Mission

The mission of the SAUSHEC Anesthesiology Residency Program is to provide clinical experience, educational resources, and mentorship support to produce America's finest military physicians, crisis managers, and expert consultants who engage in the compassionate and ethical practice of medicine.

Vision

To be the premier military anesthesiology program in the country, producing the health care leaders of tomorrow.

Aims

We aim for excellence, provide amazing opportunities, and deliver top notch care through a culture of compassion. This will be accomplished by demonstrating our graduates are:

• Lifelong learners and push to advance the science of medicine through our scholarly achievements and educational prowess.
• Leaders in the military and in anesthesiology through our military accomplishments and national specialty society presence.
• Provided access to novel and innovative clinical learning environments through our training rotations and access to military unique opportunities.
• The quintessential physician warrior and leader through their ability to lead by example, show and give compassion, and to balance the needs of the military with their individual needs.
• The best versions of themselves through their achievements, successful careers, and impact on the military, medicine, and world overall.

• Morning Didactics happen usually 3 and occasionally 4 times a week for our residents before regularly scheduled operating room cases start. This content Is led by faculty and/or residents depending on the format. We have thirteen 4-week blocks a year and these blocks have themes for didactic focus. See example schedule of didactics below.
• One-on-one daily teaching in the operating room and otherwise is led by faculty and focuses on the patients assigned that day or other curriculum-based discussions.
• Grand Rounds (GR): Grand Rounds in our didactics program includes our own faculty, world renowned speakers from different institutions including the Mayo Clinic that funds their staff to come to San Antonio and educate our department.
• Anesthesia Toolbox (an Interactive learning hub) and TrueLearn (a test and board exam preparation question bank with extensive explanations and further resources) are purchased for all our residents and is used in individual, and small and large group teaching opportunities.

• The SAUSHEC Anesthesiology Residency is 3 years (If entering as a PGY-2) or 4 years in length and follows the training requirements outlined by the American Board of Anesthesiology (ABA) and the Accreditation Council for Graduate Medical Education (ACGME).
• SAUSHEC Anesthesiology blends military rotations with civilian partner rotations across seven diverse health systems, providing the broadest training experience possible.
• We have thirteen 4-week blocks a year; below Is an example of a resident schedule.

Elective Rotations are discussed on an individual basis.

• Most of our night shifts are done with a night float system that is two weeks of a shift from 6 p.m. – 6 a.m. (with a 24-hour period with no clinical activities in between).
• On outside rotations, call shifts follow the ACGME requirements for time off and time in between.
• Each resident will have at least one day (24 hours) per week free from clinical duties.

• Dedicated military-specific focus, highlights, and pearls during didactics, grand rounds, operating room teaching, and incorporation of operational medicine during procedure labs.
• Newly returned from deployment staff lectures and lessons learned.
• Military Unique Curriculum in Honduras (MUCH) Rotation where the residents provide medical care in an austere and resource-limited environment, like a deployment.

Required courses include periodic re-certification of Advanced Life Support (ALS)/Basic Life Support (BLS)/Pediatric Advanced Life Support (PALS)/Neonatal Resuscitation Program (NRP). We highly encourage our Institution’s Root Cause Analysis course, the Intern critical care course, and Tactical Casualty Care Course (TCCC).

Procedure Lab

• Provides an opportunity for residents to learn life-saving procedures not commonly done but may be essential in deployed environments. Procedures performed include but are not limited to thoracostomy, transvenous pacing, cricothyrotomy, suturing techniques, bronchial blockers and one-lung ventilation, central lines, and other procedures.
• At least one dedicated procedure lab Is offered a year.

Simulation

• Longitudinal curriculum starting Post Graduate Year (PGY)-2 year and occurring every block throughout residency. Residents utilize BAMC's state-of-the-art Simulation Department and train on high-fidelity simulators.
• A mock oral board every block starting PGY-2 year prepares the residents for the American Board of Anesthesiology (ABA) Applied Exam that encompasses a standard oral examination (SOE) and an Objective Structured Clinical Exam (OSCE) component.
• Intradepartmental training with nursing, technicians, and surgeons, and interdepartmental simulation cases with other medical specialties.

