Mission

The mission of the SAUSHEC Endocrinology, Diabetes, and Metabolism Fellowship Program is to provide a diverse clinical experience, educational resources, and mentorship that produces military endocrinologists poised to lead the exceptional healthcare of Service Members and their families, ensuring America’s Warfighter readiness is maintained at peak performance via outstanding individual and population health.

Vision

To be recognized as a vital program that produces endocrinologists valued by the Military Health System.

Aims

• Produce competent endocrinologists who will be leaders of medical teams in deployed and garrison settings.
• Produce compassionate patient-centered physicians capable of preventing illness and healing the most complex metabolic conditions affecting our Service Members’ health and readiness.
• Promote military relevant scholarly activity that results in cost-effective medical innovations for Service Members and their families.
• Instill a spirit of lifelong learning, continuous quality improvement, and dedication to service.
• Foster resilience through healthy work-life balance, self-reflection, and professional development that will guarantee the longevity of our mission into the future.
• Generate an inclusive workplace in which all persons are respected and function as a team to achieve our mission while upholding the Department of Defense Core Values.

Didactic/conference time is split between Brooke Army Medical Center (BAMC) and University of Texas Health San Antonio (UTHSA). Each week there will be about 4 hours of didactics or other multidisciplinary conferences with generally 2 hours at BAMC and 2 hours at UTHSA.

BAMC Options

Each generally occurring 1x/month:

• Staff lecture
• Fellow lecture (each fellow will lecture every 2-3 months)
• Research discussion
• Visiting interdisciplinary lecturer (ex. ENT, Pathology, Cardiology, GI, etc)
• Military Unique Curriculum
• Leadership lecture
• Cytopathology Conference
• Nuclear Medicine Conference

UTHSA Options

• Case presentation (3x/year for each fellow)
• Grand Rounds (1x/year for each fellow)
• Journal Club (1x/year for each fellow)
• Staff lecture
• Staff/Fellow Research presentation

The academic year is comprised of twelve (1-month) blocks. Research and Consult Clinic schedule is the same between blocks to either allow for time to address consults or to do research in non-call months. Currently, all rotations are done at BAMC.

There are opportunities to rotate with Pediatric Endocrinology, Reproductive Endocrinology, or participate in a QIPS elective. Additionally, we have all fellows review the Bariatric Surgery information session as well as the Diabetes Self-Management Education and Support (DSMES) classes that we commonly refer patients to attend.

Currently fellows are on call for 1-month blocks that rotate through the fellows. Fellows will be on call every 2-3 months based on the number of fellows total in program. While on call for the month, the on-call fellow will take maintain the pager during work hours and take home call after hours. The on-call fellow will have two weekends off/month as coordinated with the other fellow(s) and/or staff to meet accrediting body work-hour guidance. On average, we receive 1-3 consults/day, which is why we maintain a clinic schedule even during the consult block.

Clinic

• Our training program sees active duty personnel and basic trainees with endocrine conditions. Our fellows learn about and apply military accessions and retention standards to these patients to make recommendations on continuation of military service or initiation of duty or mobility-limiting restrictions. Regarding current military-specific concerns, our department remains active in treating transgender service members and evaluating/managing overweight/obese service members whose weight or body mass index (BMI) is affecting readiness.
• Our fellows and faculty know to apply service-specific policies regarding obesity medications to the active duty population.

Didactic/Conference

• We seek throughout the year to discuss many topics related military readiness through each didactic session and/or specific didactic sessions about military unique aspects pertaining to being an Endocrinologist in the military.
• Topics include:
  • Service specific retention standards and how to navigate system
  • Participating in readiness skill sessions to maintain IM skills to be ready for deployment
  • Deployment experiences

Routine courses fellows are sent to include:

1st Year Fellow

• Harvard Endocrinology Review Course
• Endocrine University Y1

2nd Year Fellow

• Endocrine University Y2

At the beginning of each year, fellows participate in a thyroid ultrasound (U/S) and Fine Needle Aspiration (FNA) course co-attended by University of Texas Health Endocrinology 1st year fellows. This course is to give a comprehensive overview of thyroid ultrasound, characteristics of nodules, and hands-on simulation of performing a thyroid FNA.

