Hand Surgery Fellowship

Overview

Thank you for your interest in our one-year ACGME-accredited Hand Surgery-Microsurgery Fellowship at UCLA. The Hand and Microsurgery Fellowship is a combined program within the Department of Orthopaedic Surgery and the Division of Plastic and Reconstructive Surgery, offering fellows the opportunity to interact with residents and attendings from both disciplines. These include the primary hand surgery faculty - Prosper Benhaim, MD, Kodi Azari, MD and Roy Meals, MD. In addition to supervised clinical responsibilities in the operating room and clinics, the fellow will also have independent clinical responsibilities at all of the UCLA-affiliated hospitals - Ronald Reagan UCLA Medical Center in Westwood, West Los Angeles VA Hospital,UCLA Santa Monica Medical Center, Shriner’s Hospital and Olive View-UCLA Medical Center. The fellow will receive a temporary faculty appointment, and also have teaching responsibilities for residents and medical students. There are excellent facilities for anatomical dissections and microsurgical training. The fellow will be involved in both emergency and elective microsurgery. We anticipate that one-half day per week will be blocked off from clinical responsibilities in order to pursue clinical or basic laboratory research.

Our Faculty

Affiliated Physicians

  • Katherine Au, MD, Assistant Clinical Professor, Shriners Hospital of Los Angeles
  • Malcolm Lesavoy, MD, Clinical Professor, Division of Plastic and Reconstructive Surgery

There are 5 dedicated hand therapists at UCLA, 2 dedicated hand therapists at Olive View-UCLA Medical Center, and 2 dedicated hand therapists at UCLA Santa Monica Medical Center.

Training Institutions

Ronald Reagan UCLA Medical Center: The majority of the fellowship is based at Ronald Reagan UCLA Medical Center. The fellows will be exposed to traumatic and elective hand surgery, as well as attending the private offices of Drs. Benhaim, Azari and Meals. UCLA is one of four Level 1 Trauma Centers in Los Angeles County and one of two University Hospitals (the other being USC-LA County). RRUCLA is a new, state-of-the-art facility that integrates a large number of technical advances that facilitate the delivery of healthcare and maximize patient/family comfort.

Olive View-UCLA Medical Center: One of the fellows will attend hand clinics on alternating Tuesdays and Thursdays. The clinic sees approximately 70-100 patients per clinic. The fellow will participate in the elective hand surgeries on alternating Mondays and Thursdays. There is a high volume of straightforward hand trauma seen through the Olive View Emergency Room --primarily wrist fractures, hand fractures, tendon lacerations, and nerve injuries. There is only one plastic surgery resident at Olive View and the fellow acts as an attending hand surgeon on an alternate weekly call. However, this is not an onerous call schedule and the fellows rarely have to go out to Olive View at night. The patient population at Olive View has a wide mix of patients from nearly all cultures. The majority of these patients are motivated to return to work and are generally very grateful for their hand surgery.

West Los Angeles VA Hospital: This is not really a fellowship rotation and is primarily for the two hand surgery residents. However, the fellow may occasionally cover the Friday VA hand clinic or the Monday hand surgery operating session if the hand residents are away or if the attending is away.

UCLA Santa Monica Medical Center and Orthopaedic Instititute: This is a private hospital in Santa Monica that was acquired by UCLA and has become a second campus for the RRUCLA Medical Center. There is no primary call obligation at Santa Monica, with all significant hand trauma either stabilized and referred to an outpatient clinic, or transferred to RRUCLA in Westwood for urgent inpatient care. Dr. Azari has outpatient clinics based in Santa Monica.

Shriners Hospital - Los Angeles: One fellow will accompany Dr. Au or Dr. Jones to a monthly congenital hand clinic at Shriners Hospital on the second Tuesday of the month. Both fellows will gain experience in microsurgical reconstruction of congenital hand anomalies, such as toe transfers, approximately once a month. There is also the opportunity to perform approximately 6 pollicization procedures per year with Dr Lawrence.

