Hand Fellowship Review Thread

There's a lot of frustration involved with applying to Hand fellowships. But it mostly stems from two big issues:
1) non-standardized, PAPER applications
2) unreliable information/descriptions on program websites.

While we can't do anything about #1, we CAN help future applicants by posting some more updated information of where we all interviewed. The most recent stuff on here is nearing a decade old, and these fellowships do seem to change on a quicker cycle than that.

You all remember how annoying it was to try to pick where to apply or which date to keep when facing a conflict, when you didn't know much about either program. We all were applying and interviewing at too many programs because we didn't know what each program offered.

Applicants held on to interview dates at programs they knew they weren't interested in and ended up blocking some applicants who were very interested in those programs. There were also a few people I spoke to who didn't end up cancelling those until the last minute - which is careless and/or inconsiderate.

I think if we get a lot of good replies in this thread there's a chance we can help future applicants avoid at least some of that.

I'll start:
Thankfully, there are a lot of really good fellowships in Hand.

--The training differs most notably in terms of how proximal they go and how much complex vs. bread-and-butter work they seem to do. Some places are shoulder to finger, some are wrist-distal. Some heavily favor bread-and-butter, some do more complex stuff mostly. A bunch of fellowships also seem to have two very different sides to the experience: one half with a well-known surgeon and the rest with "other guys" or at a county hospital or something.

--Micro, plastics, shoulder, and peds seem to be the most variable aspects. Some programs feature them as a strength and some intentionally have none. Know how important each is to you.

--Research, for me, was not an important factor - it's one year, you won't be pumping out a bunch of papers. Most programs require one project, which is at least publishable.

--The other way programs differ greatly is in autonomy. Decide how much of that you want, because in some places you're really running the show, whereas in other places you are holding hooks much of the time.

--You need to know what is important to you to decide which fellowship will train you the way you want to be trained. It's also important to realize that just because you don't do a particular case in fellowship doesn't mean you can never do it afterward.

--Don't give in to the "prestige" of a program. This should really be a factor with minimal influence on your ranking and is something to consider last, or not at all. Your patients are not likely to care, and more prestigious programs don't really seem to make job hunting any easier.

--For me at least, every single program had at least one major drawback. There was no perfect program... you need to weigh the minuses against each other.

--Don't put that much faith in case numbers. They're just going to give you a rough sense of the experience you may get. But <700 is few and may mean they do more complex stuff or less easy stuff, or call is really easy. >1000 is a high number and may indicate the inverse.

--Finally, the specific info about Hand fellowships on this forum is sparse, and mostly pretty dated. If this thread gets loads of replies that'd be nice, but ultimately your best method of finding out about programs is still to ask someone personally who just interviewed (former chief, friends, etc.). Take everything you read on this forum with a grain of salt.




Pittsburgh (UPMC): Seven spots, large fellowship. Work at many different sites with a substantial, but not insane, amount of driving involved. Dr. Baratz is the man. Shoulder to fingertip exposure including almost anything you could want in the shoulder, such as arthroplasty and open instability. This is not an ideal program for those who don't want to do any shoulder. Weekly cadaver labs and weekly didactics with the attendings. Q3-4ish backup call seems reasonable. Autonomy seems appropriate, but I imagine it can be frustrating to switch attendings every 7-8 weeks. Attendings seem easy to get along with. Fellows are happy. There are standard or above average research opportunities. Program has an excellent reputation. Medium to high case numbers.

Brown: Two spots, small fellowship. One of the few programs with attending privileges = high level of autonomy. Reasonable backup q3 call (function as attending, but the attendings are available for help prn esp. in the beginning of the year). Work with 4 experienced hand surgeons, do some VERY occasional shoulder/elbow but mostly carpus-distal. Don't really seem to have any "weaker" rotations, by which I mean all of the attendings seem to be ones who are interested in teaching and you'll really learn a lot from. DRfx volume roughly 30/fellow/year. Trauma seems light, and there seems to be zero plastic surgery integration. Weekly didactic schedule is strong (just about daily at 7AM), and the business series with Dr. Peter-Weiss sounds excellent - though remember, this is not an MBA, and business didactics are to me just another "perk," not a staple of your fellowship. They go to ASSH and a flap course. Also mission trip in Honduras. Most of your experience is focused in or around RIH so minimal driving. Attendings seem to keep a good relationship with graduates. Attendings seem easy to get along with Fellows are happy. High case numbers, it sounds like they really crank out a ton of cases in their ASC.

