TY - JOUR
T1 - Survey of hand surgeons regarding their perceived needs for an expanded upper extremity fellowship
AU - Kakar, S.
AU - Bakri, K.
AU - Shin, A. Y.
N1 - Funding Information:
Recently, there has been an observed trend among hand surgery fellowship graduates to pursue additional fellowship education after their 1-year hand surgery training. This has predominantly been within areas such as shoulder and elbow for those with an orthopedic background, thereby providing the trainee with expertise within the entire upper extremity. To this end, the American Society for Surgery of the Hand (ASSH) and the American Foundation for Surgery of the Hand have devised a grant to fund an additional year of training in upper limb surgery following completion of a hand surgery fellowship.
Funding Information:
Recently, there has been a perception of increasing interest among trainees to have a more complete upper extremity training. This has led to the creation of a grant supported by the ASSH and American Foundation for Surgery of the Hand to permit an additional year of training within upper limb surgery after an established hand surgery fellowship. Within our study cohort, 48% (63) of respondents sought shoulder and elbow training during their hand fellowship. The majority were from orthopedic surgery, and there was no interest from those with a plastic surgery background. Despite their interest, the exposure they received was limited, and 40% (53) had no exposure to shoulder or elbow during their fellowship. Four respondents pursued additional training for shoulder and elbow surgery. One can only speculate about this low number, but it might be related to economic costs of pursuing additional fellowship education or the type of position the candidate entered after a fellowship that might not have included shoulder and elbow surgery.
Funding Information:
There are several limitations to this study. One of the weaknesses is a response rate of 53%. Multiple mailings were sent to the surgeons to increase their participation. Nevertheless, we feel that we have achieved a good general representation from all 3 specialties and a higher response rate compared to other studies. 2,8 Our intention was to survey all candidate members of the ASSH who had completed an ACGME-approved hand surgery fellowship from 2008–2010. Although the list might not have captured all potential respondents, it was the best available cohort provided by the ASSH. Respondents were asked to recall the number of procedures that they had been involved with during their fellowship. Given the time that had passed since their fellowship, the numbers might not have been entirely accurate. Nonetheless, the purpose of this study was to highlight deficiencies in training rather than to report complete numbers of cases performed during fellowship training. Another limitation might have been response bias from the individuals surveyed. There might have been a perception from the surgeons surveyed that the grant supported by the ASSH and American Foundation for Surgery of the Hand was to permit an additional year of training for shoulder and elbow conditions rather than upper extremity training in general. This might have resulted in a greater number of orthopedic surgeons responding to the survey than those within other specialties.
PY - 2012/11
Y1 - 2012/11
N2 - Purpose: To survey practicing hand surgeons regarding their perceived need for an expanded upper extremity fellowship. Methods: Electronic surveys were sent to 248 surgeons who had completed a hand surgery fellowship between 2008 and 2010. The survey was structured to ascertain whether there was a need for expanded education encompassing the entire upper extremity. Four separate mailings were made. Of the 248 surgeons who were sent the survey, 131 (53%) responded. Of the respondents, 74% (97) were trained in orthopedics, 16% (21) in plastic surgery, and 10% (13) in general surgery. Results: Of the 131 respondents, 7% (9) felt that 1 year of specialty training was insufficient, 48% (63) had sought shoulder and elbow training in their fellowship, and 52% (68) did not have dedicated plastic surgery rotations. Microsurgical experience was variable: 8% (10) of respondents had not been exposed to replantation, 23% (30) had not been exposed to free flap surgery, 32% (42) had not participated in brachial plexus surgery, and 17% (22) had not done a vascularized bone graft. Fifty-six percent (73) of respondents had not had dedicated time for research during their fellowship. Eleven percent (15) had obtained additional training after their fellowship, including shoulder and elbow, microsurgery, pediatrics, and peripheral nerve surgery. When asked if they would have applied to a 2-year hand and upper extremity fellowship, 60% (79) of respondents would have applied. Conclusions: Based on the results of this survey, 1 year of hand fellowship training has been perceived as inadequate by 7% (9) of respondents, with exposure insufficient in shoulder and elbow, microsurgery, pediatrics, and clinical research. Further critical review of hand fellowship education should be considered, with the availability of extended fellowship tracks for those requesting an increased breadth of upper extremity surgical training. Type of study/level of evidence: Economic/Decision Analysis II.
AB - Purpose: To survey practicing hand surgeons regarding their perceived need for an expanded upper extremity fellowship. Methods: Electronic surveys were sent to 248 surgeons who had completed a hand surgery fellowship between 2008 and 2010. The survey was structured to ascertain whether there was a need for expanded education encompassing the entire upper extremity. Four separate mailings were made. Of the 248 surgeons who were sent the survey, 131 (53%) responded. Of the respondents, 74% (97) were trained in orthopedics, 16% (21) in plastic surgery, and 10% (13) in general surgery. Results: Of the 131 respondents, 7% (9) felt that 1 year of specialty training was insufficient, 48% (63) had sought shoulder and elbow training in their fellowship, and 52% (68) did not have dedicated plastic surgery rotations. Microsurgical experience was variable: 8% (10) of respondents had not been exposed to replantation, 23% (30) had not been exposed to free flap surgery, 32% (42) had not participated in brachial plexus surgery, and 17% (22) had not done a vascularized bone graft. Fifty-six percent (73) of respondents had not had dedicated time for research during their fellowship. Eleven percent (15) had obtained additional training after their fellowship, including shoulder and elbow, microsurgery, pediatrics, and peripheral nerve surgery. When asked if they would have applied to a 2-year hand and upper extremity fellowship, 60% (79) of respondents would have applied. Conclusions: Based on the results of this survey, 1 year of hand fellowship training has been perceived as inadequate by 7% (9) of respondents, with exposure insufficient in shoulder and elbow, microsurgery, pediatrics, and clinical research. Further critical review of hand fellowship education should be considered, with the availability of extended fellowship tracks for those requesting an increased breadth of upper extremity surgical training. Type of study/level of evidence: Economic/Decision Analysis II.
KW - Fellowship education
KW - general surgery
KW - hand and upper extremity training
KW - orthopedic
KW - plastic
UR - http://www.scopus.com/inward/record.url?scp=84867884000&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84867884000&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2012.08.013
DO - 10.1016/j.jhsa.2012.08.013
M3 - Article
C2 - 23101535
AN - SCOPUS:84867884000
VL - 37
SP - 2374-2380.e3
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
SN - 0266-7681
IS - 11
ER -