Hand Surgery Fellowship Curriculum

Each of the participants in the Hand Surgery Fellowship is assigned on a rotating or intermittent basis to a member of the department’s faculty for supervision purposes. The fellow assumes substantial responsibility and accountability including examination, treatment, and follow-up for that faculty member’s patients. This applies to all clinical settings including inpatient, outpatient, operating rooms, emergency rooms and private office.

At the onset of the fellowship, the fellow is closely monitored by the staff, and all outpatient, inpatient, surgical, and emergency treatment and/or decisions are provided by the staff. However, as the fellow demonstrates increasing competency, he/she is given greater latitude in both the decision-making process as well as with treatment implementation.

The fellow is responsible for staffing hand cases at Ben Taub Hospital, Baylor St. Luke's Medical Center, Michael E. DeBakey Veterans Affairs Medical Center, Texas Children’s Hospital, and Texas Orthopedic Hospital. The primary clinical responsibility for ward management falls to the fellows on these services, or to the attending staff positions. The fellows are supervised by attending orthopedic surgeons who are full time faculty members in the Baylor College of Medicine Department of Orthopedic Surgery.

This course provides the basic development of surgical skills in microsurgery. The course description is as follows: preconditions and rules of microsurgery, basic skills in the use of a microscope, elastic sheet and tubing of various microsurgery suturing, artery end-to-end anastomosis, vein end-to-end anastomosis, and interposition vein graft on live animals. Hand Surgery fellows are required to participate in a 40-hour formal microvascular surgical course in the microvascular skills laboratory.

Early in the academic year, fellows participate in teaching of physical therapy students at Texas Woman’s University in cadaver dissection of the upper extremity. Additionally, opportunity arises throughout the year for fresh cadaver dissection for both understanding of general basic upper extremity anatomy as well as soft tissue flap design.

Subsequent laboratories are often done in association with bioskills laboratories that would be sponsored by industry and orthopedic device companies. That also gives the fellows a hands-on opportunity to familiarize themselves with certain orthopedic devices. All of these sessions provide anatomy skills and knowledge of neurovascular anatomy, and musculoskeletal anatomy understanding of carpal structure and kinematics, and in particular to understand pedicle and free flap transfers in the hand and upper extremity.