Cincinnati: A medium-sized fellowship, three fellows. Dr. Little is taking over as Fellowship director, but Dr. Stern will still be around and operating - you have to wonder how long though. For decades he has been the driving influence behind the strength of this program - and it is very impressive. The fellows are very happy. The didactics are daily and are incredible - they cover everything you can imagine - but you better be prepared to read. Clinically it's a mixed academic and private exposure, mostly seems to be a pretty traditional hand/wrist with some forearm and elbow case mix - more proximal stuff more likely to be trauma than elective. Q4 backup call seems reasonable. Strong peds exposure - two months and the PD (Little) is a peds Hand guy. Autonomy seems appropriate. There is a rat lab you always have access to for micro practice. Anatomy sessions with a cadaver every 6th Saturday. There's a micro lab that's very easily accessible for practice, and apparently is very easy to set up having a rat ready to go. Perks: They go to ASSH + another conference, and the Indiana micro course. $1000 for loupes/camera/whatever. Paid health insurance. Attendings seem easy to get along with. High case numbers. I loved this program on interview day. It could be in a more glamorous city, you know, but it's one year and you're not doing this for the tourism. Question mark here is obviously: how involved will Peter Stern be in the future, and for how long? Without question though, I think the fellows come out of here well-trained.

Beth Israel Deaconess: Three fellows per year, two Ortho and one P/S. Dr Rozental seems intent on making this fellowship the best it can be and it looks like it's really improved of late. They have a mostly young and dynamic faculty, and word is Dr Upton is still going strong, so there's a great congenital/plastic experience while he's there but he may be nearing retirement in the next 5? years (pure rumor and speculation). Plastics is integrated into the exposure, which seems to be elbow-distal but a little light on trauma. They go to ASSH and a micro course (Columbia). You get a 2-month dedicated plastics rotation with Upton that is 4 days OR one day clinic. Q3 home call seems fine. Plenty of research opportunities. Some driving one or two times/week to Needham/Dedham, seems tolerable. The fellows are very happy. Didactics include weekly classic articles Journal club, a combined Harvard journal club, and weekly indications conferences led by either a fellow or resident. Medium to high case numbers. Biggest question mark is how long will Upton still be there?

USC: Small program (2 spots) with something of a focus on micro. Definitely a "tale of two fellowships" type of situation... Working with Dr. Stevanovic for 6 months sounds like it's the highlight of this fellowship for sure, and then there's the other 6 months which don't seem bad but are not really discussed much. Micro/nerve work and plastics are definitely strengths of this program. Some driving around LA on Tuesdays (that sounds moderately annoying) going from CHLA to Keck but overall not too bad other than the craziness of every day LA traffic. Somewhat busy days go till around 6 pm often, but very tolerable q3 revasc/replant-only backup call. The 6 months at County sound busy, but with lots of autonomy. The fellows can go to several courses. Not an elbow-heavy program but you'll see some elbow trauma. Standard academic research opportunities. Fellows are happy. Dr Stevanovic seems to know everyone and has great connections for jobs etc. Didactics are currently on Friday evenings but it sounds like everyone hates that and they're going to try to change it.

UPenn: Small, micro-heavy program, two fellows both with a plastics background this year but it's technically an Ortho program. This is billed as an Ortho-plastic fellowship. Levin does all kinds of microsurgery including sometimes liver anastamoses. You may scrub some of those. While there's also a good amount of Ortho, it seems to be less than the standard Ortho fellowships. Strong peds experience, one month. There is a one month elective in case you want to do more, or some shoudler/elbow. Facilities are brand new and are gorgeous. Most of time is spent in one location at UPenn / PPMC. Q3 call, seems tolerable. Didactics are a weak point - one session every other week. They do the Penn flap course in December so you don't go to a micro course. Autonomy was a question mark, for me, it sounded like you hold a fair amount of hooks on Levin's service since he's doing some very intricate work. The fellows seemed satisfied, but cautioned that the ortho exposure might have been less than an ortho-trained resident may expect or desire.

