| Sign In to gain access to subscriptions and/or personal tools. |
DOI: 10.1016/j.jhsb.2005.05.009
A Hand Research Fellowship Training ProgrammeFrom the Department of Emergency Medicine, University of Louisville School of Medicine, Louiseville, Kentucky, USA; Christine M. Kleinert Institute for Hand and Microsurgery Louisville, Kentucky, USA; Division of Hand Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA Correspondence: Dr Raymond G. Hart, MD, MPH, Christine M. Kleinert Institute for Hand and Microsurgery, Inc., 225 Abraham Flexner Way, Suite 850, Louisville, KY 40202, USA. Tel.: +502 562 0310; fax: +502 561 4288. E-mail: rhart{at}cmki.org
There are currently 68 hand surgery fellowship programmes known to the authors in the United States and many more throughout the world. To our knowledge, there are no hand fellowships which focus on research. Such a hand surgery research fellowship is being developed to provide this training. This paper outlines the goals and objectives of the intended 2 year training programme and includes a description of the fellowship. The first year would be mostly committed to learning research methods and the second would be a clinical hand fellowship. This will combine clinical expertise in hand surgery, practical research experience and formal research training. Hand researchers would learn research methods, develop innovative research ideas and begin an active research and academic career.
Key Words: fellowship • hand • programme • research
Hand surgery has grown and expanded over the last 60 years from a small group of visionary, like-minded surgeons to an international organization of specialists. Although originally developed within general surgery, hand surgery now involves orthopaedics, plastics, microsurgery and, even, transplantation. It has been fuelled by a community demand for specialists prepared to respond to the particular challenges of hand surgery. The surgical practice of hand surgery has become a valued and recognized subspecialty that has gained respect for high-quality clinical care around the world. It continues to grow and improve under the auspices of a new generation of surgeons and teachers. Much of the improvement that has occurred in hand surgery has been through the trial and error of surgical practice. Some results and achievements have been outstanding, having evolved from thoughtful, creative surgery by surgeons willing to try new concepts and approaches. Today, there is a need for more organized research within the field of hand surgery, to bolster the quality of research done and, ultimately, improve patient care. We must develop the expertise to capitalize on our clinical innovations by appropriate high-quality research. The specific training of researchers to lead the field of hand surgery into the 21st century should have great value. Physicians and researchers with PhD and MPH credentials who can design and establish wide-ranging hand research centres will be expected. To our knowledge, there are no formal recommendations as yet by any national or international hand surgical organization to set up hand research fellowships and no formal, published outline of goals and objectives for hand surgery research. There is a need for more widespread training in basic science research, anatomy, injury prevention computer sciences, outcomes, biomechanics, bioengineering and microsurgery of the hand (Patel et al., 2003). There are many other subjects that hand surgery research could embrace, including data collection, surveillance and clinical research. The future will include composite tissue allotransplantation, tissue regeneration and neuroprosthetics. The domain of hand surgery has been defined and researchers should pursue studies in as many of these defined areas as possible (Steyers et al., 1990). Most hand surgery fellowships provide little or no formal research training to the future academic leaders of our specialty. The opportunity for hand surgery fellows to do quality, supervised research is, unfortunately, too rare. However, several hand surgery fellowships do provide research opportunities and have developed programmes to train hand fellows in research. Depending on patient volume, expertise and staff interest, the research aspect of any fellowship varies. The research being developed can be clinical, translational and/or service related. The opportunities for training in research are also varied according to the organizational interests, academic requirements and mentoring opportunities. Unfortunately, some fellowships have been unable to thrive due to an inability to recruit physician educators and researchers (Bennett et al., 1997; Beresin and Borus, 1989; Reuben, 1994). This paper examines a proposal for a more formal research programme. The goal is to develop hand surgeons as leaders and researchers in academic centres (Bachrach, 1997).
