Mission

Providing comprehensive training, clinical experience, and mentorship to foster the development of exceptional allergy and immunology experts poised to lead and deliver superior care to military beneficiaries.

Vision

Training military leaders to deliver the highest quality and safest allergy and immunizations care globally.

Aims

The SAUSHEC Allergy/Immunology Fellowship Program develops patient-centered Allergists who provide evidence-based medical care to support military medicine and the warfighter. Our mission focuses on the key concepts of Knowledge, Innovation and Leadership applied to the military unique environment.

Knowledge

The primary aim is to produce knowledgeable Allergists that are uniquely qualified to serve our patients throughout the world.

Innovation

We recognize the unique nature of our primary patient population and aim to develop innovative approaches to the care of patients. Allergy/immunology specific research and military specific quality improvement initiatives focus on advancing the care of our service members, their dependents and military retirees in medical treatment facilities and deployed environments.

Leadership

We recognize a need for strong physician leadership in military medicine and aim to develop the next generation of Allergist/Immunologist leaders through formal didactics, mentorship, and faculty development initiatives.

Our curriculum is academically rigorous and covers training on basic and complex immunology and clinical allergy topics using a mixture of delivery methods such as lectures, webinars, and readings. Core didactics occur every morning with board review occurring weekly. Faculty and guest lectures are provided bi-monthly. Journal club and immunodeficiency conference occurs once per month. Weekly clinical case conference is a highlight of the fellow experience as it allows for collaborative discussion on cases, patient safety topics, and research.

The fellow experience is divided as 50% of time devoted to direct patient care activities, 25% of time devoted to scholarly activity (research), and 25% of time devoted to other educational activities (e.g., preparation of teaching conferences). Most of the clinical experience is in the outpatient environment with fellows completing 2 months of inpatient call per year with graduated responsibility.

Second year allergy fellows participate in an outpatient immunodeficiency clinic 1 day per week at the University of Texas Health Science Center at San Antonio during their 2 elective months and during their "stellow" inpatient month (where they function as mentor to the inpatient first year fellow). This rotation provides an additional depth, breadth, and variety of immunodeficiency cases and provides opportunity for education with other clinical faculty.

Elective rotations are available for second year fellows.

Fellows have the option to participate in other outpatient electives. Examples of electives in which our fellows have participated include rotations through dermatology, pulmonary, rheumatology or otolaryngology clinics. Fellows can also opt to complete a research elective or a quality improvement/patient safety elective.

Fellows complete two months of inpatient home call per year. On average, fellows will see approximately three consults per inpatient month. Second year fellows serve as “stellows” where they assist first year fellows with evaluation and management plans, demonstrating graded and progressive responsibility, which is then presented to the faculty.

U.S. Air Force Allergy/Immunology physicians are responsible for immunization clinics within their military treatment facility and serve as consultants in all allergy and immunizations issues in their assigned regions. Allergy fellows are trained on immunization practices following Center for Disease Control (CDC)/Advisory Committee on Immunization Practices (ACIP) guidelines to prepare them to serve in the role of Immunizations Officer In Charge (OIC)/Medical Director upon graduation. Additionally, fellows get practical experience in overseeing common immunizations concerns and questions as the “outpatient clinical doctor” role occurring at least weekly during their fellowship. Allergy fellows are trained in the clinical and administrative aspects of military unique vaccines such as smallpox, anthrax, and the adenovirus vaccine. This training includes risk communication, adverse reactions, decision making, waivers, and preservation of war-fighting capabilities. The administrative aspect of managing an immunizations clinic (e.g., vaccine procurement, immunizations management in MHS-GENSIS) is also stressed preparing fellows for this role upon graduation. Fellows receive training on mass vaccination practices to include administration, logistics, point of distribution exercises, and Air Force specific regulations for vaccine exemptions.

Additionally, the fellows receive training and experience in their AFI-required role as Regional Allergist and Immunizations Consultant where they function as force multipliers, providing oversight and training to Allergy/immunization technicians and physician extenders which allows for all immunizations and allergen immunotherapy to occur in the Air Force and Space Force.

Fellows are trained on and are clinically engaged in the evaluation of patients with Allergic and/or Immunologic conditions that require adjudication of accessions and retention standards such as for basic military trainees, technical school candidates, and Military Entrance Processing Station (MEPS) candidates. Examples of these conditions include asthma, food allergy, venom allergy, atopic dermatitis, urticaria and others which may be experienced by the warfighter in garrison or in deployed settings. Fellows receive training on allergy and immunization specific deployment and readiness guidelines across the services Active Duty, Reserve, and National Guard members. This includes training on accession vaccinations and immunizations trackers.

