Fellowship

Immediately following acute trauma for evaluation and treatment. This arrangement, in addition to emergency room exposure, allows the fellow to gain diversified trauma experience.

I. Patient Care

The fellow will demonstrate the following:

  • Appropriate evaluation and treatment of patients with upper extremity disorders utilizing physical examination testing appropriately specific to each diagnosis; including Phalen’s, Watson’s, Finkelstein, Allen, Earle’s and Wartenberg signs.
  • Examination the injured hand with a high level of sophistication and detail to diagnose bony or ligamentous injuries,
    flexor /extensor tendon injuries, nerve or vascular injuries, and infections of the hand and upper extremity.
  • Performance of a detailed clinical examinations of the forearm and wrist.
  • Appropriate diagnostic referrals for tests and imaging studies to assist with injury assessments.
  • Appropriate interpretation of radiology findings, including plain films, CT, MRI and bone scans for patients complaining of chronic hand and/or wrist pain.
  • Accurate interpretation of x-rays for fractures of the wrist and hand to determine the need for closed reduction versus open treatment.
  • Formulation of a diagnosis and treatment plans for hand surgery patients as appropriate for his/her level of training as a hand surgery fellow.
  • Appropriate treatment of both simple and complex infections of the hand, wrist and forearm (e.g. flexor tenosynovitis, large or complex abscesses, deep space infections of the hand and cellulitis, with appropriate ID consultations.
  • Appropriate treatment for non-operative fractures of the metacarpals, digits, carpal bone fractures, or distal radius including reduction and cast immobilization.
  • Repair of nail beds injuries which may include nail bed grafts.
  • Steroid injections of the A-1 pulley of the flexor tendon sheath for trigger fingers, first dorsal extensor compartment tenosynovitis (DeQuervain’s), lateral/medial epicondyle for epicondylitis, and carpal tunnel for carpal tunnel syndrome.

A thorough understanding of the operative anatomy and participation and or demonstration of the following procedures:

  1. Open reduction and internal fixation of metacarpal and phalangeal fractures utilizing K-wires and plate/screw fixations.
  2. Repair/reconstruction of ligament injuries of the hand (e.g. UCL and RCL ligament ruptures).
  3. Carpal tunnel release, radial tunnel release, cubital tunnel release, and radial tunnel release.
  4. Open reduction and internal fixation of scaphoid fractures.
  5. Bone grafting for fracture nonunion/malunion of the carpus and hand (iliac/radial).
  6. Operative treatment of Dupuytren’s contracture, as well as exposure to non-operative treatment with collagenase.
  7. Arthrodesis of interphalangeal joints.
  8. Simple flap designs for coverage for soft tissue deficit.
  9. Dorsal and volar approaches to the wrist joint for treatment of distal radius fractures.
  10. Treatment of ulnar shaft fractures.
  11. Wrist arthroscopy.
  12. Limited intercarpal fusions – scaphoid excision and 4 bone fusion, RSL fusion.
  13. Proximal row carpectomy.
  14. Complete wrist fusion.
  15. Syndactyly release/reconstruction and treatment of the congenital bifid thumb
  16. Lateral/medial epicondylectomy for epicondylitis.
  17. Flexor and extensor tendon transfers, including those in reconstruction of the rheumatoid hand or for opposition.
  18. Radius and ulna shortening osteotomies.
  19. Distal ulna resection procedures (e.g. Darrach or Feldon procedures)
  20. Trapezium excisional arthroplasties for basal joint osteoarthritis of the thumb
  21. Extensor tendon injuries.
  22. Flexor tendon repairs, including those in “no man’s land” (zone II) and zone I
  23. Tenolysis, tenodesis, and flexor tendon sheath pulley reconstruction
  24. Extensor and flexor tendon grafting.
  25. Joint arthroplasties of the MP and PIP joints.
  26. Neurolysis of median, ulnar, radial nerves.
  27. Excision of upper extremity tumors (both benign and malignant).
  28. Excision of common hand masses (giant cell tumors, ganglion cysts, mucous cysts, volar retinacular cysts, neuromas, schwannomas, lipomas, etc.)
  29. Application of an external fixation system for reduction of distal radius fractures.
  30. Microsurgical skills under the operating microscope and to include arterial anastomoses and fascicular nerve repairs.
II. Medical Knowledge

The fellow will demonstrate the following:

  • A progressive and advanced understanding of the anatomy of the upper extremity
  • A thorough understanding of the treatment of fractures and injuries of the hand and wrist, fingertip injuries, tendon and nerve injuries.
  • The ability to diagnose and treat nerve compression syndromes, including carpal tunnel syndrome, cubital tunnel syndrome and radial tunnel syndrome and to correlate electrodiagnostic findings in the diagnosis and treatment of these compressions.
  • An understanding of the indications, contraindications and surgical options for patients with partial or complete digital amputations.
  • Options available for patients with fracture non-unions/malunions of the carpus and wrist, scapholunate advanced collapse, chronic TFCC ruptures and aseptic/avascular necrosis.