Our residency is a robust leadership lab for developing leaders in anesthesiology and in the military. Opportunities start from day one and increasing levels of responsibility are nurtured over the 4 years of residency. The curriculum includes:

• Leadership and team building exercises.
• Peer, near-peer, and traditional mentorship
• Quarterly protected mentorship pod time
• Semi-annual program leadership and mentoring sessions
• Progressive leadership responsibilities on shift, during medical resuscitations, and in the management of trauma or emergent patients while on late, weekend, or night float teams.
• Resident leadership roles, including chiefs (academic, wellness, scheduling, communication), Program Evaluation Committee membership and leadership, medical student interview panel participation, committee membership and chair, etc.

Requirements for graduation:

• Submission of two pieces of scholarly activity to a national conference to include medically challenging case, scientific abstract, or Quality Improvement Patient Safety (QIPS) abstract.
• Completion of a scientific abstract. This can be generated from a research project or QIPS project.
• Completion of a graduation paper. This paper can be generated from a research or quality abstract, or it can be a case report/review.
  • Training opportunities include a 4-week block at the end of the PGY-1 year for dedicated time in learning about the process of scholarly activity and begin to brainstorm likely projects.
  • There is also a myriad of courses that are open to our trainees to further their understanding and comfortability.

There are opportunities to present scholarly activity are numerous and are publicized throughout the academic year.

Our program strives to provide highly reliable, safe, and effective care for all our patients while providing high quality medical education for all learners that train in our institution. We practice a continuous quality improvement lifecycle to meet these goals and we aim to instill these habits in our trainees. Our program has a dedicated Assistant Program Director for Quality Improvement and Patient Safety to help ensure this is effectively done. In concert with SAUSHEC, we offer both program and institution level training opportunities to teach the knowledge and skills necessary to practice high quality continuous process improvement and effective patient safety practices including Lean Six Sigma, A3 decision making, and root cause analysis techniques. The program has a monthly Quality Improvement and Patient Safety Conference in which we review key patient safety concepts and learning points from actual cases (also known as Morbidity and Mortality Conference). All residents participate in team-based longitudinal quality improvement projects, some of which have won national level awards for the impact they have made within the institutional and our broader organization.

Our program has a quality improvement and patient safety graduation requirement for all our trainees.

Categorical residents at graduation are expected to:

• Complete online coursework necessary to earn the Institute for Healthcare Improvement’s Open School Basic Curriculum in Quality and Safety
• Complete a minimum of 40 quality improvement and patient safety activity points. Residents can earn these points by completing any number of a wide variety of quality improvement and patient safety activities that are specified on a menu provided by the program.
  • There are numerous and diverse Quality Improvement Patient Safety (QIPS) projects occurring throughout the department and faculty mentors are easy to find.
  • Residents participate in helping to improve the healthcare system for our patients and the experience of those around them. Residents will be educated in QIPS principles during their dedicated scholarly activity block at the end of their Clinical Anesthesia (CA)-1 year.
  • There are numerous additional trainings (Root Cause Analysis, Lean Six Sigma, etc.) and opportunities to present QIPS scholarly activity and these are publicized throughout the academic year.

• While developing excellent anesthesia skills, the SAUSHEC anesthesiology residency also focuses on developing future military anesthesiology leaders through mentoring and modeling.
• Funding for residents to attend at least one (and many times two) professional conference during residency when presenting a scholarly activity is built into the GME budget. Residents have given national lectures, research podium presentations, held national leadership board positions, and presented countless posters at the American Society of Anesthesiologists (ASA), Society for Pediatric Anesthesia (SPA), Society for Obstetric Anesthesia and Perinatology (SOAP), American Society of Regional Anesthesia (ASRA), Society of Cardiovascular Anesthesiologists (SCA), and other professional societies.

