Hand & Upper Extremity Surgery

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Number of Positions 3-4
Duration 12 months
Site Toronto Western Hospital
Supervisors Dr. Ryan Paul (Director)

The Hand Surgery Program is a collaborative effort by the Divisions of Plastic and Orthopaedic Surgery. This is a Canadian fellowship and therefore is NOT accredited by the Accreditation Council for Graduate Medical Education (ACGME). The ACGME is only responsible for the accreditation of post-MD medical training programs within the United States. Currently, this is not a paid fellowship. If you have a licence to practice medicine in the province of Ontario, then you would be able to generate income from billing as an Assistant. All other candidates must have funding from an external source.

Our practice is concentrated in the area of adult hand surgery and includes a broad spectrum of reconstructive problems, hand trauma, replantation, arthritis, paralysis and peripheral reconstructive nerve surgery.  We are also involved in a moderate amount of microsurgical activity and our hospital is the replantation center for Metropolitan Toronto.  As such, fellows will gain excellent exposure and experience in microvascular techniques.

Educational Objectives

At the end of this fellowship, the Fellow will have fulfilled the following educational objectives:


  • Demonstrate increased understanding of common and variant anatomy of the hand and upper extremity.
  • Demonstrate increased competency in the diagnosis and treatment of common hand conditions and injuries.
  • Gain experience in the emergency management of common hand injuries.
  • Gain experience in the resuscitation and early management of traumatic hand injuries.
  • Understand the principles and management of subspecialty hand surgery which may include replantation, brachial plexus injuries, peripheral nerve injuries, tendon injuries, fractures and reconstructive wrist surgery.


  • Gain experience in approaching and attending to the patient with an upper extremity injury or deformity.
  • Gain experience in working with a group of other physicians, nurses and paramedical personnel.
  • Learn the value of working in a cohesive, multidisciplinary team setting and appreciate the contributions of each group.


  • Knowledge of surgical exposures in the hand and wrist.
  • Knowledge of the use of internal fixation sets specific to care of injuries in the hand and wrist including the mini-fragment and modular hand sets, Herbert and accutrak screws.
  • Knowledge of suturing techniques for flexor and extensor tendons
  • Knowledge of basic functions of the operating microscope, skill in basic microsurgical procedures like digital nerve repair.

Position Description


  • Attend Hand Surgery Outpatient Clinics including that of the primary supervisor and the other members of the Hand Program
  • Assist in the preoperative assessment, surgery, and postoperative care of the supervisor’s and other consultants’ patients
  • Assist in the evaluation of consults referred to the supervisor and other consultants
  • Assist in the clinical teaching responsibility of the Division
  • Work with other house-staff members attending patients in the Emergency Department
  • Perform call responsibilities as required

It is clearly understood that none of the above responsibilities will in anyway interfere with the Residency Training Program but will complement the continuous teaching of residents. Fellows will often add an international outlook on teaching.


  • Complete a minimum of one clinical or basic science research project and prepare it for presentation and publication.

Eligibility Requirements

  • Must have completed or be completing a residency in plastic or orthopedic surgery.
    If not yet completed residency, may be in either 4th or 5th year of residency.
  • Must satisfy prerequisites listed in the General Guidelines for U of T Plastic Surgery fellowships.

Application Requirements

    Completed Hand Fellowship Application Form (see attachments below)
    Cover letter and statement of intent on why you wish to pursue Hand Fellowship training in Toronto.

    • Indicate your current level of training;
    • 1-year fellowship:  July 1 – June 30
    Curriciulum vitae, which should include pre-medical, medical and post-medical school training, research publications, certificates, awards, scholarships
    Three letters of reference. One letter must be from the most recent training director (residency or fellowship). If employed for more than 2 years, the chief of the division in which the surgeon is working may write this letter.
    If not eligible for practice in Canada, must provide letter of commitment of financial support for 1 year from an external source (minimum CAD78,190.61 for the 2025-26 academic year). Note, this amount changes yearly.
    If the language of your medical school was not English, you must pass the Test of English as a Foreign Language (TOEFL) and the Test of Spoken English (TSE) or the new TOEFL-lbt (http://web1.toefl.org/tstgprog01.cfm). The minimum scores required are published on the General Guidelines page for U of T fellowships.
  • Any document submitted in a language other than English must be accompanied by a certified translation.

Application Process

  • In-person interviews are mandatory for individuals on the North American continent. In-person interviews are strongly encouraged for overseas applicants, however, an online video interview will be considered.
  • If you are an applicant from Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, or the United Arab Emirates, you must apply directly through PGME, pgme.international@utoronto.ca
  • Submit by email a single PDF with all application requirements (see checklist).


Hand Fellowship Application Form

Thank you for your interest in the Hand and Upper Extremity Program. The deadline for applications for the 2025-26 academic year has now passed (March 1, 2024). An update will be sent to all applicants in the next few weeks.

Submit completed Application to:

Dr. Ryan Paul
Director, Hand Surgery Fellowship
Toronto Western Hospital
399 Bathurst Street, 2nd Floor EW, Room 400
Toronto, ON, M5T 2S8, Canada
T: (416) 603-5800 ext. 5881
F: (416) 603-5392
c/o paula.capela@uhn.ca