The Curtis National Hand Center is home to the most prestigious hand fellowship program in the U.S. Established at MedStar Union Memorial Hospital in 1977, the one-year fellowship training offers a diverse approach to the assessment and treatment of common and complex hand, wrist, arm, elbow and shoulder problems.

https://www.medstarhealth.org/education/affiliated-hospitals-2/medstar-union-memorial-hospital/hand-surgery-fellowship

Nearly all of the clinical training is performed at MedStar Union Memorial Hospital. Each fellow is appointed to the professional staff and has admitting privileges. He or she works with an attending physician in a clinic that attracts all types of hand and upper extremity problems. Each has the opportunity to conduct clinical and laboratory research and to utilize a fully staffed microsurgery lab. Orthopedic and plastic surgery residents from Johns Hopkins Hospital, Georgetown University and Union Memorial Hospital, as well as hand fellows from Walter Reed, also work closely with our hand fellows.

The teaching program includes

• Weekly conferences
• Lectures covering all aspects of hand surgery, microsurgery and anatomy
• Monthly journal club

Clinical categories are well balanced in acute trauma, replantation, and soft tissue reconstruction, as well as rheumatoid, congenital, and acquired non-traumatic problems.

In addition, each fellow spends one month at Children’s Hospital of Philadelphia (CHOP).  An apartment is furnished for them.  Fellows are fully credentialed at CHOP for the entire year so that as interesting cases arise, they may participate in complex congenital cases even if they occur outside of the designated month rotation. See the CHOP Hand Fellow Manual and the CHOP Curriculum Goals and Objectives.

With an alumni of almost 200 doctors, fellows at Curtis National Hand Center have access to some of the most complex hand and upper extremity cases, and the ability to collaborate with the best hand surgeons in the world.

Fellowship Responsibilities

The responsibilities of the fellows are broad. Each fellow will benefit from clinical rotations and time in the laboratory. Each fellow is expected to complete at least one research project with a faculty member as a mentor that will be suitable for presentation and/or publication. Grant funding is available for these projects through the Hand Research Committee and generous donations from the Blaustein Foundation. We have an active teaching schedule with clinical, surgical, and laboratory teaching. Surgical procedures of the week are discussed at a weekly conference that includes case presentations. There is a monthly Congenital Clinic and Journal Club. Fellows will attend national and local courses on hand surgery. Fellows are actively involved with resident education.

Rotations

Clinical Rotations

The Hand Service is arranged into five teams and each fellow spends time on each team. The fellow is assigned to a team with a resident and several attending physicians.  11 months of the year are spent rotating through our five busy teams.

One month is spent at the Children’s Hospital of Philadelphia (CHOP) with Drs. Ben Chang, Robert Carrigan, Ines Lin, and Apurva Shah.  This rotation allows added time for immersion in congenital and pediatric surgery.  This is the only rotation outside of MUMH/CNHC.

Clinical Responsibilities

• Patient clinics (2 days/week)
• Surgery (2 or 3 days/week)

Each patient clinic is staffed by a hand fellow, physician assistant and hand therapist. The “Fellows Clinic” provides a setting for new patient and postoperative visits for house staff patients as appropriate.

Conferences

• Monday hand conference (fellows’ responsibility)
• Morbidity and mortality and ethic case conference (fellows’ responsibility)
• Didactic hand lecture
• Anatomy
• Anatomy Dissection
• Specialty Skills Lab
• Microsurgery/plastic conference
• Congenital hand clinic
• Journal club
• Indications/didactic conference
• Therapy lecture
• Research project quarterly conference

At the weekly hand conference, the fellows present cases to the residents, attending staff, visiting specialists, therapists and interested hand and orthopedic surgeons in the community.

Call

Each fellow takes call. The call schedule will not impact on vacation, meeting, or sick time. The fellows take second call for the emergency room for hand and upper extremity trauma. The Hand Service has three Physician Assistants that carry the first call pager Monday through Friday during the day and on Tuesday and Thursday until 8:30 pm. The first call pager is then passed to the resident on call for the day. Residents from Georgetown, Johns Hopkins, Union Memorial and residents on an elective rotation from various institutions take first call. Second call is taken by the fellow and third call is taken by the attending.

Performance feedback

Each fellow will spend two months on a team. A written performance evaluation will be completed mid-term (by the Program Director) and at the end of each rotation by a faculty member from their assigned team. The evaluation will be compiled and reviewed with the trainee with an assigned member of the faculty.

