Hand & Upper Extremity

The goal of the hand and upper limb rotation is to provide a breadth of experience and exposure to disorders affecting the hand and upper limb. Patients are seen in clinic at VUMC, surgery is at the Nashville Surgery Center (NSC) or at VUMC.

Resident role and expectations:
Residents on the hand and upper limb service (PGY-2 and 4) will be a primary member of the care team under the supervision of attending staff.  The residents will work closely with the hand fellow.  The resident will gain proficiency in soft-tissue handling and microsurgery as well as the treatment of a broad variety of hand and upper limb disorders.

Green’s operative hand surgery

Don Lee, M.D.
Douglas Weikert, M.D.
Mihir Desai, M.D.

Goals and objectives by the end of the rotation:

  1. Medical Knowledge: Obtain knowledge and comprehension of the basic disorders that afflict the upper limb, and gain insight into the methodology and procedures incorporating its treatment.  Particular emphasis is placed on the importance of interdisciplinary approach. Interpreting information obtained from a history and physical examination, incorporating data from radiology and laboratory studies, understanding anatomy, and incorporating this knowledge into surgical skills for hand and microsurgery is fundamental to the required knowledge. Soft tissue handling, microvascular environment of the limb, and pathology of systemic disease processes are as essential as learning the indications for surgery and the type of fixation chosen.
  2. Patient Care: Obtain acumen in diagnosing and proposing treatment in the clinical setting, and analyze available information to make diagnostic and therapeutic decisions based upon sound clinical judgment, best available evidence, and patient preferences.  Perform at an upper resident level in surgical techniques pertaining to soft tissue, nerve, skeletal structures, and microsurgical procedures. The resident will participate in self-evaluation and improvement in the anatomy lab for surgical skills.
  3. Interpersonal and Communication Skills: Demonstrate the interpersonal skills and professionalism necessary to adequately diagnose and treat a variety of traumatic and elective hand injuries and disorders. This reflects the behavior of a role model to peers, junior residents, and medical students.  Demonstrate courtesy and timeliness with patient, family, and professional interactions.
  4. Professionalism:  Demonstrates respect, compassion, integrity, and honesty as it relates to patient interaction. Takes initiative in addressing the needs of patients and peers; acknowledges and addresses errors, and pursues self-improvement.
  5. System-Based Practice: Demonstrate competence and ability to interact with outside institutions in the timely transfer and decision making process for traumatic hand injuries, and utilizes resources such as the Transfer Center in the emergent care of amputated digits at outside hospitals. Interpret and apply techniques and protocols in conjunction with hand, physical, and occupational therapy as it relates to patient care and management.
  6. Practice-based learning:  Demonstrate self-improvement through a critique of their performance during presentation of M&M cases.