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European and American Microsurgery Training Programs

The Fellowship Concept Difference

Maldonado, Andrés A. M.D., Ph.D.; Song, David H. M.D., M.B.A.

Author Information
Plastic and Reconstructive Surgery: August 2015 - Volume 136 - Issue 2 - p 292e-293e
doi: 10.1097/PRS.0000000000001441
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As advances are made in medicine and areas within plastic surgery, the benefits of undergoing further training will continue to increase. In the United States, supplemental fellowship training in addition to residency training is very popular and growing. Hand surgery, aesthetic surgery, craniofacial surgery, and microsurgery1 are the main fellowship options after a plastic surgery residency.2,3

Microsurgery is of special interest, because of a long and meticulous learning curve. Microsurgery requires from the outset a high level of accuracy and development of precise skills. Manual dexterity plays a fundamental role during microsurgery training. Therefore, we find protection of the concept of “fellowship” to be essential. Ideally, trainees should be given exposure to a high number of microsurgical cases, progressively advancing in their level of surgical case participation and gradually decreasing the level of supervision, with the final goal of performing these procedures independently and with reproducible results.

Although the American Microsurgery Fellowship Match was established in 2010 by the American Society for Reconstructive Microsurgery,1 fellowship programs have a long history in the United States, whereas in Europe formal clinical fellowship programs are more of a rarity and also usually have different content.4 On the American Society for Reconstructive Microsurgery Web page, clear information about every program can be found: faculty members, number of cases, salary, and others. Moreover, the fellow has a recognized position in the department, with clinical and teaching responsibilities midway between residents and attending physicians.

We agree with Niemelä and Hernesniemi4 in that, in Europe, fellowships are more observational compared with America. Moreover, information about these European “microsurgery fellowships” is sometimes difficult to find on the respective institutions’ Web pages. There is no central organization and there is a lack of information in terms of exposure to cases, final goals, salary, status inside the department, and so forth. Moreover, the terms “master” and “observership” in microsurgery are sometimes used for training programs, causing some degree of confusion in terms of the type of exposure and level of microsurgery skills after successful completion of the program.

In summary, we believe that (1) the only way to receive proper microsurgery training is through genuine fellowship programs modeled after well-recognized programs in the United States, which implies high hands-on exposure to microsurgery cases, progressive advancement in the level of surgical case participation, a decreasing level of direct supervision, and the final goal of performing these procedures independently with reproducible results; (2) the word “fellowship” should be kept only for training programs with the above requirements and characteristics; and (3) in the authors’ opinion, and considering the level of excellence of microsurgery in Europe, a central organization with genuine fellowship training programs (described above) should be considered for the future to continue and expand the European microsurgery school.


The authors have no financial interest to declare in relation to the content of this article.

Andrés A. Maldonado, M.D., Ph.D.

David H. Song, M.D., M.B.A.

Section of Plastic and Reconstructive Surgery

The University of Chicago Medical Center

Chicago, Ill.


1. American Society for Reconstructive Microsurgery. 2011 Match information. Available at: Accessed February 1, 2015
2. Brotherton SE, Etzel SI.. Graduate medical education, 2012-2013. JAMA. 2013;310:2328–2346
3. Elliott RM, Baldwin KD, Foroohar A, Levin LS.. The impact of residency and fellowship training on the practice of microsurgery by members of the American society for surgery of the hand. Ann Plast Surg. 2012;69:451–458
4. Niemelä M, Hernesniemi J.. Response to an article entitled “Fellowship training in the United States and Europe”. World Neurosurg. 2014;82:e554–e555


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