Approximately 97% of orthopaedic surgery residents pursue fellowships, yet how lifestyle and psychosocial factors influence hand fellowship selection is not well defined. This multi-year survey evaluated the importance of clinical, lifestyle, and cultural variables for orthopaedic, plastic, and general surgery residents applying to hand fellowships. An anonymous survey was distributed by the American Society for Surgery of the Hand to 1,464 applicants to Accreditation Council for Graduate Medical Education accredited hand fellowships between 2019 and 2025. The survey captured demographics, geography, personal and family circumstances, academic priorities, and exposure to plastic surgery, arthroplasty, and microvascular. Analyses included Mann-Whitney, Kruskal-Wallis, Wilcoxon tests, and factor analysis to explore underlying relationships among variables. Of 267 participants (71% orthopaedic surgery, 25% plastic surgery, and 4% general surgery residency trained), 72% were married and 43% had or were expecting children at the time of application. Family and residency location were not associated with fellowship match location. Mentorship , case volume , and institutional culture were the top three selection factors, and program culture showed a strong correlation with interview rapport (r=0.63). Male applicants more frequently preferred programs with full upper extremity training ( P =0.004), including shoulder emphasis and elbow training, with no gender difference in wrist training ( P =0.582) or exposure to plastic surgery-trained faculty ( P =0.214). Factor analysis linked perceived program prestige with Level I trauma exposure, plastic surgery, microvascular, and soft tissue training. Both traditional metrics and intangible qualities drive hand fellowship selection, highlighting evolving applicant priorities, including male applicants’ preference for full upper extremity training. Programs that intentionally develop culture, provide longitudinal mentorship structures, and use virtual interview formats that allow authentic interaction (e.g., short faculty interviews with semi-structured questions and unstructured fellow question and answer sessions) are likely to be viewed favorably by hand fellowship applicants. • In this study, mentorship, program culture, and case-volume were the three most important selection factors for hand fellowship applicants. • Geographic factors, including where applicants grew up, the locations of family and significant others, and residency location, did not correlate with fellowship destination. • Hand fellowship applicants relate program prestige to programs with Level I trauma exposure, soft tissue management, microvascular training, and plastic surgery integration.
Light et al. (Sun,) studied this question.