Mission

The mission of the San Antonio Uniformed Services Health Education Consortium Cytopathology Fellowship Program is to educate and train pathologists to perform all the functions essential to the effective operation of a cytology laboratory and to support mission requirements in designated military hospitals worldwide.

Vision

• Produce clinically proficient cytopathologists who will be leaders in the field of cytopathology and within military medicine.
• Produce educators who strive for life-long learning.
• Build upon foundations of leadership skills as a physician and military officer.

Aims

• The SAUSHEC Cytopathology Fellowship program aims to train board-certified pathologists to be clinically proficient in all aspects of cytopathology, capable of working in austere and/or isolated military environments.
• As a vanguard of emerging technologies, the fellowship strives to expand our curriculum, keeping pace with the rate of change in this arena. Pathology continues to advance at a rapid rate in areas of molecular pathology, laboratory processing techniques/equipment, and digital pathology. Our graduates must be knowledgeable of these emerging technologies and the impact, cost effectiveness and medical necessity for laboratory testing.
• In keeping with optimal patient care obtained in a multidisciplinary setting, our fellowship aims to create a multidisciplinary Fine Needle Aspiration (FNA) clinic with our clinical colleagues, and state-of-the-art training in ultrasound guided FNA procedures.
• The program strives to produce educators who continually pursue life-long learning, along with producing leaders in both cytopathology and military medicine who will lead the way for future generations.

Training is divided among several modalities at BAMC in a manner that is tailored to meet the needs of the fellow. The training modalities include the following areas:

• Technical training in cytology, i.e., bench work in preparing the slides from the various specimen sources
• Diagnostic training in gynecologic and non-gynecologic specimens
• FNA cytology procedures and interpretation, to include performance of ultrasound guided Fine Needle Aspiration (FNA) procedures
• Cytology laboratory management

• The majority of the fellowship Is on-site at BAMC, where fellows will rotate every other day on GYN and Non-Gyn services. The fellows are responsible for covering all hospital fine needle aspirations (FNA) adequacy (rapid on-site assessment) procedures as they occur each day between the hours of 7:30 a.m. and 4:30 p.m.
• Additionally, the fellows are required to perform fine needle aspiration biopsies as requested by clinicians. A staff cytopathologist must accompany the fellows on all adequacy procedures and performance of fine needle aspiration biopsies until deemed competent to perform these duties autonomously.
• Fellows will attend a 2-week outside rotation at Thyroid Cytopathology Partners in Austin, Texas, typically scheduled in the latter part of the academic year.
• Two weeks of dedicated research time are allowed in the one-year fellowship. The research time can be taken at any point of time during the fellowship with the approval of the program director.

As Cytopathology is a one-year program, we are not able to offer elective rotations.

Cytopathology fellows do not take call.

• Trainees are provided opportunities to compete for the Expert Field Medical Badge, attend Air Assault/Airborne school, or participate in various medical readiness competitions. U.S. Army Combat Casualty Care Course is a required component of the Army military curriculum and is a tri-service medical education course presented under the auspices of the U.S. Army Academy of Health Sciences. Training is conducted at Camp Bullis, a military reservation north of San Antonio. The C4 course is designed to provide training in the skills necessary for direct medical support of tactical units under combat conditions. (This training has typically been completed prior to fellowship).
• Continuing Medical Readiness Training. CMRT is an annual Air Force requirement and entails one day in a simulated field hospital environment plus a mass casualty exercise involving treatment and triage of a variety of casualties. The casualties simulate those expected from ground combat in an area under chemical and/or biological agent attack.
• A Military Unique Curriculum for residents and fellows with specialty-specific focus was created for pathology and cytopathology fellows. Portions of the laboratory management/operations module will address military unique/leadership issues.

• Fellows will take the Progressive Evaluation of Competency (PEC) online exam three times over the course of the training year, which will track the fellows’ baseline, mid-year and final level of knowledge, and overall competency in cytopathology. Topics covered will include GYN, Non-GYN, FNA, and Laboratory Operations.
• Re-certification of Basic Life Support (BLS).

The cytopathology fellowship program currently utilizes simulation training models (i.e., “Phantoms”) for practice of fine needle aspiration (FNA) biopsies; however, the Program Director and Associate Program Director are working to develop a military unique curriculum utilizing BAMC's state-of-the-art Simulation Department which offers low-fidelity and high-fidelity simulators. Cytopathologists and residents rotating on cytology service will participate in an ultrasound guided FNA training workshop at the simulation center.

• Leadership skills for laboratory management are essential skills which take time to nurture during the fellowship. Therefore, at the beginning of the fellowship, fellows are considered the “first responder” to any laboratory issues which need to be addressed. These issues will be discussed with the Cytopathology Medical Director and solutions implemented afterwards.
• Fellows are present at all weekly Visual Management Board (VMB) meetings where laboratory management issues are further discussed in detail with the entire interprofessional cytology team to include cytotechnologists, cytopathologists, and cytology processors.
• Fellows participate in the College of American Pathologists (CAP) laboratory inspection process for laboratory accreditation. This generally occurs through a self-inspection, which the fellow takes the lead on.