Program Structure

This is a combined service between the Department of Orthopaedic Surgery and the Division of Plastic and Reconstructive Surgery at UCLA. There is no alternating trauma call between orthopaedic surgery and plastic surgery. All bony and soft tissue injuries of the wrist and hand go to the Hand Surgery Service. Virtually all distal radius fractures go to the Hand Service, as do a large proportion of both bones forearm fractures. Complex combined injuries of the upper extremity and nerve injuries of the upper extremity also go to the Hand Service.

The Hand Surgery Service consists of:

  • 4 attendings
  • 2 hand surgery fellows
  • Senior Orthopaedic Resident – PGY4 or PGY5 - 6 residents alternating every two months
  • Junior Plastic Surgery Resident - PGY6 - 3 residents alternating every four months
  • Junior Orthopaedic Resident - PGY2 or 3 alternating every month. The junior orthopaedic resident takes care of all the minor hand trauma in the Emergency Room, including finger tip injuries and initial reduction of wrist and hand fractures. Patients with more severe hand injuries are initially seen by one of the 2 hand residents, with the hand fellow thereafter involved in the operative treatment or in a consultant role.

Fellowship Goals

The UCLA hand fellowship is completely integrated between orthopaedic surgery and plastic surgery. There are very few such truly integrated fellowships in the United States. The fellowship program stresses mentorship, with "one-on-one" relationships between the fellow and faculty. This is in contrast to fellowships where a fellow only spends 1 or 2 months with numerous attendings and does not get to understand the thinking and judgment of an attending. The fellow spends three months with Dr. Azari and Dr. Meals and then three months with Dr. Benhaim on a repeating cycle, for a total of six months on each of the two services. The attending physicians are effective and patient teachers with numerous awards for their teaching acumen. The attending will take the fellow through surgical procedures, rather than having the fellow "hold hooks", or "reinvent the wheel" at the other extreme. The full spectrum of hand surgery is seen at UCLA, with a good balance of exposure to all aspects of hand surgery. Fellows typically do not see an excessive amount of any one particular condition and nothing is really missed. Fellows will see a wide variety of trauma, post-traumatic reconstruction, distal radius fractures, wrist pain, rheumatoid arthritis, osteoarthritis, compression neuropathies, and congenital deformities. The UCLA fellowship is strong in microsurgery with a good volume of peripheral nerve surgery, reconstructions of the upper extremity, and tendon transfers. There is excellent exposure to extremity salvage reconstruction after malignant tumor resections.

Policies

Educational Program

Weekly Hand Conference. On Tuesday afternoons at 5:30 PM, either a resident or fellow will give a 30-45 minute didactic talk, followed by a lively discussion generated by the attendings. On the second Tuesday of the monthly hand conference, the two fellows show all of the interesting cases from the previous month, which also acts as an audit of cases preformed by the fellows in their attending role. This conference also serves as the morbidity conference, and is probably the most informative conference. The fellows present digital photographs and relevant x-rays of all cases. This photographic documentation allows teaching at all levels, from the medical student level through the orthopaedic and plastic surgery residents, up to the fellow and attending level.

Monthly Journal Club. Held at the home of Dr. Roy Meals, this is attended by the UCLA attendings, residents, fellows, hand therapists, and several of the community hand surgeons. Interesting or complicated cases are routinely presented, followed by review of 8-10 articles per month from the Journal of Hand Surgery or other appropriate journals. This has proven to be a valuable format for both social interaction and informal learning.

Orthopaedic Surgery Core Curriculum. Presented Wednesday mornings from 6:45 AM to 8:15 AM, two lectures per week for 8 weeks are given on basic hand surgery topics to the orthopaedic surgery residents and usually each fellow will give two of these lectures. This 8-week series of lectures takes place on a two-year cycle.

Hand dissections. Each fellow and each resident on the service in July will demonstrate hand and upper extremity anatomy to all the orthopaedic surgery and plastic surgery residents during one or two sessions.