Fellowship goals The goals of a hand research fellowship include the following broad educational aims:
Fellowship objectives The objectives of a hand research fellowship correspond to the listed programme goals:
Skills and measurable objectives
The programme presented promotes the completion of a varied curriculum. There are fellowships formatted in a similar fashion (Maizes et al., 2002; VanRooyen et al., 1995, 1997). Fellows would develop expertise in the area of hand surgery research through research, clinical hand surgery and elective course work. The curriculum is divided into four specific areas (Table 1).
The clinical practice of hand surgery would help to further develop the fellow’s skills as a clinician and is considered an essential component of the fellowship. The fellow would have the opportunity to apply acquired skills under the direct supervision of well-trained hand surgeons in varied patient experiences. The fellow would complete a minimum of 12 months of clinical hand surgery. This would include hospital, clinical and operating room experience. The fellow might serve as a supervising physician for more junior hand fellows, residents and students. The fellow would be exposed to the entire range of hand surgery and be encouraged to develop his, or her, projects in areas of special interest. The fellow would be expected to develop skills as an educator. The fellow would prepare presentations and education modules on topics related to hand surgery research (Melchior and Meals, 1998). He or she would also participate in educational seminars and conferences of the hand fellowship and other related departments. The programme here also allows access to the fresh tissue labs for cadaveric studies, anatomy and understanding perforator flaps. The hand research studies curriculum may be coordinated with the curriculum of the existing programmes, such as public health and biomechanical engineering. Although formal course-work would not be required for completion of the fellowship, exposure to areas of study such as epidemiology, biostatistics, grant writing, organizational structure and fundraising would be beneficial and is strongly recommended as a key component of the programme. A given research fellow might choose to continue formal education toward a Masters or PhD. The fellow would complete at least two research projects of publishable quality that pertain to hand surgery. Research would emphasize innovative clinical hand surgery concepts and presentations at national meetings would be encouraged. Clinical trials with surgery groups may lead to better and more cost-effective patient care (Rusch, 1997). Research projects would be supervised by the fellowship faculty. The fellow might also participate in additional course work related to hand research based on specific interests, as deemed appropriate by the fellowship director. These might include biomechanics, bioengineering, microsurgery, outcomes, composite tissue allotransplantation, neuroprosthetics and tissue regeneration. The suggested duration of the fellowship is 2 years. The length would be contingent on the duration of clinical hand surgery experience, the availability of formal graduate course work, time needed to complete research projects or associated degrees (Eng, MPH, etc.) and institutional requirements. A fellowship programme director would coordinate all of the activities of the fellowship, including education and continued programme development. The programme would be designed on a dynamic model, enabling the programme director to make changes as needed. The administration of the fellowship should be the responsibility of the institutions, hand surgery practice and the hand surgery fellowship. The fellowship faculty would guide the fellow in the development of research projects and clinical hand surgery rotations, as well as promote interest in standardized areas of study such as epidemiology, computer sciences, biomechanics, bioengineering, microsurgery and composite tissue allotransplantation. Faculty activities would be coordinated by the fellowship director. An advisory committee consisting of individuals with desired areas of expertise would be set up to support the fellowship director. The advisory committee would need individuals with unique resources to contribute to the fellowship. Specialized expertise including statistical analysis, biomechanics, education and administration should be included. The development of the curriculum for a hand research fellowship would evolve and become an ongoing project. The fellowship director would explore and develop clinical, educational and research ties with programmes within each institution for this purpose. The curriculum should be evaluated and critiqued each year by the fellows, fellowship director, and the advisory committee. The curriculum would be evaluated on the basis of its educational value and on the relevance of its content to the fellowship goals and objectives. Each elective opportunity would be evaluated by the fellow and the director based on the quality of the experience. The fellow would receive monthly evaluations from the appropriate clinical directors regarding his, or her, acquisition of the core knowledge of hand surgery research. Clinical hand surgery work would be evaluated by the hand surgery faculty. The fellow would function as a surgical hand fellow in the clinical area. The fellowship director would conduct a formal quarterly interview for evaluation purposes. Work in related schools would be evaluated by the appropriate school faculty in relation to the students there. The fellowship director would provide supervision pertaining to the completion of fellowship educational requirements. The funding for these fellowship positions should be determined and secured in advance. The funds should be available on a renewable yearly basis. Funding for the fellowship positions may be a combination of institutional support, grant funding and clinical hand surgery work. The clinical work would be the primary source for funding, although this cannot be expected to fund the entire research experience. Institutional scholarships, endowments and other creative funding options must be pursued. Government funding for specific research projects is an option that should be pursued (Trimble et al., 2003). The positions may prove to be low cost or revenue-neutral but develop valuable researchers and new faculty (Curtis et al., 1998).
