SCIENTIFIC ARTICLE
Hand Education for Emergency Medicine Residents:
Results of a Pilot Program
Scott D. Lifchez, MD
Purpose Multiple studies have demonstrated the lack of knowledge of hand anatomy and
pathology among those who first see patients with hand disorders. The goal of this study was to
determine whether a hand surgery rotation for emergency medicine residents would improve this
group’s knowledge of the hand and its disorders as assessed at the end of their residency training.
Methods Seven postgraduate year (PGY) 2 emergency medicine residents completed a
4-week hand surgery rotation. Hand knowledge was assessed at the start, at the end, and 1
year after this rotation (end of PGY 3). Knowledge of a control group of 7 PGY 3 emergency
medicine residents who did not have this rotation was also assessed.
Results Hand knowledge in the residents who completed the rotation was significantly
improved. This was true for overall test performance (88% vs 70% correct responses), as
well as for each of the anatomy and function (89% vs 57%), diagnosis (96% vs 86%), and
treatment (79% vs 51%) categories. Overall test performance (78% vs 66%) and anatomy
and function category performance (75% vs 43%) were significantly better at the end of PGY
3 for the residents who completed the rotation as compared to the control residents.
Conclusions A hand surgery rotation during an emergency medicine residency program improved
the knowledge of hand anatomy and disorders. This knowledge was retained 1 year later and was
greater than the knowledge of matched emergency medicine residents who did not have this
rotation. Better knowledge of hand anatomy and disorders among emergency physicians might
improve their ability to initially evaluate and treat patients with these conditions. Such knowledge
might allow emergency department physicians to play a more important role in the management
of hand emergencies. A hand surgery rotation has been incorporated into the PGY 2 curriculum
for all emergency medicine residents at my institution. (J Hand Surg 2012;37A:1245–1248.
Copyright © 2012 by the American Society for Surgery of the Hand. All rights reserved.)
Key words Hand education, hand emergency, hand fracture, hand infection, hand trauma.
M
ULTIPLE OBSERVERS HAVE reported the difficul-
ties emergency department (ED) are experi-
encing in obtaining sufficient specialty cov-
erage for hand surgery emergencies. Some have
focused on the limited availability of hand surgery
specialists for ED patients.
1
Others have focused on the
burden sustained by level I trauma centers when pa-
tients with isolated and often non-emergent hand con-
ditions are transferred from outside institutions.
2–3
Several studies have shown a high incidence of hand
trauma among the general population. More than 10%
of ED visits in the United States due to injury are for
problems of the wrist, hand, and finger.
4
In 2006, nearly
4.5 million patients presented to an ED for these disor-
From the Department of Plastic Surgery, Johns Hopkins University, Baltimore, MD.
Received for publication September 14, 2011; accepted in revised form March 13, 2012.
No benefits in any form have been received or will be received related directly or indirectly to the
subject of this article.
Corresponding author: Scott D. Lifchez, MD, Johns Hopkins Bayview Medical Center, Division of
Burn and Plastic Surgery, 4940 Eastern Avenue, Suite A520, Baltimore, MD 21224; e-mail:
slifche1@jhmi.edu.
0363-5023/12/37A06-0024$36.00/0
http://dx.doi.org/10.1016/j.jhsa.2012.03.022
© ASSH Published by Elsevier, Inc. All rights reserved. 1245