Explore the Foot & Ankle Fellowship

Overview

Thank you for your interest in the Massachusetts General Hospital/Harvard Medical School Orthopaedic Foot and Ankle Fellowship program. Under the direction of Daniel Guss, MD, MBA, our program is designed to help you develop into an accomplished Orthopaedic foot and ankle surgeon – clinically insightful, technically capable across a wide range of surgical procedures, and a critical analyst of the latest research. We pride ourselves on the interdisciplinary care of each patient, working as a team with other surgical and medical specialties, as well as podiatrists, physical therapists, cast techs, medical assistants, research assistants and support staff.

Please click on the above tabs to learn more about the fellowship experience, our philosophies, and our team. Please reach out to us with any questions you might have.


Fellowship Structure

The program offers two fellowship spots of one-year duration. Eligible fellows must successfully graduate from a residency program in Orthopaedics and obtain full Massachusetts licensure. Fellows are credentialed at Massachusetts General Hospital (MGH), the flagship teaching hospital of Harvard Medical School, as well as Newton-Wellesley Hospital (NWH), a 300-bed community hospital in a Boston suburb. The current fellowship is divided into two six-month blocks based on a mentorship model, designed to foster a lifelong network of support and friendship. You will spend six full months with Dr. DiGiovanni, as well as an additional six months with Dr. Guss and Dr. Waryasz.

Fellows are credentialed at all hospitals and clinical sites as full attending physicians, with the goal of progressively nurturing a high degree of independence in both the operating room and clinical settings. Through an apprenticeship model with graduated autonomy, fellows are comfortable running their own foot and ankle clinic and are technically capable of independently operating on a spectrum of complex foot and ankle pathology by the end of their fellowship year. The opportunity to operate independently with immediate attending back up readily available, as a supplement to the expansive amount of time spent operating alongside an attending, is something past fellows have relished.

Fellows also run a longitudinal, personal clinic that mirrors clinics run by the attending staff, often physically alongside an attending clinic. Fellows see their own patients 1.5 to 2 clinic days a week in order to foster independent decision-making in clinic, management strategies, and ownership of care. As always, attending staff members are always readily available to answer patients and facilitate the care of patients.


Educational Program - Basic Curriculum

  • General requirements: In accordance with the general teachings defined by the American Orthopaedic Foot & Ankle Society, our Fellowship program emphasizes professionalism, clinical competence and system-based practice.
  • Professionalism: The fellow is expected to demonstrate respect, compassion, and integrity to faculty, staff, and their patients. He/She is expected to be responsive to the needs of his/her patients and demonstrate commitment to excellence and on-going professional development.
  • Clinical competence: The fellowship has been designed to develop advanced technical competence in the field of foot and ankle. Focus will be on advanced skills in the operating room, diagnostic competence in the clinic, and will foster analytic research excellence through our robust research program.
  • The surgical experience: The fellow is scheduled to be in the operating room 2.5-3 days/week with an Attending. The fellow will operate in the Main OR at both MGH and NWH, as well as our Ambulatory Care Centers at MGH, NWH and Northshore Danvers.
  • The outpatient experience: The fellow is scheduled to be in clinic 1.5-2 days/week. Each full day clinic is usually done in conjunction with a Faculty clinic. The outpatient clinics allow the fellow the chance to follow patients he or she has operated on, to see new patients and devise management plans. The fellow has their “own patients” and are expected to manage all patient needs. The fellow has administrative assistance to manage these clinics.
  • Inpatient responsibilities: There are two fellows and one PGY-3 resident on service. The inpatient care is typically divided up by the service member who is on site at MGH for the day. There is PA floor coverage at both MGH and NWH hospitals.
  • Call responsibilities: Fellows take non-trauma call with their attending. Fellows will round on inpatient consults and bill when appropriate. Fellows will also have the credentials to take foot and ankle cases to the operating room independently with attending level back up.