Participation as faculty in the Allergy Extender course and initial and/or periodic re-certification of Basic Life Support (BLS), Advanced Life Support (ALS), and Pediatric Advanced Life Support (PALS).

The program conducts annual Objective Structured Clinical Examinations (OSCEs) for the fellows- anaphylaxis, skin testing, immunotherapy dilutions, and spirometry. Our annual OSCEs are the program’s process for providing a standardized experience for fellows on key procedural skills.

Fellows complete the LEAD 2.0 curriculum during training which includes military relevant topics to assist with understanding their role in the larger context of military medicine. The curriculum also includes a discussion of topics such as emotional intelligence, mentorship, and coaching which are applicable to all medical professionals.

Fellows work with experienced faculty mentors on research projects throughout their time in fellowship. As a graduation requirement, fellows must design and complete a literature review project on an allergy or immunology topic that is presented orally and in writing. Most fellows typically exceed this requirement and conduct multiple scholarly projects throughout their fellowship time. There are multiple venues to present research as well as competitions which the fellows are encouraged to submit to and have been successfully recognized for their work.

Fellows complete the SAUSHEC Quality Improvement Patient Safety (QIPS) curriculum during their fellowship time and complete the Institute for Healthcare Improvement (IHI) open school certification. In addition, all fellows complete an allergy or immunizations specific quality improvement project from design to execution during training. Fellows then have the option to present their findings as presentations and/or publications locally and nationally. Additionally, fellows are encouraged to submit patient safety reports (PSRs) which are reviewed weekly in our clinical case conference. End of month PSR reviews are also conducted to identify systems issues and trends.

Fellows complete the LEAD 2.0 curriculum and are encouraged to attend the Uniformed Services University professional development workshops and lectures. As part of our military unique curriculum, we deliver lectures on military professional development such as military promotions. Fellows are encouraged to become involved in specialty specific organizations which offer additional venues for professional development and leadership opportunities.

• Brooke Army Medical Center
• University of Texas Health San Antonio

Rotators are assigned to interview, examine, and evaluate patients in the allergy/immunology clinic under faculty supervision. The full range of allergic disorders is potentially available in these realms: allergic/non-allergic rhinitis, asthma, eczema, food, and drug allergies, acute/chronic urticaria, etc. Rotators are also exposed to a variety of procedures, such as skin testing and spirometry. Rotators have the option to see inpatient allergy consults with fellows. At the end of the rotation there is a knowledge assessment conducted. Medical students interested in scheduling a rotation should contact: usarmy.jbsa.medcom-bamc.mbx.saushec-clerkship@health.mil.

Interested applicants should contact the program to schedule an in-person or virtual interview. The benefit of in-person interviews allows the applicant to spend a full day with the fellowship, participate in our educational program, meet with staff and fellows, and participate in a formal interview. For applicants who interview virtually, separate from the formal virtual interview we arrange a virtual meet-and-greet with current fellows as a forum for asking additional questions about our learning environment and culture of the program.

If you would like to schedule an interview with our program, please contact dha.jbsa.brooke-amc.list.saushec-allergy@health.mil.

Program graduates take the American Board of Allergy and Immunology (ABAI) certification examination. This exam is offered annually in October. The American Board of Allergy has established a time limit for candidates to apply for the certification examination in Allergy/Immunology. Certification must be achieved within seven (7) years of successful completion of an ACGME-accredited fellowship program in Allergy/Immunology. The seven (7) year window to apply for and successfully complete the certification examination begins immediately after training is completed. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the American Board of Allergy and Immunology.

Fellows are expected to provide teaching and education to rotating medical students and residents. As they assume increasing levels of responsibility, fellows are also expected to educate their peers. Fellows provide lectures on allergy topics to outside departments and during the Allergy Extender course.

Fellows are also exposed to training and education of other members of the healthcare team such as allergy and immunizations technicians. They also participate in education of provider and technician allergy extenders who rotate through the department to complete their initial and refresher training.

Most faculty are double board certified in both their primary specialty (Internal Medicine or Pediatrics) and Allergy/Immunology (or board-eligible). Additional faculty certifications and/or training include:

• Diagnostic Laboratory Immunology fellowship trained and board certified
• Preventive Medicine residency trained and board certified
• Aerospace Medicine residency trained (no board examination offered)

Fellows are assigned a faculty mentor at the start of their fellowship; however, most fellows typically acquire additional mentors throughout their time in fellowship as they work on research or other scholarly projects.

Our wellness curriculum includes biannual lectures and discussions on identification and mitigation of fatigue and burnout. In addition, residents and staff are encouraged to participate in SAUSHEC’s wellness fair and wellness committee. We host monthly “fellowship” fellowship lunches for the fellows and faculty to continue to interact and get to know each other in a more relaxed setting.