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Excellent Training

By John Fowler, MD

It has been my experience, both in residency and fellowship, and now as a faculty member at an academic institution, that the field of hand surgery excels at allowing our trainees to have significant hands-on experience in both the operating room and office.  Several of my co-residents noted that their fellowship training, in fields other than hand surgery, consisted mostly of watching and “assisting” the senior surgeon.  This experience occurs at all levels of residency training as well.  There is no substitute for actually performing the procedure, the examination, and injection.  The reason for the difference is unclear.  It is likely a combination of culture, types of procedures, and confidence of the faculty member in facilitating the trainee having the opportunity to “do” rather than “watch.”  Decreasing reimbursement and increasing pressure on our time in both the operating room and office provide understandable reasons to “take the knife” and move the case along.  However, I sincerely hope that hand surgery continues to be a specialty where we provide our trainees with incredible learning opportunities.

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