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Hypothesis: One year of hand fellowship education is inadequate based on the experiences of fellows having completed a fellowship.

Methods: Electronic surveys were sent to 248 surgeons who had completed a hand surgery fellowship from 2008-2010. The survey was structured to ascertain whether there was a need for expanded education encompassing the entire upper extremity. Four separate mailings were conducted to increase the response rate.

Results: One hundred and thirty one surgeons responded to our survey (53%). Sixty nine percent were in private practice. Seventy four percent were trained in orthopaedics, 16% in plastic surgery, and 10% in general surgery. Seven percent of candidates felt that 1 year of specialty training was insufficient. Forty eight percent of trainees were seeking shoulder and elbow training in their fellowship. Fifty two percent of candidates did not have dedicated plastic surgery rotations and 40% received no shoulder and/or elbow training during their fellowship. Microsurgical experience was lacking with 8% of trainees not having performed a replantation, 23% not being involved in a free flap, 32% not participating in brachial plexus surgery and 17% not having done a vascularized bone graft. Forty percent of orthopaedically trained surgeons stated they did not feel competent in performing a replant as opposed to 11% of plastic surgeons. In contradistinction, 94% of orthopaedic trainees felt comfortable treating a both bone forearm fracture compared to 41% of plastic surgeons. Fifty six percent of candidates did not have any dedicated time for research during their fellowship. Twelve percent of trainees were enrolled in additional training after their fellowship including shoulder and elbow, microsurgery, pediatrics and peripheral nerve surgery. When asked if they would have a sought a 2 year hand and upper extremity fellowship, 60% of candidates would have applied.

Summary: Based on the results of this survey, one year of hand fellowship training has been perceived as inadequate in 60% of respondents, with focus lacking in shoulder and elbow, microsurgery, pediatrics and clinical research. Further critical review and consideration of extended training should be considered.