Hand education for emergency medicine residents: results of a pilot program

Multiple studies have demonstrated the lack of knowledge of hand anatomy and pathology among those who first see patients with hand disorders. The goal of this study was to determine whether a hand surgery rotation for emergency medicine residents would improve this group's knowledge of the hand and its disorders as assessed at the end of their residency training.

Seven postgraduate year (PGY) 2 emergency medicine residents completed a 4-week hand surgery rotation. Hand knowledge was assessed at the start, at the end, and 1 year after this rotation (end of PGY 3). Knowledge of a control group of 7 PGY 3 emergency medicine residents who did not have this rotation was also assessed.

Hand knowledge in the residents who completed the rotation was significantly improved. This was true for overall test performance (88% vs 70% correct responses), as well as for each of the anatomy and function (89% vs 57%), diagnosis (96% vs 86%), and treatment (79% vs 51%) categories. Overall test performance (78% vs 66%) and anatomy and function category performance (75% vs 43%) were significantly better at the end of PGY 3 for the residents who completed the rotation as compared to the control residents.

A hand surgery rotation during an emergency medicine residency program improved the knowledge of hand anatomy and disorders. This knowledge was retained 1 year later and was greater than the knowledge of matched emergency medicine residents who did not have this rotation. Better knowledge of hand anatomy and disorders among emergency physicians might improve their ability to initially evaluate and treat patients with these conditions. Such knowledge might allow emergency department physicians to play a more important role in the management of hand emergencies. A hand surgery rotation has been incorporated into the PGY 2 curriculum for all emergency medicine residents at my institution.