To be the finest hand/upper extermity surgery fellowship in the United States training compassionate, technically masterful and academically productive hand/upper extremity surgeons who are leaders in the field.

To provide a solid basic science foundation for understanding and practicing hand/upper extermity surgery.

To teach the art and science of clinical diagnosis of upper extremity pathology.

To provide the technical skills necessary to perform all hand/upper extermity surgery operations expertly.

To teach and demonstrate by example the principles of the ethical practice of hand/upper extermity surgery.

To reinforce the importance of compassion and respectfulness in interactions with patients and their families.

To encourage and facilitate scholarly investigation and academic productivity through publication and presentation.

To provide guidance in developing familiarity and comfort with the managerial aspects of hand/upper extermity surgery practice.

To provide and receive feedback concerning performance of fellows and attending staff.

To encourage participation in local, regional and national organizations promoting the art and science of hand/upper extermity surgery.

To foster and encourage comraderie with colleagues and loyalty and future participation in St. Luke's Roosevelt Hospital Center Hand/Upper extermity Surgery Service activities.

An educational curriculum has been developed in order to achieve the goals noted above. The foundation of the c urriculum is a series of weekly lectures at Grand Rounds on Tuesday morning on clinical and basic science subjects covering the majority of areas within hand and upper extremity surgery. Most of these lectures are presented by members of the hand surgery attending staff, the fellows and attendings from other specialties within the hospital and local hand/upper extermity surgery community. Outside lecturers are invited to provide additional expertise in areas like microsurgery, orthopedic oncology and the treatment of tetraplegia. Each fellow will be responsible for one lecture quarterly. In addition, each fellow invites a visiting professor of his or her choosing who will spend a day and a half with the fellows and hand surgery service.

There are weekly anatomy dissections and teaching conferences in which the fellows perform the dissection of the anatomic region to be presented along with the orthopedic resident on the service. The fellow and resident present the dissection with relevant clinical correlations to the hand service, orthopedic residents and medical students. Pertinent journal articles dealing with anatomy and clinical correlations are provided in advance for all participants in these anatomy sessions. It is expected that the fellows and residents will have read these a rticles in advance and be conversant with their content. The format of the conference is the Socratic method in which the presenter of the prosection questions the residents and medical students about the anatomy and its clinical significance. There is an atttending present at all of these sessions who provides clinical correlations to the anatomy being presented.

There is a weekly indications conference, research conference and a journal club on Monday mornings. The indications conference reviews the planned operative cases for the upcoming week and those completed during the previous week. The research conference reviews the progress of ongoing research projects. Fellows are assisted in selecting one or more projects, usually clinical, which form the basis for his/her investigative work for the year. Help is also provided in preparing applications for IRB approval. At least two journal articles are selected by the fellows, with attending approval, for the weekly Journal Club. They are presented by the fellows and discussed by the entire hand service. In addition to current journal articles, classic papers selected from the "Stern Reading List" will be reviewed. It should be a goal for the fellows read most of the articles on that list by the end of the year. An additional goal should be for the fellows to read Green's textbook Operative Hand Surgery by years end. Toward that end, one or more chapters in that book have been assigned for each week of the academic year. The chapter(s) will be read by the fellows and geographically full time attendings and discussed on Wednesday morning at 7 A.M. The chapter will be summarized and presented by one or both fellows and controversial or particularly informative areas discussed in greater detail. Fellows and attendings are expected to enhance the content of the chapter from their personal experience and literature review. There is a conference each Thursday morning before Orthopaedic Grand Rounds concerning topics in Hand Therapy with the Director of Hand Therapy, Caryl Johnson, OTR.

There are numerous videotapes within the J. William Littler Library including many of the series of ASSH videotapes. At a minimum, the videotapes developed on the Roosevelt Hand Service and most of the ASSH videotapes should be reviewed during the course of the fellowship year.

Fellows attend a one-week, intensive course on microsurgical technique early in their fellowship in order to master in the technical aspects of microsurgery. In addition, one fellow spends one month and the other, three months at the Texas Scottish Rite Children's Hospital. The fellow should have read the chapter on Congenital Differences in Operative Hand Surgery prior to leaving for Dallas.

