title: A national survey of program director opinions of core competencies and structure of hand surgery fellowship training.
abstract: OBJECTIVE
  We assessed hand surgery program directors' opinions of essential components of hand surgery training and potential changes in the structure of hand surgery programs.
  
  
  METHODS
  We recruited all 74 program directors of Accreditation Council of Graduate Medical Education-accredited hand surgery fellowship programs to participate. We designed a web-based survey to assess program directors' support for changes in the structure of training programs and to assess opinions of components that are essential for graduates to be proficient. Respondents were asked to rate 9 general areas of practice, 97 knowledge topics, and 172 procedures. Each component was considered essential if 50% or more of respondents thought that graduates must be fully knowledgeable of the topic and be able to perform the procedure at the end of training.
  
  
  RESULTS
  The response rate was 84% (n = 62). A minority of program directors (n = 15; 24%) supported creation of additional pathways for hand surgery training, and nearly three-quarters (n = 46; 74%) preferred a fellowship model to an integrated residency model. Most program directors (n = 40; 65%) thought that a 1-year fellowship was sufficient to train a competent hand surgeon. Wrist, distal radius/ulna, forearm, and peripheral nerve conditions were rated as essential areas of practice. Of the detailed components, 76 of 97 knowledge topics and 98 of 172 procedures were rated as essential. Only 48% respondents (n = 30) rated microsurgery as it relates to free tissue transfer as essential. However, small and large vessel laceration repairs were rated as essential by 92% (n = 57) and 77% (n = 48) of respondents, respectively.
  
  
  CONCLUSIONS
  This study found resistance to prolonging the length of fellowship training and introduction of an integrated residency pathway. To train all hand surgeons in essential components of hand surgery, programs must individually evaluate exposure provided and find innovative ways to augment training when necessary.
  
  
  CONCLUSIONS
  Studies of curriculum content in hand surgery affect the future scope of hand surgery practice and highlight areas in need of reform and enhancement.
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Erika Davis
authors.initials: ED
authors.lastname: Sears
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Larson
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D005257:Fellowships and Scholarships / Q000458:organization & administration* / Q000706:statistics & numerical data; D006225:Hand / Q000601:surgery*; D006801:Humans; D008866:Microsurgery / Q000193:education / Q000592:standards; D009985:Orthopedics / Q000193:education* / Q000458:organization & administration / Q000592:standards; D013518:Surgery, Plastic / Q000193:education* / Q000458:organization & administration / Q000592:standards; D011795:Surveys and Questionnaires; D014481:United States