Fellows will spend six months at Tufts Medical Center, the tertiary care facility for the Tufts University-Affiliated Hospitals in New England. This 415-bed university hospital also has 60 beds for pediatric cases. The Hand Service performs an average of 815 surgical cases and sees approximately 6,800 patients each year for traumatic injuries and post-traumatic reconstruction of the elbow (arthroscopy and arthroplasty). In addition, the hand service provides soft-tissue coverage for the orthopedic service.
Diagnose and Treat Complex and Rare Hand Problems
While at Tufts MC, faculty and fellows diagnose and treat a large variety of uncommon hand and upper extremity problems. These include acute and chronic trauma cases, congenital anomalies, tumors, arthritis, arthroscopy, joint replacement and some micro-surgical cases.
Fellows also assume primary responsibility for the Hand Clinic patients and work closely with the senior staff at Tufts MC, assisting them in the operating room and in outpatient settings. The team consists of two attending physicians, a fellow, a PGY-4 resident, PGY-2 resident, a physician assistant and two certified hand therapists.
In addition to the clinical experience, fellows participate in weekly hand surgical rounds.
Work with Specialists at a Nationally Renowned Orthopedic Hospital
New England Baptist Hospital (NEBH) is a 100-bed referral hospital with a large emphasis on orthopedic and reconstructive hand surgery. It is one of the Tufts-affiliated orthopedic teaching hospitals, training six orthopedic residents and several fellows in reconstructive total joint surgery, spine surgery, hand surgery, foot and ankle surgery and sports medicine.
During this rotation, fellows work with the attending physicians, scrub in on all cases and see patients in the office. Our approach is for fellows to work up new patients, formulate treatment programs and see the patient along with the attending. A large volume of hand, wrist and elbow pathologies come through the office. About 50 new patients seek treatment each week.
The spectrum of surgical pathology includes elbow ligament, bone and tendon injuries, rheumatoid and degenerative arthritis of the elbow, wrist and hand, as well as nerve entrapments, fractures, Dupuytren's, tumors and other common hand problems. Fellows will learn both surgical and nonsurgical management of degenerative arthritis, rheumatoid arthritis, common hand problems, entrapment neuropathies and cumulative trauma.
We often follow the preceptorship method of instruction. Difficult and intriguing cases are discussed between patient meetings or at the end of the day.
Additionally, fellows will be involved with the management of the post-operative patients. Our hand therapy department resides across the hall from the office.
Because the practice is mainly elective, there are not many night or weekend responsibilities, which provides ample time for study and research. Clinical research opportunities are always available, and you are encouraged to participate in these projects.
Gain Experience in Workman’s Compensation Cases
Our responsibility in workman’s compensation cases is to recommend further treatment when necessary and evaluate the ability of patients to return to work. Many times a final disability evaluation is rendered. Fellows are involved in these evaluations and learn how to prepare medical/legal reports.
Manage Cases at a High-Volume Community Hospital
The Newton-Wellesley Hospital emergency room handles more than 33,000 visits annually. Hand injures are treated regularly, but aside from the occasional brush chipper or snow blower, mutilating hand trauma is seen only from time to time.
The emergency room physicians manage much of the primary care before referring patients to the orthopedic office. Orthopedic residents don’t staff the emergency room, but hand fellows will make occasional trips to the emergency room for non-operative cases. One Tufts orthopedic resident is assigned to the hand service at Newton-Wellesley Hospital.
Build Advanced Surgical Skills at a Busy Boston Hospital
St. Elizabeth's Medical Center is a 350-bed community and Tufts-affiliated teaching hospital located in the Brighton section of Boston, about halfway between Newton-Wellesley Hospital and downtown Boston. Emergency room coverage is provided by orthopedic assistants who are employed by St. Elizabeth's Medical Center who only call the hand fellow for cases that require admission or surgical attention.
As a fellow, about 25 percent of your time is spent at St. Elizabeth's Medical Center while on the Newton-Wellesley Hospital rotation. St. Elizabeth's Medical Center is the specialty referral center for all of the military services in New England. It provides a diverse base of acute and reconstructive hand problems. Fellows accompany the staff physician in his or her office and in the operating room, gaining experience both as first assistant and primary surgeon.
This portion of the fellowship generates few nights or weekends in the hospital, freeing up time to read, spend time with family and enjoy the Boston area. Many fellows have commented on the side benefit of learning about the business side of medical practice.
Although the day-to-day clinical load is substantial, fellows are given a half day off weekly for study time, hand dissections or personal business. Our goal for this part of the fellowship is to provide an intensive and broad exposure to hand surgery while also allowing time to absorb and integrate what is learned.