Mission

The mission of the SAUSHEC Dermatology Program is to provide an extensive clinical, procedural, and pathological experience that, when accompanied by detail-rich academics, educational resources, and mentorship, produces exceptional military officers and dermatologists who engage in the ethical and compassionate practice of medicine while providing safe, high-quality health care to patients.

Vision

The vision of the SAUSHEC Dermatology Residency Program is to be the military’s premier dermatology training program, excelling in academic education, clinical medicine, and innovative research for the benefit of our military and beneficiary population.

Aims

• Produce physician-leaders for military medicine and the field of dermatology.
• Encourage compassionate physicians dedicated to serving the local and global community.
• Instill academic curiosity and a passionate commitment to lifelong scholarly activity.
• Model innovation, dermatological excellence, and education of others.
• Exemplify military-unique dermatologic expertise in support of active duty, wounded warrior, and veteran care.

Our program’s academic sessions occur Mondays, Tuesdays, Thursdays 11:15 a.m. - 12 p.m., and Fridays 1 – 4 p.m. for all residents and rotators. These sessions may be structured as lectures, journal clubs, morphology conferences, case presentations, and koda or CORE exam reviews. Each PGY class has a half-day dedicated to dermatopathology didactics and slide review weekly. Semi-annually we hold a joint City-Wide Grand Rounds with the University of Texas Health Science Center dermatology program that occurs on a weekday evening.

The rotations’ duration and number may vary based on the complement of residents within a PGY group, which may range from 4-9 residents.

Residents may choose from a list of local physicians/practices that have an established training agreement such as podiatry, Bucay Center for Dermatology and Aesthetics, or the Limmer Hair Transplant Center. Residents who have obtained mentorship awards may use this time to visit with their mentor at their institution.

There is an inpatient rotation for PGY4s for daytime (7 a.m. – 4 p.m.) inpatient consults at BAMC. Overnight (4 p.m. -7 a.m.) and weekend call coverage is shared among PGY3 and PGY4 residents.

Specific conditions and military dermatology relevant skills include extensive training in laser treatments for scars (more significant than non-military residencies), botulinum toxin injections and microwave thermoablation for hyperhidrosis of residual limbs, medical and laser treatment of pseudofolliculitis barbae (PFB) which is more common in the military population, infectious diseases (more common in deployed locations and those returning from deployment), and vaccination reactions. These topics are discussed in an academic setting and experienced in direct clinical care for active duty service members.

Our program has an Operational Medicine Clinic specifically for the routine care of ADSMs in addition to an Ambulatory Service for the urgent care of ADSMs and Basic Military Trainees (BMT). Residents are required to consider, document, and counsel patients on fitness, duty, and mobility restrictions for each ADSM. Residents are instructed on how to enter profiles into service-specific tracking systems. When appropriate, residents enter profiles themselves or provide dermatology-specific recommendations directly to patient’s Primary Care Manager. Upon request, residents and staff may assist with writing Narrative Summaries or Nexus Letters for dermatologic conditions. Residents and staff may participate in lectures for the Transgender Health Medical Evaluation Unit regarding dermatologic care and services for ADSMs undergoing gender transition.

The residents have a rotation entitled the Resident Clinic Liaison, which focuses on leadership and administrative skills necessary for successful independent practice as a military dermatologist. For any dermatologic condition that is identified as disqualifying for military entrance or retention, that information is discussed during the corresponding lecture. Interested residents may choose to use elective time for the Tropical Medicine Course, to recertify in Advanced Trauma Life Support, or to attend other military trainings such as Air Assault. Depending on the individual’s prior service history, residents or staff may lecture on prior deployment or utilization tour experiences.

Pre-requisites include passing all 4 CORE subject examinations in Surgical, Medical and Pediatric Dermatology as well as Dermatopathology. Although not required, PGY2s are encouraged to take the Basic Examination in the spring of that year to gauge their preparedness for the CORE and Applied examinations.

Quarterly, we do surgical simulation laboratory exercises for suture and surgical techniques using different skin models. All interested residents are encouraged to participate in the root cause analysis (RCA) course at BAMC, where participants engage in a simulation of a RCA and can practice interviewing and leading an investigation.

In the Post Graduate Year (PGY) 4 year, there is a required rotation entitled Resident Clinic Liaison (RCL) where the resident takes on additional leadership responsibilities within the clinic that simulate running clinic operations as a solo staff military dermatologist. During this rotation the RCL assists the Referral Management Officer In Charge with scheduling close follow-up routine patients (i.e. trainees) to be evaluated in RCL time and assists the inpatient resident with scheduling/evaluating other 72 hour consults when necessary. They help to triage and evaluate walk-in/urgent patients or those who have been waiting a long time for their scheduled clinic appointment. The RCL also assists residents with clinic issues as they arise (residents who are running late, residents who need help with clinic procedures, etc.).

