper extremity. These include trauma, post-traumatic reconstruction, arthritis, brachial plexus injuries and reconstruction and a wide-breadth of congenital deformities. Brigham & Women’s is a well-known arthritis hospital and generates a large amount of reconstructive surgery in the arthritic upper extremity. This includes not only the more common osteoarthritis but also rheumatoid arthritis, lupus, scleroderma, psoriatic arthritis, etc. The majority of these latter patients are generated from the staff physician’s offices with the fellows acting as assistants rather than the primary treating physician. The Veteran’s Administration is the Spinal Cord Injury Center for New England. This population generates tendon transfers in the quadriplegic upper extremity.
The Massachusetts General Hospital has the busiest emergency room in the state, and besides a broad spectrum of upper extremity cases, there is an emphasis on both acute trauma and post-traumatic reconstruction.
Besides these specialty areas the offices generate most of the routine problems of the hand and upper extremity seen in practice. These include common problems about the shoulder and elbow, nerve entrapments, post-traumatic reconstruction, wrist problems, Dupuytren’s disease, repetitive trauma syndromes, the injured worker, etc.
Faculty Participation
Drs. Simmons, Blazar, Earp and Dyer are based at the Brigham and Women’s and Drs. Waters and Bae are based at Children’s Hospital. Dr. Waters directs the service at Children’s Hospital. Dr. Dyer directs the service at the Veteran’s Administration Hospital. Dr. Blazar is the director of education for the fellowship. Some of the total joint replacements in the shoulder and elbow are performed by the other staff orthopaedic surgeons at the Brigham. The fellows on the hand service are welcome to participate in these cases at any time if time and responsibility permit.
Drs. Jupiter, Sang-Gil Lee, Ring and Mudgal staff the Massachusetts General Hospital. Dr Mudgal is director of the fellowship.
A close liaison exists with the Plastic Surgery Service. Their staff is especially experienced in microsurgery, including free tissue transfers. As time and responsibility allows the Hand Surgery Fellows are encouraged to participate in those cases and patient care.
Conferences & Research
1.) Residents Hand and Upper Extremity Conferences
The conference meets every other week. A pre-selected curriculum is followed with presentations given by the house staff on the service. Didactic sessions alternate with core presentations. Presenters are given a previously prepared Powerpoint presentation on the topic so that preparation time is focused on learning. The topics are presented in conjunction with a member of the faculty who assists in determining which aspects of the topic are to be presented and providing clinical material (x-rays, photos, etc.)
2.) “Classics” Journal Club
An informal “breakfast” conference attended by the fellows and residents rotating on the service discussing 5-12 classic articles per session on a 52-week schedule.
3.) Anatomy
Hand and upper extremity anatomy is explored in detail in this 13-session conference with dissection of fresh frozen cadavers and directed bibliography. Presentations and prosection are the responsibility of a resident/fellow team.
4.) Indications Conference
Weekly conference to discuss selected cases for the upcoming week in detail.
5.) Journal Club
Journal club occurs 6x/year and meets in conjunction with the MGH Hand Fellows and Faculty.
Other conferences that the fellow is encouraged to attend include the Fracture Conference, Orthopaedic Grand Rounds, the total joint conference and the monthly complications conference.
Before the beginning of the academic year the fellows are sent to spend a week at the Microsurgical Laboratory at Columbia University in New York. As well, there is a micro laboratory available in the plastic surgery department. Also, laboratories are available for research in biomechanics, cartilage repair and synovium metabolism if the fellows wish. Any other research project that the fellow would like to pursue would be encouraged. The facilities of Harvard Medical School are across the street. The service, with the consultation of the rheumatologists, offer “outcomes research” possibilities.
During his/her tenure the fellow will be expected to complete a research project and paper of his/her choosing. This could be either in basic science or a clinical area. Time is left during the fellows rotations for these projects. Complete computer facilities are available for word processing, databases, medline communications, slide production, scanning, etc.
A small library with texts and relevant journals is kept in the offices. The Brigham Medical Library is nearby in the building and Harvard’s Countway Medical Library is adjacent to the hospital.
Each fellow is supported for two courses yearly, one locally and one nationally.
Salary and Benefits
The fellows are employed by the Brigham and Women’s Hospital. The salary is commensurate with the level of training, usually PGY 6. Benefits include malpractice insurance, health insurance, disability insurance, parking, computers, photography support, an office and secretaries. A business office is available to allow the fellows to become acquainted with the business aspects of medicine including CPT coding, running an office, dealing with insurance carriers and managed care.
The Selection Process
This fellowship participates in the “Combined Musculoskeletal Matching Program (CMSMP)” run by the National Resident Matching Program. Inquiries and registration should be directed to the National Resident Matching Program, 2450 N. Street, N.W., Suite 201, Washington, DC 20037-1141. Telephone: (202) 828-0676.
Prospective applicants should enroll directly.
The match date is the second week in June and the rank order lists are due approximately three weeks earlier. Interviews are by invitation. Applicants are encouraged to submit their applications by the December 1 deadline. The Universal Hand Surgery Application form is preferred and is available through the web. Formal interview days are scheduled then. If these are inconvenient, an attempt will be made to accommodate individual requirements. Also, an attempt will be made to coordinate interview days with other geographically local programs.
Revised Sept2009/kga,mmm
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