Rotations

Dr. Green’s Rotation: You will work with Dr. Green in clinic at The Hand Center on Tuesdays and Wednesdays. Dr. Green currently works 1 ½ days in the clinic. The fellow from Dr. Bagg’s, Person’s, and Srinivasan’s rotation will each spend one ½ day of clinic with Dr. Green. In total each fellow will interact with Dr. Green for a total of 9 months out of 12 months. This presents a unique opportunity to not only learn from the patients seen directly in Dr. Green’s clinic, but to also discuss patients/cases from the other rotations with him.

Dr. Bagg's/Dutta’s Rotation: You will spend an average of 2.5 days in the OR and 2 days in clinic. You will encounter a wide breadth of orthopaedic cases, including shoulder and elbow arthroplasty. The fellow will encounter “cold trauma cases” throughout the entire year, but the majority of fractures proximal to the elbow are treated while on service with Dr. Bagg. Dr. Bagg will also perform microsurgical reconstruction of lower limb and upper limb soft tissue defects. The fellow will gain confidence with the anatomy of the upper extremity given the wide variety of procedures performed on the upper extremity (from fingertip to shoulder) on this rotation. On average a half day/week will be committed to research and academic activities. The fellow may choose to scrub with Dr. Dutta at UHS and do additional trauma, complex shoulder and elbow cases, assuming they have completed all requirements of their rotation with Dr. Bagg under his supervision.

Sample cases include:
Mini open carpal tunnel releases, thumb CMC trapeziectomy with LRTI, total elbow arthroplasty, total and reverse shoulder arthroplasty, rotator cuff repair, DRUJ reconstruction, thumb UCL repair and reconstruction, ORIF distal radius, CRPP and ORIF metacarpal fractures, lateral epicondyle release, ORIF olecranon fracture, ORIF humerus fracture (distal, shaft, and proximal), vascularized bone grafting of scaphoid nonunions with medial femoral condyle, opponensplasty.

Dr. Person’s Rotation: You will spend an average of 2 full days in the OR and 2.5 days in clinic with Dr. Person. ½ day per week will be spent doing “minors” (small surgical procedures such as trigger fingers etc.) in the clinic as well. You will be exposed to a wide variety of cases, ranging from the common to the exquisitely complex. You can expect to add considerably to your skill set in the evaluation and surgical treatment of complex problems.

Dr. Person sees both pediatric and adult patients and performs a variety of surgical procedures, ranging from “typical” elective hand surgery cases to complex microvascular head and neck reconstruction. Fellows will benefit from exposure to a wide array of hand pathology as well as microvascular reconstruction of complex head and neck defects after radical tumor resection. ½ day per week on average will be dedicated to research activities.

Dr. Srinivasan, Dr. Dutta, Dr. Morrey, Dr. Wirth and Dr. Cromack’s rotation: A true “flex rotation”, the hand and upper extremity surgery fellow will spend time with both Dr. Srinivasan and Dr. Dutta during this rotation in scheduled fashion, sharing time between the Hand Center and the University (UTHSCSA). On average 3 days per week are spent in the operating room and 1 day in the clinic. In addition to that, the fellows have the opportunity to work with Drs. Morrey, Wirth and Cromack depending on interest and time available on the fellows’ part. The hand surgery fellow will be exposed to a wide variety of techniques in the care of upper extremity conditions. The fellow can expect to see a wide range of conditions, from the simple to the complex for hand, wrist, elbow and shoulder. ½ day per week will be available to the fellow on this rotation to perform research related activities.

Sample cases include: Elbow and wrist arthroscopy, ORIF wrist fracture, shoulder arthroscopy (including sad, dce, rcr, capsular release), ulnar shortening osteotomy, open and endoscopic carpal tunnel release, thumb CMC trapeziectomy with LRTI, elbow arthrotomy and contracture release, total elbow arthroplasty-primaries and revisions, total and reverse shoulder arthroplasty, rotator cuff repair, DRUJ reconstruction, thumb UCL repair and reconstruction, CRPP and ORIF metacarpal and phalangeal fractures, lateral epicondyle release, ORIF olecranon fracture, ORIF humerus fracture (distal, shaft, and proximal), vascularized free fibula reconstruction of nonunion.

Dr. Saucedo’s and Dr. Desai’s rotation: VA experience--Generally acting as the supervising surgeon, the fellow teaches and assists the resident through surgical cases at the VA, thereby gaining mastery of these procedures through instruction and performance. In the remainder of the workweek, the hand surgery fellow works with Dr. Saucedo and/or Dr. Desai. Typically the fellow does clinic with Dr. Saucedo on Monday at the Hand Center in the Morning and the VA in the afternoon, OR at the VA on Tuesday, OR with Dr. Desai on Wednesday, clinic with Dr. Desai at the Hand Center on Thursday, and OR with Dr. Saucedo on Friday.

Dr. Saucedo sees and treats a wide variety of conditions in pediatric and adult patients, including acute and cold trauma from fingertip to elbow, post-traumatic sequelae, and "typical" elective conditions, such as cubital and carpal tunnel syndrome, thumb CMC arthritis and trigger digit, to name a few.

Dr. Desai, sees a typical variety of congenital and adult elective hand surgery cases. Fellows will also be exposed to complex upper and lower extremity microvascular reconstruction for scaphoid nonunions, trauma, and following tumor extirpation surgery. Fellows will also be exposed to complex peripheral nerve reconstruction and challenging hand ischemia cases. In addition, he, staffs the Brachial Plexus clinic at Methodist Hospital and is responsible for the assessment and subsequent surgical management of these patients.

