As the first Pediatric Hand and Upper Extremity fellow at Children’s Healthcare of Atlanta, I wasn’t exactly sure what to expect. The experience, however, has far exceeded any expectations I could have had. The variety of patients and operative cases I experienced was incredible, and the hospital staff was extremely welcoming and helpful in all aspects of this fellowship.

A typical week consisted of time spent both in the operating room and the clinic. I had the opportunity to work with each of the five hand and upper extremity surgeons on the fellowship staff, which provided exposure to many different approaches to complex pathology. In addition to seeing patients at their private clinics, I took part in two specific pediatric clinics that are included in the fellowship–a monthly congenital clinic and a bi-monthly brachial plexus clinic. Although each of the surgeons care for many children in their own private clinic, the opportunity to have a combined clinic with their expertise was invaluable.

The brachial plexus exposure at Children’s is excellent. The bi-monthly clinic includes two of the surgeons (Allan Peljovich, M.D., M.P.H., and Joshua Ratner, M.D.), a physiatrist and the therapy staff. It is an outstanding chance to interact with these children and their families at many different points in time. That interaction helped me truly understand the operative indications as well as how to care for these children from birth to their teenage years, maximizing their functional outcome. I had the opportunity to participate in numerous brachial plexus explorations and nerve transfer operations on top of later procedures, including Hoffer tendon transfers and rotational osteotomies of both the humerus and radius.

In addition to time spent in the clinic and operating rooms, I also had the chance to take emergency and trauma calls. These responsibilities are certainly not onerous, but they do present plenty of learning opportunities. I had attending physician privileges, but one of the faculty members was always available to back me up when I needed advice or an extra set of hands.

Another exceptional aspect of this fellowship is its variety of educational opportunities. A weekly journal club is held with the attending physicians, residents and fellow, focusing solely on pediatric upper extremity literature. The topics range from congenital disorders (such as syndactyly, radial longitudinal deficiency, Poland syndrome and Apert syndrome) to brachial plexus injuries and pediatric trauma. Additionally, I was able to participate in the pediatric orthopaedic residency curriculum by giving a talk at the monthly conference on a pediatric upper extremity topic. There are many opportunities to get involved in research within this program and the attending physicians are eager to assist the fellow in a project geared toward his or her particular interests within the field of pediatric hand and upper extremity.

Overall, this is an excellent fellowship with outstanding exposure to diverse pathology. I would highly recommend this experience and feel that it has truly helped me to be better prepared to care for children in my practice.

Felicity Fishman, M.D., 2013 Pediatric Hand and Upper Extremity Fellow