 A detailed understanding of educational material available, including:

*Examination of the Hand, published by the American Society for Surgery of the Hand.
*Essentials of HAND SURGERY, by John Gray Seiler (ASSH)
*Green’s Operative Hand Surgery textbook, Hand Surgery Update V.
*Focused reading of other appropriate articles (including faculty reprints) textbooks and  journals of hand surgery.
*Online sources of information are available such as JHS, Pubmed, Hand Clinics, JBJS.

  • Detailed understanding of the use of splints for fracture immobilization and tendon rehabilitation programs.
  • The fellow must prepare and present an original research topic which will be presented at the NY Society for Surgery of the Hand (NYSSH) and /or a national meeting (ASSH /AAOS) during the year.
  • Presentation and reporting of any appropriate patient related issue at monthly QI conference
  • Attendance at two NYSSH open meetings and lectures.
  • Participation in the NYSSH Resident’s and fellows Night with presentation of a topic of interest determined by Fellow and Program Director.

 

III. Practice-Based Learning and Improvement
The fellow will demonstrate the following:
  • The ability to locate and interpret scientific studies and sound medical practice into an appropriate knowledge base that will be of direct benefit to patients. These finding will be discussed with the Program Director during operative case conferences and post surgical rounds every Tuesday and Thursday. These discussions often lead to the selection of a presentation topic.
  • The ability to formulate a clinical or surgical plan of treatment, which will be reviewed in detail with the treating physician (faculty), as necessary to achieve optimal patient outcomes.
  • Appropriate use of resource material (e.g. textbook and related articles) in preparation for operative cases which will foster educational discussions that arise as part of surgical experience.
  • Participation in the role of teaching Plastic Surgery resident rotators (Montefiore) on the service.
  • Expertise in the use of available information technology and hospital information systems to manage patient data (e.g. PRISM, E-clinical works, lab tests, imaging tests, etc.) with appropriate entering of pre and post-operative orders and care plans.
  • The ability to integrate feedback from faculty and staff to ensure constructive improvement in practice that, in the future, will improve patient care. The fellow is urged to discuss questions regarding practice as they arise and performance feedback is provided systematically, but especially during the formal quarterly “faculty to fellow” evaluations.

 

IV. Interpersonal and Communication Skills
The fellow will demonstrate the following:
  • The ability to participate in the development of others.
  • Effective communication with all members of the hospital staff (nurses, technicians, radiology staff, social workers, hand therapists, operating room/surgery center staff, and office support staff) and members of the Hand Surgery Service.
  • Effective, professional and ethical interaction with patients and family members.
  • The ability to provide appropriate and detailed information to patients and family members utilizing sound medical facts as they relate to specific hand surgery topics.
  • The ability to develop appropriate relationships with patients that foster communication, trust and respect
  • The ability to recognize important cultural differences and plan interactions with these differences in mind
  • Age appropriate competencies with the ability to modify approaches based on these criteria.

 

V. Professionalism
The fellow will demonstrate the following:
  • Strict adherence to medical/ethical principles while acting within the scope of his/her practice.
  • An understanding of social, economic, emotional and work-related implications that a hand injury may represent for the patient and formulation of a treatment plan based on these issues.
  • Competent and ethical patient care.
  • Patient confidentiality and strict adherence to HIPPA guidelines.
  • Informed consent from patients, in accordance with established guidelines, that ensure full patient comprehension and demonstrate the ability to modify communication based on culture, age, gender or education.
  • Knowledge of the philosophy, standards, policies and objectives of Mount Sinai Beth Israel and the Hand Surgery Fellowship.

 

VI. Systems-Based Practice

The fellow will demonstrate the following:

  • An awareness that the care provided to patients may affect institutional goals and objectives.
  • The ability to effectively utilize hospital resources in a way that directly benefits patient care.
  • Exposure to aspects of medical and office management that are available at The Hand Surgery Center.
  • An understanding of the differences in payer types, such as worker’s compensation, managed care, HMO, PPO, and Medicare plans. With on-site billing expertise available, resources are available to learn current trends.
  • An understanding of the necessity to provide efficient and cost-effective health care in the context of appropriate use of limited medical resources, without sacrificing quality of care.
  • The ability to establish good public relations within the department and community
  • The ability to act as patient advocate and family resource for post-discharge activities which may include interaction with interdisciplinary and community resources.

 

Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.


Previous page