It is expected that the fellow will master all basic techniques of hand/upper extermity surgical procedures including fracture fixation, osteotomy, tendon repair, vascular repair, neurorrhaphy, nerve grafting, tendon grafting, neurolysis, tenolysis, skin grafting, local flap coverage and free tissue transfer. The technical expertise of each fellow is evaluated on an ongoing basis throughout the year.

The primary goal of the fellowship is to use the core curriculum as a body of knowledge with which to teach diagnostic and clinical skills and surgical technique. Most of of the teaching is done in the office and operating room on a one-on-one or two-on-one basis.. Fellows see patients in the office with Drs. Glickel, Barron and Catalano and follow those patients through their operative course and during their post operative follow-up.

Clinical rotations will be in three month blocks. One fellow will work primarily with Drs. Glickel and Fietti the other with Drs. Barron and Catalano.. As a basic framework for the fellows time with Drs. Barron and Catalano, he or she will work with Dr. Catalano Monday morning and during his time in the operating room on Monday afternoon and Wednesday. He or she will spend the remainder of the time except Tuesday and Thursday mornings with Dr. Barron. The rotation with Drs. Barron and Catalano focuses on evaluation and treatment of problems of the hand, wrist, forearm, elbow and shoulder with a significant emphasis on the shoulder. The goal of the rotation is to learn how to examine the upper extremity, order appropriate diagnostic tests, formulate a diagnosis and develop a treatment plan. The indications for and appropriate use of conservative and operative treatment modalities will be emphasized. During the rotation with Drs. Glickel and Fietti, the fellow will work the office with Dr. Glickel on Monday. Dr. Fietti has surgical cases most Wednesdays which the fellow will cover. If he is not operating, the fellow will see patients in the office with Dr. Glickel. The fellow will cover operative cases with Dr. Glickel on Tuesday afternoon and all day Friday. The focus of this rotation is the hand, wrist forearm and elbow and the specific goals are the same as for the Barron Catalano rotation in terms of learning physical examination, diagnostic and treatment skills.

Fellows will also staff the hand surgery clinics which are conducted on Tuesday at St. Luke's Hospital and Thursday at the Roosevelt site. In addition, fellows will provide coverage, when they are not otherwise committed, for hand/upper extermity surgical cases done by the other member of the hand surgery attending staff, Dr. Rosenstadt. Assignment of coverage for operative cases is made by the senior fellow in consultation with the attending staff and should include appropriate case experience for the orthopedic resident rotators. The more complex surgical cases should be covered by the fellows and more basic cases by the resident house staff.

The 12 month fellow spends one month and the 18 month fellow spends 3 months at the Texas Scottish Rite Hospital for Children working with Marybeth Ezaki, M.D. and Scott Oishi, M.D.. This is a comprehensive experience in the evaluation and treatment of congenital differences and acquired pediatric hand and upper extremity pathology. The fellows see patients with Drs. Ezaki and Carter and scrub with them on their surgical cases. The goal of this rotation is to develop a thorough understanding of the range of congenital hand/upper extermity pathology, become facile with the examination and diagnosis of those problems and comfortable deciding upon the timing of reconstruction. The fellow should have seen enough reconstructive surgery during the rotation to have an understanding of the indications for and the basic techniques of surgical reconstruction.

It is mandatory that each fellow complete one, and preferably, two publishable research projects during his/her fellowship year. One must be done while at the St. Luke's Roosevelt Hospital Center and, the other, when the fellow rotates through the Texas Scottish Rite Children's Hospital. Certainly, more than two projects would be ideal but it is more important to finish one or two projects than to start several and complete none. The majority of research done at both sites is clinical and full access to all office and hospital records is afforded to the fellows. Patients may be scheduled for recall during regular office hours or at the fellows convenience.

