Training Tomorrow's Hand Surgeons: Clinical, Leadership, and Structural Trends in Fellowship Education

Area of Science:

• Medical Education
• Surgical Fellowships
• Graduate Medical Training

Background:

• Hand surgery fellowships attract trainees from orthopedic, plastic, and general surgery.
• Existing research on the structural and leadership characteristics of these fellowships is limited.
• Understanding fellowship variations is crucial for optimizing graduate medical education.

Purpose of the Study:

• To assess the structural and leadership characteristics of Accreditation Council of Graduate Medical Education-accredited hand surgery fellowships in the United States.
• To hypothesize variations in faculty-to-fellow ratios and case volume based on specialty sponsorship.
• To investigate leadership demographics and diversity challenges within these programs.

Main Methods:

• A cross-sectional analysis of 95 U.S. hand surgery fellowship programs was conducted.
• Program characteristics were compared based on region and specialty sponsorship.
• Data included program size, faculty-to-fellow ratios, and annual case volume.

Main Results:

• Most fellowships were orthopedic-sponsored (77.9%), followed by plastic surgery (20.0%).
• Orthopedic-sponsored programs had more fellows, lower faculty-to-fellow ratios, and were less open to general surgery applicants.
• Program directors were predominantly male (85.3%) and orthopedic-trained (73.7%).

Conclusions:

• Hand surgery fellowships exhibit consistent structures but differ significantly between orthopedic and plastic surgery sponsorships.
• Variations exist in fellow enrollment, faculty ratios, and applicant openness.
• Underrepresentation of women in leadership positions requires further investigation.