• Brooke Army Medical Center (BAMC), San Antonio, Texas
• Driscoll Children's Hospital, Corpus Christi, Texas
• University of Texas Southwestern Medical Center, Dallas, Texas
• Baylor University Medical Center, Dallas, Texas
• University of Texas Health Science Center at San Antonio, San Antonio, Texas
• Methodist Hospital, Houston, Texas
• Wilford Hall Ambulatory Surgical Center, San Antonio, Texas

Medical students will be exposed to basic anesthesia principles including pathophysiology and pharmacology, as well as learn and practice hands on skills such as airway procedures and IV placement. During the rotation they will work with a resident and attending team (or an attending alone) with whom they will provide pre-operative, intraoperative, and post-operative care to a variety of patients from healthy outpatients to the critically ill. They will be exposed to some of our subspecialties such as pain, peds, ambulatory, neuro, trauma, and obstetrics. In addition to patient care, medical students will attend departmental morning conferences as well as a resident-led afternoon conference series directly geared to their level of training. There is a final evaluation at the end of the rotation for fourth year medical students.

To schedule a rotation, please email the GME Medical Student Coordinator org box, usarmy.jbsa.medcom-bamc.mbx.saushec-clerkship@health.mil or by phone: 210-916-3231.

If in person, the interviewee should plan to wear their service dress or class A uniform for interviews (or business professional attire if they have not gone through the service appropriate officer training school). All interviewees should be authentic to themselves and practice answering common interview and behavioral based questions beforehand.

• To schedule an interview, please contact our program coordinator at dha.jbsa.brooke-amc.list.saushec-anes@health.mil.
• To schedule a rotation, please contact the GME Medical Student Coordinator org box: usarmy.jbsa.medcom-bamc.mbx.saushec-clerkship@health.mil.

Program residents will take the American Board of Anesthesiology (ABA) BASIC written examination after their PGY-2 year and program graduates will take the American Board of Anesthesiology ADVANCED written examination graduation and the American Board of Anesthesiology APPLIED Standardized Oral Examination (SOE) and Objective Structured Clinical Examination (OSCE) after successfully passing the BASIC and ADVANCED written examinations. The written examinations are offered bi-annually, and the APPLIED examination is offered on a continuum a total of six times a year. The BASIC, ADVANCED, and APPLIED examinations all must be passed to become fully board certified. 

Board eligibility is described on the ABA website.

Residents are expected to assume increasing levels of responsibility as teachers to their peers, lower-level co-residents, medical students, and interprofessional teams in the department and throughout their home institution and participating sites for the duration of their residency.

Residents are offered opportunities to teach courses at local, regional, national, and international events and conferences.

Our faculty have subspecialty training in the following: 

• Trauma Anesthesia
• Pediatric Anesthesia
• Cardiothoracic Anesthesia
• Critical Care
• Regional Anesthesia and Acute Pain
• Chronic Pain
• Obstetric Anesthesia
• Sleep Medicine
• Neuroanesthesia

Residents are split into mentorship pods with a member of each class (PGY 1-4), a junior faculty and a senior faculty to encourage peer, near-peer, and classic mentorship relationships. Mentorship pods solidify and keep each other accountable for individualized learning plans and participate together during dedicated mentorship time at the hospital and at offsite wellness events.

• Wellness: The entire residency program had been structured to ensure maximal opportunities for resident wellness consistently over the course of the entire residency to include assessing and reassessing curriculum and participating sites, utilizing a night float system for call coverage, and creation of resident academic days at the end of each academic block. We have worked to consolidate all official activities in such a manner as to maximize off time without reducing the maximal opportunities for training.
• Residents will be afforded Resident Wellness Home Call Days when assigned to Brooke Army Medical Center an average of once per block.
• Residents can participate in an optional Wellness Committee geared at optimizing program wellness and involvement with hospital-wide peer wellness and support groups.
• There is also an opportunity for our residents to work on the Program Evaluation Committee which creates new opportunities for wellness and wellbeing annually.