All PGY4 residents must complete a publication-quality manuscript of at least 3 pages and submit to the Program Director for review by the spring of their final year of residency. All residents will have 1 or 2 research rotation blocks depending on the current complement of residents. We have guest lecturers on the Institutional Review Board (IRB) process, developing a research idea, and statistical support. Residents are encouraged to submit and present posters or presentations at local, national, and international dermatology meetings.

Quality improvement and patient safety (QIPS) is emphasized in our program. We have an Assistant Program Director of QIPS to help guide residents on their ideas/projects and ensure that a minimum of 30 Quality Improvement Patient Safety (QIPS)-related points will be achieved by the completion of the residency program. Residents complete Institute for Healthcare Improvement (IHI) open school certification at the beginning of internship (or residency if not completed prior). Residents are encouraged to submit Patient Safety Reports which are reviewed monthly during clinic-wide meetings. All residents are encouraged to participate in the Root Cause Analysis (RCA) courses offered at BAMC and in actual RCA investigations when they arise.

Annually we have a Transition to Practice guest lecture that discusses topics such as life as a staff dermatologist, Off-Duty Employment (ODE), and civilian contracts.

• Brooke Army Medical Center
• Texas Dermatology and Laser Specialists
• Audie Murphy Veterans Hospital
• University of Texas Southwest Hospital
• Christus Children’s Pediatric Hospital
• University of Texas Health San Antonio

Medical students will be oriented to the clinic and assigned a rotation schedule that includes working with residents and faculty. The rotation includes routine clinic, urgent clinic, high-risk skin cancer clinic, Mohs surgery, dermatologic surgery, and laser clinic, but the schedule can be customized to support the student's interests. Medical students may participate in inpatient consults with the resident and attending assigned to that service. Medical students will attend all academic sessions (Mondays, Tuesdays, Thursdays 11:15-12 p.m., and Fridays 1 – 4 p.m.) and selected dermatopathology sessions. Students are encouraged to assume greater responsibility for patient care as they advance through the clinical rotation under the direct supervision of residents or attending physicians.

These responsibilities may include the following tasks:

• Shadow residents or faculty in the clinic
• Interview patients
• Examine patients
• Define and prioritize patients' dermatologic complaints
• Generate and prioritize differential diagnoses for dermatologic complaints
• Develop rational, evidence-based diagnostic and therapeutic strategies to manage and care for the patients
• Present patients to the supervising resident or attending physician in real-time
• Expand their knowledge base about symptoms, signs, diagnoses, and management of common dermatologic conditions
• Learn, perform, and become competent in common office dermatologic procedures

• Interviews are offered early September – mid October. Interviews may be conducted in-person or by phone depending on the preference/circumstances of the applicant. Interviews generally run 30-45 minutes and are by a panel (Program Director, Associate Program Director, Chief Resident, other faculty).
• To schedule an interview, e-mail the program coordinator, dha.jbsa.brooke-amc.list.saushec-derm@health.mil.
• Dress uniform is encouraged, but Operational Camouflage Pattern (OCP) is also acceptable.

Program graduates take the American Board of Dermatology (ABD) Applied board certification exam. This exam is offered annually in July. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the American Board of Dermatology by 30 September of the graduation year. The pre-requisites include passing all 4 CORE subject examinations in Surgical, Medical and Pediatric Dermatology as well as Dermatopathology. Although not required, PGY2s are encouraged to take the Basic Examination in the spring of that year to gauge their preparedness for the CORE and Applied examinations. Additional information on the certification pathway may be found at the ABD Website and clicking on the ABD Certification Pathway bar.

PGY 3 and 4 residents play an integral role in teaching junior residents, medical technicians, various rotators (medical students, off-service residents, Physician Assistants, Nurse Practitioners, Phase II students, and other observers).

There are volunteer opportunities outside of the normal duty day where interested residents may participate in teaching. Examples include pre-medical student lectures on basic suturing techniques through the US Army Recruiting Command throughout the state of Texas and the American Academy of Dermatology’s youth education program, Good Skin Knowledge where residents teach young people facts about common skin, hair, and nail conditions.

We have multiple subspecialist fellowship-trained faculty in Dermatopathology and Micrographic Dermatologic Surgery.

Residents are formally assigned a staff dermatologist mentor on an annual basis. Mentors and mentees meet monthly to discuss Individualized Learning Plans, feedback form the Clinical Competency Committee, curriculum vitae formatting, and other professional best practices (i.e. maintenance of an up-to-date biopsy log).

We have guest lectures on wellness-related topics such as burnout. Quarterly, we have off-site social events where staff and residents can engage outside of work; such events have included Top Golf or fly fishing. Our department also hosts promotion and hail/farewell events, Holiday parties, potlucks and graduation get togethers.