Philadelphia Hand Center: Large program (7) that seems to have a fairly traditional case mix with good arthroscopic exposure and mostly private practice environment. Driving is a HUGE drawback IMO - you may need to commute over 90 minutes some days. The days are LONG on Osterman's service. They do take primary call, but while I was concerned about this initially, its q6 and honestly doesn't seem that terrible - with the caveat that the fellow in the Center City location occasionally (read: "regularly") has to leave clinic to go take care of consults for the on-call fellow if on-call fellow is far away. Relatively traditional case mix without much shoulder. Some research opportunities. Strong didactic schedule. The fellows are mostly very happy - though one of them seemed to really hate the driving. Large alumni network and an excellent national reputation. No question fellows will come out of here well-trained.
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Indiana: Large program (7 spots). Always has been a program that will work you hard, but reward you for that work. Seems to be no different today. Private practice exposure, some shoulder and elbow, some peds, some micro, they try to give you it all. Call is roughly Q4 and at St Vincent's, you have a hand procedure room and a PA (day) or hand tech (night) who can help set things up for you so you can get in, do the procedure, and get out - and you're not primary call, the attendings are, so they'll call you and tell you what needs to be done or seen. Several times you will be driving over an hour to get to outlying areas. "Logic" every Saturday morning with Dr. Kleinman. Bottom line, you'll work hard but come out better for it. Fellows seem happy. Excellent reputation. They say they are frequently tweaking the program to make it better for the fellows. Very high case numbers, as you'd expect. No question fellows will come out of here well-trained.

NYU-HJD: Now 5 spots following the hospital merger acquiring the St Luke's / CV Starr guys - big program. Mostly a traditional case mix. There was no longer a "pimp room" at the interview day (they had been the only program to do that up until last year). Dr. Posner stresses that you learn by working under direct supervision and learn more outside of the OR than in it, which leads one to wonder slightly about autonomy. Fellows are all happy and seem like a fun bunch. Attendings seem easy to get along with. Call seems very reasonable but with opportunities for micro if you want to take advantage of them. Somewhat lower case numbers. They say they are frequently finely tweaking the program to make it better for the fellows. Dr. Posner seems like an excellent salesman - on the interview day he will say all the things you want to hear as an applicant - that the program is fellow-focused, that they offer things other fellowships do not offer, that the purported strengths of other programs are actually weaknesses such as fellow's clinics. I hesitated to buy it all, but the fellows seemed happy to corroborate what he was saying. I'm sure it's a good experience, but I wasn't totally sold on it. Alumni network seems pretty strong.

Mount Sinai (Hausman): Small fellowship, one spot. Another "tale of two fellowships" story here. Not a traditional bread and butter experience, with Dr. Hausman doing all kinds of "different" procedures even including random stuff like lumbar plexus explorations. Lots of micro and peripheral nerve work. Lots of elbow but not a lot of TEA's. Autonomy seems appropriate. Call is light backup ("very reasonable") and semi irregularly scheduled at Sinai. Also rotate for 4 or 5 months at Bellevue with the NYU crew where the experience is more traditional. Case numbers seemed a bit low which is explained by the easy call and complex cases. The current fellow has gone to several meetings and courses. Currently one fellow but may increase to two. Currently separate from the Beth Israel Melone fellowship but sounds like that may change at some point in the future.

Cleveland Combined: Medium sized program (3 spots) which boasts shoulder and elbow as strengths. Micro and plastics exposure are integrated but replant volume seems pretty low (on the order of 1/fellow/yr if that). Fellows are mostly happy. They do their own micro course. Call seems reasonable even though on the surface it sounds very frequent. Didactics are a recently-improved area. I think fellows will come out of here well-trained, and I got a pretty chill vibe, but just didn't feel like it had what I wanted.

