Structure of the Fellowship
The Harvard Shoulder Fellowship began in 1999 and has evolved into a program of three (3) fellows who are selected each year in December through the A.S.E.S. (American Shoulder and Elbow Surgeons) match. An additional fourth fellow position is offered for six months, and this fellow facilitates the elective program which is described in the following text.
Core Program (Harvard) at MGH & BWH:
Fellow #1: Warner Rotation (at MGH): This fellow will work with Dr. Warner as his(her) primary responsibility. An outline of the weekly schedule is provided below.
Fellow #2: Higgins Rotation (at BWH): This fellow will work with Dr. Higgins as his(her) primary responsibility. An outline of the weekly schedule is provided below.
Fellow #3: Holovacs/Jupiter/Research (at MGH): This fellow will divide his(her) time in three areas. Each week the fellow will be responsible for finding out the operative schedule of Dr. Jupiter in order to identify elbow surgeries. Attendance to these elbow cases is his responsibility. When Dr. Jupiter is not performing elbow surgery the fellow will work with Dr. Holovacs. Additional open time will be available for research. On Fridays, this fellow will be responsible for running the fellow’s clinic. Fellow’s clinic will be on Friday mornings each week except when fellow’s surgical cases are scheduled on a Friday.
(Schedule may change according to attending’s own schedule changes)
Fellow’s Responsibilities:
Patient Care: The Shoulder Fellow is responsible for care of in-patients for Drs. Warner, Holovacs, and Higgins. There should be a discussion with each attending at the start of the rotation, and as needed throughout the rotation in order to clarify this role. All patients admitted to the hospital after surgery should be rounded on by the fellow in addition to the resident. Shoulder fellows are also responsible for assisting Drs. Warner, Higgins, and Holovacs in outpatient questions related to ongoing care. The fellows cover patient calls on weekends and after hours through our answering service. There is no trauma call.
Conferences
MGH Indications Conference:
There will be an Indications Conference on most Tuesdays between 7-8am at the MGH. Shoulder Fellows #1 and #3 who are working with Drs. Warner and Holovacs will be responsible for organizing x-rays and charts of all patients who will be having surgery the coming week. In addition, Shoulder Fellow Clinic cases which are selected for surgery should also be presented. The opportunity to present interesting or challenging cases will also be available on an ongoing basis. The purpose of this conference is to develop an insight into decision-making in straight-forward and routine cases. From time to time this period will be used as a journal club discussion of important articles.
BWH Indications Conference:
There will be Sports/ Shoulder conference every 1st, 3rd, 5th Monday at 6:45-7:30am. The first 15 minutes will be dedicated to an indications conference and the last 30 minutes to a rotating topic. The fellows are to be responsible for collecting, organizing, and presenting the cases for indications conference and will be rotating during the presentations. Furthermore, the fellow will review all xrays for cases to be done on the Shoulder Service that week and review these cases immediately to follow this conference. The intent of this conference is to discuss the decision making process and pre-operative planning for each shoulder surgery done that week.
MGH Combined Sports Medicine & Shoulder Conferences:
Each Thursday from 8-9AM The Sports Medicine Service holds it’s conferences. Periodically the topic will be shoulder and the Shoulder Service will be invited to participate. In advance of these dates where shoulder is the specific topic the Fellow on either Dr. Warner’s Service or Dr. Holovac’s service will be responsible for preparing the presentation. These presentations are to be case-based. For example, Instability cases to illustrate the treatment of these conditions. Many such conferences have already been saved on the Fellow’s Educational Database on the computer in the Fellow’s office. Dr. Warner will review each presentation with the assigned fellow prior to his (her) presentation.
MGH Elbow Conference:
The program is being developed between the MGHHand and Upper Extremity Service and the Shoulder Service and will take place every six weeks on Tuesday morning at 8am in place of Indications conference.
MGH Shoulder Fracture Conference:
The program takes place once every six weeks on Thursday mornings at 8am in collaboration with the Trauma Service at MGH.
Combined MGH & BWH Research Conference:
There will be a research conference on designated Friday mornings each month. The time and location are yet to be determined. The purpose of this conference is to review ongoing shoulder research and to brain-storm new areas of research. The shoulder fellows are, of course, expected to attend and present updates to their projects.
Special Conferences:
Throughout the year the Shoulder Service may host visiting professors and meetings, including cadaver arthroscopy workshops. The fellows’ responsibility at each of these events will be clearly outlined in advance.
Annual New England Shoulder and Elbow Society Mtg., Jay Peak, Vt. (www.neses.com):
This is an annual meeting held at Jay Peak Ski Resort in Northern Vermont each January or February. It is a Friday-Sunday meeting. JP Warner is President of the society.
Annual N.E.S.E.S. Visiting Professor Elbow Sports and Arthroscopy Lectureship and Teaching Laboratory (Spring of each year):
In April 2007, Drs. Augustus Mazzocca and Frank Alberta taught UCL Reconstruction and, Distal Biceps Repair, and Elbow Arthroscopy at Smith and Nephew in Andover)
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Advance Arthroscopy Course, val d’Isere, France:
This course is available every other year in val d’Isere, France. It is a week-long course dedicated to advanced arthroscopic shoulder surgery. JP Warner acts as Member of Scientific and planning committee for the course.