The ideal for a hand researcher may be the path of a physician/researcher, trained from undergraduate or medical school forward (Seely et al., 1997). However, a significant number of surgeons and hand surgeons do not receive the training or the opportunity to develop these skills until later in their careers. There are also a significant number of international hand surgeons who would welcome the opportunity to develop these advanced research skills (Montesano and Akroud, 1999). A programme affiliated with our University School of Public Health and Information Sciences is demonstrated here as part of a 2-year hand fellowship. This outline of a fellowship contains essential components that define the fellowship and provide necessary training (Table 2) (Smith and Gonzalez, 2003; VanRooyen et al., 1999). Optional components include those that may increase the fellow’s level of competence and ability but may not be uniformly available, or may be given variable emphasis in a particular programme. Nevertheless, it would provide excellent skills for a research physician. There are further components that include course work with the School of Engineering in Biomechanics and Bioengineering. Detailing the core curriculum for a hand research fellowship is beyond the scope of this paper. However, these guidelines will direct the present hand research fellowship programme.
Such a hand research fellowship would help train and prepare the next generation of hand researchers. These goals and objectives may serve as a template for further development of hand research fellow opportunities. As hand surgery grows in expertise, recognition and complexity, the need for well-trained senior academic researchers becomes more and more evident. These research careers may lead to greater career satisfaction, improved clinical care and discovery of new research opportunities in care of the hand (Wax and Donovan, 2000). This experience does not propose isolating hand surgeons as researchers. On the contrary, it will facilitate formal exposure to the varied disciplines and encourage work across specialties within a medical school, engineering school and/or schools of public health. It allows for the exposure of experienced clinical hand surgeons to interact with, teach and expose hand surgery researchers to their expertise. This proposal for hand surgery research has limitations. Two years may not be sufficient time for the development of true researchers and leaders in the field. There may not be enough interest. Hand surgery is a small community of specialized surgeons, the financial rewards of this programme may not have appeal and it may be more valuable to spend the time training hand surgeons as opposed to hand surgery researchers. There is even a question whether hand surgery research should be organized at all. However, hand surgeons bring such valuable and varied training to the field. It is a melting pot of general, orthopaedic, plastic and microvascular surgeons and the skills they bring culminate in the best of practices. Research could be conducted in the same culture. There is a vital exchange and sharing of ideas that produces research questions and promotes the change and growth that hand surgery needs. An organized, committed group of hand surgery researchers could help define and refine the questions that hand surgeons need to have answered. In turn, the scarce financial resources could be directed toward the most pressing issues. The ideal length of time committed to research, as with clinical work, will ultimately be determined by the accrediting bodies (Allen, 1990). Hand surgery has traditionally been a purely clinical academic department and historically has not attracted grant money or high citation index publications. In some locales, there is a move away from financing academic posts in hand surgery for clinical specialists and toward funding basic science areas related to those specialties. Can these potential researchers be developed in a hand surgery setting or would this be better in a wider research community? This programme may attract and produce future researchers for hand surgery while other formats and settings may be needed elsewhere. This paper outlines one programme for hand surgery research but additional questions to be asked include: Is it needed? Where should it best be developed? The recommendations in this paper are broad but fit within the institution here and may be applicable in other institutions. We believe that this study provides the opportunity for academic and research-orientated hand surgeons to expand and improve upon this concept.
Received for publication November 5, 2004. Accepted for publication May 26, 2005.
  CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
|
|
 |
 |
Sign In to gain access to subscriptions and/or personal tools.
TOP
Abstract
INTRODUCTION