Columbia: Small program (1 spot, 3 attendings). Department with a rich ortho history that they will tell you about on interview day. Relatively traditional case mix. Autonomy seems appropriate. Drive/commute doesn't seem awful, especially for NYC. Research opportunities abound for those interested. I really didn't know what to make of the call. I got a bizarre vibe on interview day but I could never quite put my finger on it. Seemed like a good program overall though.

Campbell Clinic: Small program (1 spot, 5 attendings). Recently re-started program and it seems like you get a really solid bread-butter exposure here with a fairly traditional case mix. Micro and peds are weak spots while lifestyle is a strength. Side perk, but the benefits package is pretty sweet. Call is basically nonexistent. Attendings seem really friendly and appear like people you could easily enjoy a beer with and hang out at their house, esp. Dr. Cal. Fellow is very happy. Moonlighting: quasi-mandatory "opportunities" at an urgent care one evening/week which, if you elect to do more, over time add up and you can make decent money on... but remember while that's nice, you're not doing a fellowship to make that extra $20,000 or whatever. This is not an academic powerhouse and research opportunities are not a strength. This looked like it would probably be the most enjoyable of the places I interviewed at.

--

I ended up matching about halfway down my list, and I am ecstatic because it is a fantastic program and I will come out really well-trained. And because I'm going to be a hand surgeon. Also I wasn't that invested in any particular program as "THE ONE." Like I said, each program had at least one pretty heavy drawback for me. So I was ready to be equally happy with any of the top 8 or 9 on my list.

Final words of advice..

--TAKE NOTES THE DAY YOU INTERVIEW because these programs will blend together extremely quickly.

--Do TSA Precheck.

--Sit down and think about what YOU want out of fellowship because no single program will give you everything and you need to prioritize.

--Be a decent person and don't hold interviews you don't intend to go on.

Any updates on this?

You could get us started?

Wanted to share some thoughts on programs. Felt like information was sparse when we applied and would be nice if we could give future applicants more information. General advice similar to as posted above - there's no perfect program and a lot depends on what you are looking for (ie micro, research, elbow, shoulder)

Grouped into general categories

A little bit of everything
OrthoCarolina (shoulder distal) - high-volume program with 10 attendings (one is ortho/plastics trained, one is plastics, one is shoulder/elbow and hand trained). Well-rounded with regard to trauma (level 1, q4 backup call), micro (Mayo micro course, solid amount of brachial plexus and nerve transfers, micro lab), shoulder, and complex versus bread and butter cases. Daily didactics and monthly "logic" sessions, with an overall good environment amongst fellows and accessible attendings. Potential drawbacks are that it doesn't have a long history of training hand surgeons (fellowship is ~6-7 years old, not a lot of congenital cases, not as much elbow

Duke (elbow distal) - There are ~8 attendings (2 plastics, 6 ortho), though Dr. Leversedge is moving to Colorado. Main rotations were previously Ruch, Richard, Mithani, and Leversedge, not sure how they will change the Leversedge rotation. Good trauma experience (level 1, q3 backup call), micro experience (micro lab, free fibula transfers), elbow experience, with several didactics and weekly anatomy labs. The attendings are very accessible. Potential drawbacks are resident-fellow overlap, not as high-volume compared to some other programs


Micro/trauma heavy
Curtis (shoulder distal) - There are 15 attendings (5 plastics, 10 ortho). High replant/trauma volume (any isolated upper extremity injury goes to Curtis, a lot of replants, q5 backup call), excellent micro experience (high replant volume, micro lab), some shoulder, do a lot of complex cases (presented a second toe to finger transfer). There is a weekly fellows' clinic. Go to CHOP for one month for congenital experience. Potential drawbacks are perhaps not as many bread/butter cases, hierarchical feel, not much elbow, and very high replant volume

University of Washington (elbow distal) - 9 attendings (3 plastic, 6 ortho). Very heavy trauma experience (complex trauma, level 1, Harborview, q4 backup call), heavy micro experience (replants/flaps associated with traumas), and revision elbow experience (Hanel). Attendings seemed accessible, with good camaraderie. Potential drawbacks are high complex trauma volume and lower bread/butter volume