SAUSHEC has a research requirement for graduation. Research projects are completed, and manuscripts submitted to the Program Director by the end of April of the training year. The research requirement for graduation can be accomplished by original scientific research, a performance improvement project, or by completion of a case report with review of pertinent literature. Other possible submissions for the graduation paper can be approved through the Program Director. Each fellow will select at least one research topic in cytopathology. Pre-approval of a research project is required by the Program Director. For original research, approval is required by the appropriate institutional review boards (IRB). The research subject will be written up by each fellow and should be of publishable quality.

Our program offers numerous quality improvement initiatives, including quarterly departmental Patient Safety Report (PSR) reviews. We have a dedicated Quality Improvement and Patient Safety (QIPS) cytopathology staff to engage with the fellows and promote/implement quality improvement initiatives. Additionally, we encourage fellows to attend the Root Cause Analysis (RCA) course and participate in hospital RCAs when possible. Fellows are also encouraged to join and participate in the SAUSHEC QIPS subcommittee.

• While developing superior diagnostic acumen and lab management/administrative skills, our program also focuses on developing future military leaders through mentoring and modeling.
• Funding is available for fellows to attend at least one professional conference during the training year when presenting a scholarly activity. Fellows have given national lectures, research podium presentations, and held national leadership positions at United States & Canadian Academy of Pathology (USCAP), College of American Pathologists (CAP), American Society for Clinical Pathology (ASCP), American Society for Cytopathology (ASC), American Society of Dermatopathology (ASDP), National Association of Medical Examiners (NAME), and American Association of Neuropathologists (AANP), among others.
• Fellows receive training from senior officers on military evaluation writing.

Thyroid Cytopathology Partners - Austin, Texas

The pathology residency program offers rotations to fourth-year medical students and transitional year interns. Rotations are typically 4 weeks long, and medical students rotate through the cytopathology service as part of their pathology rotation. Rotators will work with our resident medical student coordinator to finalize their rotation schedule to include at least one day in all areas of pathology, and elective days to highlight areas of interest. Rotators will take a quiz at the end of their rotation and are expected to deliver a pathology presentation.

Those interested should contact dha.jbsa.brooke-amc.list.saushec-cyto@health.mil and follow guidance through SAUSHEC Graduate Medical Education regarding rotation logistics.

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

Cytopathology fellowship program graduates take the American Board of Pathology (ABP), Cytopathology subspecialty board examination. This one-day exam is offered annually at the conclusion of the cytopathology fellowship. Applicants must complete the cytopathology fellowship before taking the board exam. Additional information on eligibility requirements can be found on the American Board of Pathology website.

Fellows play an important role in teaching residents and rotating medical students and are required to present weekly at the cytopathology interesting case conference, as well as the cytotechnologist correlation conference. Fellows teach residents and medical students daily at the microscope, as well as give scheduled didactic conferences at least quarterly.

Additionally, there are opportunities for the fellow to teach at a multi-disciplinary level, during didactic and tumor board conferences held in other departments throughout the hospital.

Fellows are offered opportunities to teach courses at local, regional, and national conferences, as well as at virtual workshops for the Uniformed Services University medical students.

The fellowship program continues to have board-certified cytopathologists with varied backgrounds, from both civilian and military training centers, who bring a breadth of knowledge and experience to the program. The cytopathology faculty as well as the other pathology subspecialists are dedicated to improving the program with their excellent teaching skills and mentorship.

The program has a robust mentorship program, pairing trainees with staff for mentorship sessions to include mentorship in pathology, career aspects, military life, leadership, and finances.

Residents and fellows also build laboratory management skills through partnership with faculty medical directors through laboratory oversight and laboratory site inspections.

• Trainees and faculty are given the opportunity to attend institutional-sponsored well-being/wellness lectures/activities during duty hours. The services of the Health and Wellness Centers at both Joint Base San Antonio (JBSA)-Ft. Sam Houston and JBSA-Lackland are available for faculty and trainees.
• Protected time for trainees is offered to ensure adequate physical fitness is maintained to promote a healthy lifestyle and pass the service specific physical fitness tests.
• In conjunction with the pathology residency program, the cytopathology fellowship program has developed a program level wellness curriculum, which is chaired by the cytopathology Associate Program Director. The program is centered around achieving and maintaining well-being, with protected time and activities scheduled monthly with the trainees. The goal is to help foster a well-rounded approach to health and well-being in the training environment as well as off-duty.
• Fellows can participate in an optional Wellness Committee geared at optimizing program wellness and involvement with hospital-wide peer wellness and support groups.