The Hand Center of San Antonio: Recurring DIDACTIC SCHEDULE
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

6-6:30am Dr. Green Lecture series

The Hand Center Library

4TH MONDAY

6-6:30am Weekly Journal Club

(UT Health, School of Medicine)

Room 309L

WEEKLY

TBD Radiology Conference

7-9pm Orthopedic Surgery Department Journal Club

QUARTERLY

6:30-7:30am

Hand SAE review

1st and 4th

The Hand Center Library

1ST AND 4TH WEEKS

7-8am Orthopaedic Grand Rounds

Location (UT Health, School of Medicine), 409 L

WEEKLY

6:30-7pm Hand Conference (UT Health) Room 309L

WEEKLY

4-5pm Srinivasan fellow anatomy cadaver prosection

(TCA wetlab in basement)

WEEKLY

Bimonthly Journal Club with Dr. Green and other faculty TBD

6:30-8am

Case Conference/

Indications Conference/

Research Meeting

The Hand Center Library

2ND AND 3RD WEEKS

TBD

Coding/Billing with Catharine

The Hand Center Library

MONTHLY

4-7pm Orthopaedic Resident didactic schedule, topics and location tbd

5-6pm Srinivasan fellow presents anatomy dissection

TCA wetlab in basement

**OR**

Therapy Conference

The Hand Center Library

WEEKLY

   

TUESDAY AM HAND CONFERENCE/Journal Club, 6:00 AM-7:00 AM

  • Our major teaching conference is every Tuesday morning at 6:00AM. A copy of the conference schedule is in this packet.
  • Journal Club is from 6:00 am-6:30 am
    • Journal Club articles will parallel the lecture topic
    • Review suggested journal club articles on Fellows Computer one week prior. Confirm with Lecture presenter which articles they would prioritize (3-5 articles). Place those articles in folder, place the rest of the articles in a folder that says “additional articles.”
  • The fellow on Dr. Person’s service will be primarily responsible for all Tuesday AM conferences during his rotation. Keep your copy of the conference schedule that is provided in this packet. The fellow’s responsibilities will also include:
    • Calling each week’s speaker 5 to 7 days in advance to remind him or her of their impending conference. Some of these are not Hand Center staff, and Lashaun can help you get their numbers.
    • Bring to the conference each week:
      • A backup presentation (e.g. some cases to discuss) in case the speaker doesn’t show or has technical problems.

Cadaver Lab: Most Wednesdays 4-6 pm, TCA Wet lab

  • Srinivasan Fellow is responsible for prosection 4-5 pm
  • Srinivasan Fellows presents to other fellows/staff from 5-6 pm

OT Lectures: once per month: 5-5:30 pm, Hand Center Library, please see separate schedule

 

DR. GREEN LECTURE SERIES
At the suggestion of former fellows, Dr. Green now gives a lecture series on various topics of his choice (hand surgery, giving lectures, etc.) once a month on a selected Monday morning. This gives you a chance to get to know Dr. Green better and the recipient of his wisdom. He will give you a schedule for this series.

SELF ASSESMENT EXAMINATION REVIEW, 1st and 4th Fridays, Hand Center Library
Review self-assessment questions every Friday. Likely 5 to 10 questions will be reviewed. The time may vary but will usually be 7AM-8AM.

Case Conference/Indications Conference/Research Meetings, 2nd and 3rd Fridays, Hand Center Library 7-8am. Fellows case conference will be the 2nd Friday of the month. 2 fellows should bring one case each to present to the other fellows and Faculty.

LIBRARY
The Hand Center maintains a fairly extensive library of Journals and books covering Hand Surgery, Microsurgery, Orthopaedic Surgery, and Plastic Surgery. These books are here for your edification. You are welcome and encouraged to make use of these facilities, but please return books to their place on the shelf and do not take them home. There are also videotapes of many procedures and a large series on flaps. The library is here for you.

The UTHSCSA has a reasonable library, and any resources not found at The Hand Center should be able to be found here. Most journals are available online. Carla will guide you in obtaining online access to the UTHSCSA library.

ASSH CANDIDATE MEMBERSHIP
I hope that you all have at least applied for Candidate membership in the American Society for Surgery of the Hand. The fee is relatively small and includes a subscription to the Journal of Hand Surgery. This is a fairly inexpensive way to get the Journal, and sort of sets you up for membership when you are ready. It also gives you access to the ASSH listserv which is a valuable source of information. If you haven’t already done this, please do so.

EVALUATIONS
Each fellows’ performance is evaluated quarterly by the attending on that rotation. These are on file and available for review with you and you will sign. The fellows also will evaluate each of the staff at the end of each rotation. They also should do an evaluation of the program at the end of the year.

As mandated by the ACGME accredited training program, we have begun the process of “360 degree” evaluations. It means that you will be evaluated at some point by everyone- from patients to staff.

GRIEVANCES
As an ACGME accredited training program, we have a Grievance Policy on file with the University. We have never needed this in the past, but it does exist. Carla has a copy for your perusal. By far the best way to handle issues is to deal with them before they become “grievances.” Please come and talk to me if anything that seriously bothers you arises. By the same token, if I see an issue related to performance, we will talk about it- hopefully before it becomes a problem.

MOONLIGHTING
Moonlighting is not allowed during the Fellowship, except under specific, rare circumstances.

OTHER POLICIES
We adhere to all other policies of the University of Texas Health Science Center at San Antonio in terms of residency training, etc. These are all spelled out in the “Fellows Handbook” which is part of this packet.