Educational Conferences and Teaching

  • Multidisciplinary conference: Each Tuesday morning there is a multidisciplinary conference at the Foot and Ankle Center in Waltham. The fellow is expected to attend and participate actively. The current structure is as follows: 1st week – indications conference/case presentations presented by the fellows and Faculty; 2nd week – multidisciplinary lecture; 3rd week - journal club lead by fellows and other disciplines; 4th/5th week – Faculty presentations. There are also several presentations by invited speakers throughout the year.
  • Indications conference: This weekly conference is held on each Monday or Tuesday. It is designed to review the indications for, and treatment options pertaining to, the surgical cases for the next 2 weeks. It is designed to be a very interactive discussion and is consistently highlighted by the Fellows as one of their best learning opportunities.
  • Departmental conference: Each Thursday morning there is morbidity/mortality conference or grand rounds at MGH. Fellow attendance is expected. Fellows often present service cases at “M&M” conference and engage in multidisciplinary discussions with other Orthopaedic surgery specialties.
  • Research conference: There are bi-weekly research conferences and the fellows are expected to attend. These conferences occur Tuesday mornings at MGH – Waltham and Thursday mornings at MGH – Boston. These conferences are attended by the Research Fellows and Faculty.
  • Conferences: We believe strongly that training outside of the hospital is an important part of the fellowship experience. Each fellow is allotted a $2,000 stipend to spend on educational conferences and/or other educational related expenses.
  • Salary and Benefits: Salary is commensurate with that of a PGY-6 in our system. The salary for the 2019-2020 academic year is $80,000. Salaries are adjusted by 2-3% each year. Benefits include many competitive health, dental, and vision coverage options. Each fellow is allotted 3 weeks of vacation time to use for conferences, interviews, family time, etc.

Research

General

The Foot & Ankle Research and Innovation Lab (FARIL) opened January 1, 2019. FARIL is a groundbreaking initiative by the MGH foot & ankle service focused on pioneering breakthroughs in foot and ankle research and innovation that will directly impact the care of the foot and ankle patients. Perhaps the most important quality of FARIL is its ability to integrate all aspects of Foot and Ankle care by incorporating every facet of research. From top institutions in the US to internationally recognized academia, FARIL researchers bring their diverse training and experience to create new tests and treatments. FARIL also brings together organizations (MGH research institute, AOFAS) and industry leaders to implement new technology used to treat foot and ankle injuries. With patient care at its center, FARIL brings every component of foot and ankle research to one cutting-edge location.

Right now, researchers are pioneering new ultrasound techniques to create a dynamic picture of the ankle. This will allow physicians to accurately diagnose ankle injuries that would have previously been difficult or even impossible to recognize without surgery. The lab is also developing new treatment methods for common foot and ankle problems. New arthroplasty techniques and equipment are being established to improve total ankle replacement. Biomechanic studies are being undertaken to improve surgical techniques and reduce recovery time. These are just some of the ways FARIL leads the way in foot and ankle research.

Fellows are expected to complete two research projects throughout the academic year. By the end of the fellowship, you are expected to have a manuscript prepared for presentation at the AOFAS meeting with the ultimate goal of publication.

We have several international research fellows, research students and statisticians to assist you with your research projects.

Partners Healthcare System Research Patient Data Registry (RPDR)

The RPDR gathers clinical data from several hospital systems at Partners Healthcare. (Enterprise Master Patient Index - EMPI, Hospital Decision Support System - EPSI (formerly TSI), Physician Billing System - IDX and EPIC, Longitudinal Medical Record - LMR, Corporate Provider Master - CPM, Clinical Data Repository - CDR, and Partners Personalized Medicine - PPM) and stores the data in one central data warehouse. Researchers can query this data by using an online query tool. The query tool returns aggregate totals of patient data that are populated with appropriately obfuscated, de-identified/encrypted data as per HIPPA privacy rules and the HHS Common Rule. With the proper IRB approval, researchers may access the patients’ detailed medical records for their specified cohorts of patients. The detailed medical records are returned to researchers in an encrypted Microsoft Access file and text (.txt) files. Detailed medical records may include the following types of data: Transfusion, Cardiology, Contact Information, Demographics, Diagnoses, Discharge Notes, Endoscopy, Laboratory Tests, PEAR Allergies, LMR Health Maintenance, LMR Medications, LMR Notes, LMR Problems, LMR Vital Signs, Medications, Microbiology, Operative Notes, Pathology Reports, Procedures, Providers, Pulmonary, Radiology Reports, Radiology Tests and Transfusion. Furthermore, images from hospital image repositories can be returned and viewed online.

Research Staff

Bart Lubberts, MD, PhD
Instructor in Orthopaedic Surgery, Harvard Medical School
Director of Research and Development, Foot & Ankle Research and Innovation Lab

Mike McTague
Clinical Research Program Manager