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 two 1/2 days in the clinic. Each fellow will each spend one ½ day of clinic with Dr. Green. In total each fellow will interact with Dr. Green weekly for the entire 12 month fellowship experience. 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 Rotation: You will spend an average of 2 days in the OR and 2.5 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. 

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's Rotation: On average 2 days per week are spent in the operating room and 2.5 days in the clinic.  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. 

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. Desai’s rotation:  Dr. Desai, sees a typical variety of congenital and adult elective hand surgery cases. Fellows will 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.  By the end of this rotation, fellows should be comfortable with the management of skin and soft tissue, nerves and blood vessels, WALANT and the operating microscope.

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

6:30-7pm Hand Conference 

WEEKLY

TBD Anatomy Lab

 

Monthly Journal Club with Dr. Green and other faculty TBD

 

7-8am Orthopaedic Grand Rounds

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

WEEKLY

 

OT Lectures TBD

Monthly Research Meeting

 

TBD

Coding/Billing

The Hand Center Library

MONTHLY

 

 

Monthly Self Assessment Exam Review  

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 Thursday evening once per month TBD

Cadaver Lab: Monthly, PRN

OT Lectures: once per month: 5-5:30 pm, 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, Thursdays once per month, TBD
Review self-assessment questions every Friday. Likely 5 to 10 questions will be reviewed.

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 TIGMER in terms of residency training, etc. These are all spelled out in the “Fellows Handbook” which is part of this packet.