The fellows are second call for all hand/upper extermity surgery problems at both the St. Luke's and Roosevelt Hospital Centers. First call coverage is provided by the orthopedic housestaff who see all patients initially and consult with the fellow as deemed necessary. In order to be readily available at all times, fellows are expected to live in hospital sponsored housing within one block of Roosevelt hospital. On-call coverage will be on an every third night schedule. When one of the fellows is not on-call, call will be be taken by the orthopedic resident with backup by the attending on-call.

The Hand Surgery Service provides emergency room coverage at both St. Luke's and Roosevelt Hospital Divisions of the Hospital Center. In the emergency room, fellows are responsible for the evaluation and treatment of all hand/upper extermity problems, all soft tissue problems below the elbow, all infections distal to and including the elbow, all upper extremity peripheral nerve problems and complex wrist, forearm and elbow fractures. Emergency Room patients are initially evaluated by the orthopaedic resident rotating on the hand surgery service. The resident treats simple problems independently and consults with the hand/upper extermity surgery fellow for more complex problems. The hand/upper extermity surgery fellow will either supervise treatment of the patient by the resident or will treat the patient himself/herself if it is more complicated than the resident can handle. Members of the Hand/Upper extermity Surgery attending staff are always available for consultation by phone or in person with the fellows. All cases requiring surgery i n the operating room are s upervised by an attending who is onsite and in the operating room. All patients seen in the emergency room not requiring emergency surgery are referred for follow up to the private office of the attending surgeon on call or to the hand surgery clinic of the outpatient department of the respective division. In the hand surgery clinic the fellows supervise the care of patients along with the orthopaedic residents. The hand/upper extermity surgery attending is present and supervises patient care at all clinic sessions. All surgical cases arising from the clinic are performed by residents under the supervision of the hand/upper extermity surgery fellows or by the fellows with the attending on call. When fellows take residents through cases there is always an attending in or near the operating room supervising the surgery.

Fellows see patients in the private office with Drs. Glickel, Barron and Catalano. They participate in the initial evaluation of new patients as well as the follow up of patients particularly those in whose surgery then participated. Each patient is first evaluated by the fellow and then presented to and discussed with the attending surgeon

In the operating room, the fellows function as the surgeon under the supervision of an attending or as a first assistant to the attending surgeon for private cases and most cases from the hand surgery clinic. On cases originating from the hand clinic the fellow may take the resident through the case with the attending surgeon acting as second assistant or involved more peripherally as an unscrubbed consultant. Surgical cases are done at both divisions of the hospital center and the fellow or resident covers all upper extremity cases done by the hand/upper extermity surgery attending staff.

Inpatient care is provided by the orthopaedic housestaff backed up by the fellow and, ultimately by the attending involved in the case.

Fellows will be evaluated quarterly by all of the members of the attending staff. The evaluations address the six core competencies developed by the ACGME. The fellows will also be evaluated by some of the non medical personnel with whom they interact within the hospital. The director of the hand service will review the results of those evaluations with the fellow quarterly and an end of the year evaluation will be provided as well. The fellows will be asked to evaluate the attending staff with a performance questionnaire quarterly. The results of that questionnaire will be used to advise members of the attending staff of ways in which they can contribute more successfully to fellowship education.

Fellowship promotion is based upon successful completion of all of the clinical requirements of the fellowship including clinical rotations at the parent and affiliated institutions and a research project suitable and ready for publication.

Clinical requirements include completion of rotations at St. Luke's Roosevelt Hospital Center at both the Roosevelt and St. Luke's divisions and the rotation at the Texas Scottish Rite Hospital. Performance deemed to be unsatisfactory by the faculty at any one of the aforementioned institutions represents possible grounds for withholding the certificate of completion of the fellowship. If there is a negative evaluation by faculty at other than the parent institution, the ultimate disposition will be determined by the fellowship director in consultation with those faculty. The fellow is entitled to appeal the decision of the fellowship director but final determination of fellowship completion rests with the director.

The other requirement for completion of the fellowship is completion of a research project, either clinical or basic science, which culminates with a paper suitable and ready for submission for publication. The paper must be written, fully referenced and appropriate figures made prior to the fellow finishing the program.