True upper extremity
Pitt (shoulder distal)- 14 attendings (3 plastics, 11 ortho). High-volume, true shoulder-to-fingertip fellowship with a robust/consistent shoulder experience, truly excellent elbow experience (Baratz), with good trauma as well (level 1, q3-4 backup call for 6 months, otherwise take "practice call" with phone calls for the other 6 months). Attendings seem accessible and fellows had a good camaraderie. Potential drawback includes not as much micro

Indiana (shoulder distal) - high-volume program with 10 attendings (all ortho), with a robust shoulder/elbow experience (approximately 25% shoulder/elbow), trauma experience (cover two level 1 hospitals, so end up being on primary call ~7-8 days/month, though might pull out of one of the hospitals), excellent didactics (weekly "logic" sessions, practical practice management lectures as well). Potential drawbacks include not as much micro, primary call

Cleveland Clinic (shoulder distal) - 8 attendings (2 plastics, 6 ortho) with a shoulder-to-fingertip experience and a solid amount of shoulder/elbow (~1/3 the case load, Dr. Evans who did a lot of elbow is moving to Florida location, might do a 1 month rotation with him there). Has good trauma (level 1 trauma at MetroHealth), and great variety. Potential drawbacks include not as much micro, not as robust didactics


Truly academic
WashU (forearm distal) - 6 attendings (all ortho) that are all very active within the Hand Society. Dr. Gelberman is retiring so won't be on faculty when we start. Solid trauma experience (level 1, q4 backup call), robust micro experience (2 week trip to Coimbatore, India for micro course/observational period with Dr. Sabapathy in the beginning of the year, soft tissue coverage cases), excellent case complexity (congenital, plexus, nerve transfers), good didactics, has a fellows clinic, accessible attendings with great camaraderie amongst the attendings. Potential drawbacks include mostly forearm-distal pathology, not as high volume bread and butter, and high micro/flap volume

Mayo (mostly forearm distal, plus shoulder) - 12 attendings (3 plastics, 9 ortho) who are well-connected and active within the Hand Society. Good variety (replants, plexus, nerve work) and complexity, solid micro experience (Mayo micro course/flap course, micro lab), solid teaching (Dr. Rhee seems like an great teacher), good trauma experience (level 1, q5 backup), has some shoulder surgery (with Elhassan), excellent anatomy lab. Potential drawbacks include not a ton of bread and butter cases, not much elbow


Mostly balanced
Cincinnati (elbow distal) - 14 attendings with incredibly high case volumes, excellent culture, good variety, good trauma experience (q4 at a non level 1 hospital and q8 backup at the University hospital), robust didactics/courses (daily didactics, Dr. Stern's reading list), and a solid congenital experience. Potential drawbacks include possible retirement of Dr. Stern, not super high micro volume

Utah (mid humerus distal)- 4 attendings (all ortho) that gives a very robust mid humerus-distal experience, great trauma (busy level 1, q4 resident backup), good micro (micro course), solid congenital experience (probably the most robust, also do an international trip). Attendings are incredibly accessible and accordingly the culture is great here. Potential drawback might be heavier congenital experience than some might want

I like the idea that the above post had with regard to splitting them up. I honestly did not know what I wanted when I went through but the programs are very diverse and this is how I thought of them when I finally made my list.

Grouped into general categories. These categories are not reflective of quality but just to give people an idea of how each program is characterized so that if they know what they want they can target these places. I would be curious what others thought.

Somewhat balanced
OrthoCarolina (shoulder distal)
Duke (elbow distal)
WashU Ortho
Ohio State
Baylor Houston
MCW

Trauma heavy
Curtis (shoulder distal)
University of Washington (elbow distal)
MGH (Shoulder distal)
NYU
UCLA

True upper extremity
Pitt (shoulder distal)
Indiana (shoulder distal)
Cleveland Clinic

Micro Heavy
Mayo
USC

Truly academic
WashU Plastics
UMichigan (Research heavy)

Maximum Flexibility (generally these were programs with 1 fellow such that they couldn't depend on you and you could do whatever cases you wanted and make your own call schedule)
Yale
Hopkins

Pediatrics Heavy
Beth Isreal Boston

Bread and Butter
UMass
Beth Isreal New York
Kleinhart

Any new information or posts for this thread? Just bumping back up.