Annecy Live Surgery Shoulder Meeting:
This is a every other year meeting held in June. Dr. Laurent LaFosse is the Course Chairman and JP Warner is a surgeon participant. It is a unique shoulder surgery course in the world and over three days there are over 30 live surgeries broadcast from the local hospital to an audience of over 1000 surgeons. Highlights are the open microphone and live interaction with the operating surgeon. It is truly the best shoulder course in the world.
San Diego Shoulder Institute:
This is the largest Private Shoulder Meeting in the United States and takes place every June in San Diego. Dr. JP Warner is a member of the Board of Directors of the meeting.
Fellow’s Clinic:
On Fridays Fellow #3 is responsible for running the Fellow’s clinic. When Dr. Warner is out of town or not in the operating room, Fellow #1 will assist Fellow #3 in Clinic or the operating room.
Resident Interaction:
The Shoulder Fellow’s role is to act as a facilitator for the resident’s education and to guide the resident in the care of patients on the Shoulder Service. Residents at the PGY-5 level will rotate on the Shoulder Service, though their participation in clinic and the operating room will vary on a day-to-day basis. When they are present in the operating room Dr. Warner and Dr. Holovacs will discuss with the team the role each will play with the cases to be performed that day. The goal is to teach not only clinical and surgical decision-making for the resident, but also some components of surgical technique.
Relationship with Residents:
It is expected that at all times the relationship with residents on the Shoulder Service be a cordial and collegial one in which the resident feels welcome as a member of the team. Specific educational goals have been set forth for the residents and the Fellow should be an active participant as a teacher in order to help them achieve these goals.
Vacation policy:
This is a rigorous fellowship with extensive commitment to clinical experience. Furthermore, the fellow is an active participant in the team both in and out of the operating room. Thus vacations had been an afterthought in the past. Our policy would be that Fellows are entitled to vacation time, but it would be best to try and coordinate with your individual attending to take this time when he is away. Furthermore, we are aware of the need and support your time away to interview for potential job opportunities. Moreover, with the elective opportunities in Europe there will be plenty of time for R & R.
Other Teaching Opportunities:
From Time to time Fellows may be asked to play a role in local courses teaching on behalf of Drs. Higgins, Warner, or Holovacs. There will also be Cadaver Shoulder Arthroscopy Labs. For the residents and the fellows will be instructors at these labs. during the year.
Evaluation:
Each fellow will receive a formal written evaluation from the attending(s) with whom they rotate. Ongoing feedback will also be given by each attending in the spirit of constructive criticism. The goal is to help each fellow grow professionally in their skills as clinicians making treatment decisions, and as surgeons who improve their skill.
Questions & Concerns:
Drs. Warner, Higgins, Holovacs, and Jupiter remain open at all times to any questions and concerns; indeed, we encourage input from Fellows to improve this program. If problems arise the fellow should feel comfortable to approach any one of us at any time. Welcome and have a good year.
Elective Program
Europe: French & Swiss Connections: 1-3 month elective in one or more centers.
Laurent Lafosse, M.D.
World renowned shoulder arthroscopist and reconstructive surgeon who is redefining the limits of arthroscopy and arthroplasty and in so doing, redefining the standard of care. Key areas of pioneering:
• Arthroscopic suprascapular nerve release
• Arthroscopic Latarjet Procedure
• Arthroscopic subscapularis repair
• Arthroscopic tendon transfer for irreparable RCT
• Developer of new DeltaTM Reverse Prosthesis (DePuy).
Gilles Walch, M.D.
World renowned arthroplasty and reconstructive shoulder surgeon who has been President of the European Society for Surgery of the Shoulder and Elbow( S.E.C.E.C.). He has redefined the state-of-the-art of shoulder arthroplasty through his clinical and basic science work which lead to the development of shoulder arthroplasty. Key areas of pioneering:
• Development of the AequalisTM (Tornier) Shoulder Arthroplasty
• Development of the Aequalis Reverse Prosthesis (Tornier)
• Clinical pioneer in methods of rotator cuff repair
Christian Gerber, M.D.
World renowned shoulder surgeon and scientist who is, quite simply, the “Albert Einstein” of Shoulder Surgery. He is currently Chairman of Orthopaedic Surgery at Balgrist Clinic, University of Zurich, and has been President of the European Society for Surgery of the Shoulder and Elbow (S.E.C.E.C.). Key areas of pioneering:
• Development of the Anatomical Shoulder SystemTM (Zimmer) for modular and unified approach to conventional arthroplasty, Inverse prosthesis, and Fracture stem
• Kappa Delta Award for Research on Bench to Operating Room for Rotator cuff Repair
• Scientific contributions to understanding rotator cuff disease and it’s treatment.
• Developer of Latissimus dorsi transfer for irreparable RCT
• Contributions to clinical and basic science of all aspects of shoulder disease and it’s treatment
Mayo Clinic Elbow Elective:
Our colleagues at the Mayo Clinic have graciously offered to allow our fellows a one month elective rotation to observe the management of Elbow surgery.