The fellow will complete a program evaluation twice a year and faculty evaluations at the end of each two month period on each faculty member from their team. 360 degree behavioral and technical assessments are completed quarterly by nursing staff from the OR, floor and ED, physician assistants, therapists, clinic staff, and therapists. The mid-term meeting with the Program Director ensures that goals and expectations are being met and provides performance feedback and guidance.

Research

Ongoing clinical research takes place throughout the year.

Our research department is dedicated to advancing the knowledge base of our research fellows, faculty, and the orthopedic community in general. Clinical practices and basic sciences of the musculoskeletal system have begun to be closely examined in the past several decades in formal research studies, making an understanding of scientific method, research practices and data analysis critical skills for today’s practitioner. Technical advances also require an ability to assimilate new information and evaluate different surgical techniques, new prosthetic devices, new drugs therapies and biomaterials.

In addition to providing administrative and regulatory support for fellow projects, the research department is actively involved in the development of intramural studies and participation in commercially sponsored and NIH studies.

Each fellow at CNHC, along with a faculty member as mentor, is expected to complete at least one research project that will be suitable for presentation and/or publication.

Research projects may take the form of retrospective evaluation of data collected in clinical studies or a focused study of medical records, biomechanical evaluations of devices, anatomical studies or prospective studies of specific diagnoses or treatments.

The objectives of the research program are:

Objective 1: Identify appropriate research questions and design a well-controlled study, including understanding independent and dependent variables and potential sources of error.

Objective 2: Conduct a literature search, critically read the literature (understanding the difference between peer-reviewed and non peer-reviewed literature), and interpret pertinent research to formulate scientific hypothesis.

Objective 3: Evaluate facility and equipment needs including staffing, time frame, and budget for the study.

Objective 4: Develop specific objectives to address the hypothesis, understanding of the statistical tests necessary to analyze the data, methodology to address each objective, and an understanding of basic technologies associated with the area of hand surgery/orthopedics being investigated.

Objective 5: Select sample size, design questionnaires and/or data collection sheets and conduct pilot studies, when applicable, to assess effectiveness of the procedures. In clinical trials, the Fellow/Resident will present a professional manner and show respect for the patient. In laboratory trials, the Fellow/Resident will work methodically, practice safety, clean up, and use research etiquette. In both cases, the Fellow/Resident should work in a repeatable manner and understand the importance of handling all patients, specimens, and data collection consistently.

Objective 6: Develop a basic understanding of statistical tests and why they are appropriate, including the relevance of a p value, alpha and beta error, standard deviation, standard error of the mean, and confidence intervals.

Objective 7: Interpret the data and results, apply findings to the original questions, determine if the results have answered the basic research question, evaluate whether the objectives have been met, and accept or reject the hypothesis based on these findings.

Objective 8: Discuss the results and conclusions, compare the methodology and findings to other papers, understand the contribution of the results to the general body of knowledge, and relationship to clinical applications and implications for future studies.

Objective 9: Present at the Visiting Professor Lectureship, and/or regional or national meeting via a poster or podium presentation. For written publication, obtain the advice of the editor in the selection of an appropriate journal based on the scope/results of study and the journal audience, follow the journal format for submission of articles, and gain an understanding of the publishing process including editing and creating effective figures and tables.

Timetable for Completion of Research Projects

August

Research Orientation: Introduction to key personnel involved in research and introduction to the research requirements. Start developing ideas for potential studies. Select and meet with faculty advisor to formulate question and discuss scope of project.

September

Begin developing study design, conduct literature search, write protocol, calculate budget and complete IRB or IACUC forms. Complete submission for Hand Center Research Committee approval and funding request.

October

Submit completed IRB or IACUC application.

November

Revise protocol, budget or ICF in response to stipulations for IRB or IACUC approval. Obtain final approval. Order supplies or tissue, if needed.

December

Begin experiments/subject enrollment/data collection. Design database to record data. Begin drafting abstract, introduction, background, and methods sections of manuscript. Discuss potential journals to submit to with editorial staff to determine manuscript requirements.

January – May

Complete experiments/subject follow-up/data collection. Meet with statistician for data analysis. Begin preparation for presentation (oral or poster). Continue work on manuscript, moving on to results and conclusion.

June

Finalize presentation for Visiting Professor Weekend. Submit manuscript to Faculty Advisor for review and comment. Turn manuscript in to editorial staff. Turn in raw data files to Hand Center Research office.

July

Complete any manuscript revisions. File Study Termination forms with IRB or IACUC.

Vacation

Each fellow is allocated four weeks of vacation during their one-year training. However, only one week of vacation may be taken per quarter. Vacation may be taken in conjunction with, but not in addition to, specialty meetings and national hand surgery courses. Prior approval must be arranged with the Program Coordinator to ensure adequate clinic, OR and call coverage.