Basic microsurgical lab course. This weeklong program is for an incoming orthopaedic-trained fellow. We usually arrange for such a fellow to spend one week in the microsurgery lab during the first month of the fellowship in August to hone his or her microsurgical skills. However, we would also prefer any incoming orthopaedic-trained fellow to have completed a one-week basic microsurgery course at his or her home institution prior to the fellowship. Similarly, we would prefer to have any plastic surgery-trained fellow complete a basic AO internal fixation course prior to beginning the fellowship.

Local courses and lectures. The hand fellows are encouraged to attend lectures by visiting hand surgeons at other institutions such as Orthopaedic Hospital and USC. Dr. Meals has organized a number of hand surgery courses (Doctors Demystified series), in which many of the fellows have participated.

Independent Responsibility

The UCLA fellowship does expect that each individual fellow will gain progressive confidence over the course of the fellowship in transitioning from fellow to independent surgeon, yet with the assurance that attending staff is available at all times for supervision and mentoring. Our goal is that the fellows will learn the critical nuances from the attending staff that will allow him or her to become a highly competent and independent hand surgeon. In conjunction with the attending staff, the fellow is expected to be actively involved in teaching both orthopaedic residents and plastic surgery residents the wide spectrum of hand surgery during both emergency and elective hand surgery.

Research

Each fellow is expected to complete two research projects, one of which is usually presented at the annual UCLA Orthopaedic Residents Day, but ultimately should be presented at a national meeting and published if possible. Fellows have usually become involved in clinical projects, but there are multiple opportunities for projects in basic science. Previous research includes Gordon Singer, M.D., who completed a biomechanical study of flexor tendon repairs and Ranjan Gupta, M.D., who studied nerve compression. The Sumner Koch prize for the best research paper at the annual meeting of the American Society for Surgery of the Hand has been won by a UCLA fellow or resident four times out of the last fourteen years.  

  • Microsurgery Lab in plastic surgery
  • Bio-mechanics Lab staffed by a full-time PhD biomechanical engineer
  • Fresh cadaver dissections in the anatomy department
  • Basic research: Dr. Benhaim has directed a basic science lab with a major emphasis on tissue engineering of cartilage and bone. A number of labs at UCLA have focused on tissue engineering with musculoskeletal emphasis.

Salary, Vacation and Meetings 

The fellows are paid at approximately $68,000 annually. Travel and accommodation expenses are paid for one meeting per year, which is usually the American Society for Surgery of the Hand meeting in the Fall or the American Association for Hand Surgery meeting in January. Each fellow receives one month of paid vacation.

Application Process

Applications are accepted via the ASSH Online Fellowship Application portalPlease arrange to have four letters of recommendation forwarded, one from the chief of your residency training program and one from the hand surgeon who knows you best.

UCLA participates in the NRMP Hand Fellowship Specialty Match and you should contact the NRMP for an applicant agreement for the Hand Surgery Specialty Match. Applicants should have completed a residency in orthopaedic surgery, plastic and reconstructive surgery, or general surgery. A California license is a requisite for the incoming fellow.

After review of the applications, applicants will be invited to Los Angeles, usually in late February-March, for a mutual visit and interview.

Application Deadline

The deadline for submitting application materials to UCLA is December 15.

Thank you again for your interest in the UCLA Hand and Microsurgery Fellowship. We encourage you to remain in touch with the Fellowship Coordinator regarding the status of your application.

Interview Dates

2022 - 2023 dates coming soon!

Contact Information and Application Submissions

Applications can be submitted electronically via the ASSH Online Hand Fellowship Application Platform

Orthopaedic Surgery Education Office
David Geffen School of Medicine at UCLA
10833 Le Conte Avenue, 76-143 CHS
Los Angeles, CA 90095

Tel: 310-825-6557
Fax: 310-825-1311
Email: [email protected]