Andrew S. Moon, MD
July 31, 2026
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Choosing a fellowship is one of the most important decisions you will make during orthopaedic residency. It’s only one additional year of training, but that year can shape the surgeon you become, the procedures you feel comfortable offering, the mentors and professional network you develop, and even the type of practice you ultimately pursue.
My own experience was in choosing a spine fellowship, but many of the same principles apply across orthopaedic subspecialties.
I would start by thinking about what you want your future practice to look like and what types of procedures you want to focus on. Programs within the same subspecialty may offer very different training. In spine, one fellowship may emphasize deformity, while another focuses more on degenerative conditions or minimally invasive surgery. Some programs may also offer greater exposure to robotic and navigation technology. The same applies elsewhere. For example, you may want to consider whether a sports fellowship includes exposure to shoulder arthroplasty, how much direct anterior approach experience you can expect in a particular joints fellowship, or how much elbow, peripheral nerve, or microsurgery a particular hand fellowship offers.
One of the most informative things you can do is speak with current and former fellows. Ask about their actual day-to-day experience during the fellowship year. How much autonomy did they have, and did this change over time? Did the operative experience match their expectations? Did they feel prepared for independent practice? Were the faculty invested in teaching, mentorship, and helping them find the right job?
It’s particularly helpful to speak with people from your residency program who pursued the same subspecialty. They can tell you how their fellowship experience complemented the strengths and gaps of your residency training and can also offer insight into other programs where they interviewed.
I would also look beyond case volume. A large number of cases doesn’t always translate into meaningful training. Ask which portions of the operation the fellow performs, how this evolves over the course of the year, and how involved fellows are in decision-making before and after surgery. In spine in particular, I felt that developing sound surgical indications was just as important as learning the technical aspects of each procedure. Ownership of the entire episode of care may matter more than the raw number of cases.
The breadth of the faculty is also worth considering. In spine, I valued training with both orthopaedic surgeons and neurosurgeons because they brought different perspectives and approaches. Similar cross-specialty exposure may be valuable in other fields, such as training with both orthopaedic and plastic surgery-trained hand surgeons.
Call is another important consideration. What types of cases will you see? How much responsibility will you have? Will that experience prepare you for the type of practice you want? A fellowship’s call structure can give you insight into both the educational experience and the practice environment it prepares you to enter.
Lastly, I would try to be as flexible with geography as your personal circumstances allow. Fellowship is only one year, but the training, mentorship, and professional relationships you develop can influence the rest of your career.
There is no single best fellowship, and certainly no one fellowship that is best for everyone. The right program is the one that provides the clinical exposure, autonomy, mentorship, culture, and career preparation that best aligns with your goals.
DISCLOSURES: Dr. Moon This individual reported nothing to disclose
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