Hand versus Shoulder & Elbow

[kkruse89]

I have gone back and forth for the last two years about whether to do a Shoulder/Elbow or a hand fellowship and here is what I have learned. Nobody comes straight out of fellowship and has an exclusive shoulder elbow practice with possible the exception of an academic position. So if you do a shoulder/elbow fellowship expect to do some general ortho when you get out i.e. knee scopes/ankle fx's/ hip fx's. Now there are several hand fellowships that provide and excellent shoulder experience, in these fellowships you will have less micro training as this is replaced by the increase shoulder volume. When talking with guys that have done this fellowship most of them will tell you that they feel totally comfortable handling anything in the shoulder. When I asked them what the difference between there fellowship and an ASES fellowship most will say that they lack the high volume of arthroscopic instability as this tends to go to sports/pure shoulder surgeons however they still did enough to be comfortable. So these "upper extremity fellowships" get a a solid hand experience they do a lot of cuff and a lot of shoulder arthroplasty. I have talked to a few guys who have done a hand fellowship and then went out afterwords and did a 3-6 months mini shoulder fellowship to get whatever they needed extra. These guys have all told me that with the combo of their hand and shoulder training they felt like they could handle anything in the shoulder and hand. The ASSH has started four hybrid two year programs that combine a hand and a shoulder/elbow fellowship. The four places are columbia, stand for, thomas jefferson (I think), and cleveland clinic. I have considered these as well however a considerable amount of this time is going to be spent doing research. The more I have thought about it I think I am going to try to find a hand fellowship that gives a great shoulder experience and then go do a little extra shoulder. I think I can handle 18 mnths post residency but two years just seems like too much. In the end I really want to just do shoulders but I would rather do hand stuff than general ortho coming out so I think I am gonna go this route.

[Tanujan01]

Dr Levine

What advice do you have for UK residents wishing to apply for the ASES matching system and are you able to clarify whether the USMLE scores are taken into consideration when calling applicants for interview. Moreover, are you able to divulge the proportion of international medical graduates securing a fellowship through the matching process. Any details regarding how one can maximise the chances of being selected for a fellowship would be welcomed.

Many thanks

TT

UK Trauma and Orthopaedic Resident