While leadership topics are intermixed throughout the year, we also dedicate one-month block to leadership where staff and fellows lead topic discussions or workshops. Topics include:

• Officer Performance Brief/Training Reports
• Promotion in the Medical Corps
• Leadership Fundamentals
• Leadership in Endocrinology
• Clinical/Physician Leadership
• Mentoring/Coaching
• Emotional Intelligence
• Conflict Resolution
• Feedback
• Implementing Change

• Preparation of an original research protocol for presentation to the Institutional Review Committee.
• Participation in a research protocol to include being primarily responsible for direction of the scientific work.
• Submission of abstracts annually to the Air Force chapter of the American College of Physicians Meeting, if held, or Military Health System Research Symposium, if appropriate submission category is available.
• Submission of an abstract to a national endocrinology meeting once each year. The program is budgeted for the junior fellow to submit an abstract to the American Diabetes Association Scientific Sessions and for the senior fellow to submit an abstract to the Endocrine Society Annual Meeting. If these abstracts are accepted for presentation, then current Air Force and institutional policy is to fund these fellows to attend these meetings.
• Preparation of a written manuscript suitable for submission to a medical journal or other scientific publication.

Note: The components above can be from different projects. It does NOT have to all be from one project as it can be difficult to conceive, develop, submit, execute, and publish on 1 project within a 2-year fellowship.

Fellows participate in helping to improve the healthcare system for our patients. Fellows will develop at least 1 quality improvement and patient safety (QIPS) project in coordination with our Research Director. Additional opportunities exist through the SAUSHEC QIPS Committee.

The SAUSHEC Endocrinology, Diabetes, & Metabolism Fellowship fosters growth for early endocrine clinicians by providing opportunity to attend at least 1 national conference per year when presenting scholarly activity (more conferences if develops more projects).

Fellows also have opportunities for educating primary care providers through many local avenues as well as our twice annual Diabetes Champion Course where provider teams from military treatment facilities around the world participate to improve meeting standards of care in managing patients with Diabetes.

Currently we are rotating only at Brooke Army Medical Center (BAMC).

• Rotators are assigned to interview, examine, and evaluate patients in the endocrinology clinic under faculty supervision. The full range of endocrine disorders is potentially available in these realms: hormonal disorders and diseases such as diabetes mellitus, hypothyroidism and pituitary adenomas.
• Rotators are also exposed to a variety of procedures, such as fine needle aspirations of the thyroid nodules.
• Rotators have the option to see inpatient endocrinology 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.

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

Program graduates take the American Board of Internal Medicine (ABIM) Endocrinology, Diabetes, & Metabolism Board. This exam is offered annually. To become fully board certified, applicants are eligible to take board certification exam following graduation. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the ABIM by October 31st. Boards are generally in late October to November of each year dependent on ABIM. Please see the ABIM site for pre-requisites. 

Fellows are expected to assume increasing levels of responsibility as teachers to their peers, internal medicine residents, medical students, and NP/PA rotators in the department throughout their time.

• We participate routinely in the internal medicine resident didactic sessions where fellows are expected to deliver topics and run interactive sessions.
• Multiple opportunities for local primary care clinic educational opportunities.
• Fellows required to participate in our bi-annual Diabetes Champion Course.
• Fellows required to participate in Diabetes Extension of Community Healthcare Outcomes (ECHO) webinar lectures.

All our faculty are sub-specialty trained in Endocrinology, Diabetes & Metabolism.

Well-being is discussed as part of the leadership-block curriculum that occurs annually. We receive annual training on suicide prevention, and how to notice co-workers that are exhibiting signs of stress or burn-out. Fellows and faculty are given a burn-out survey at the end of the academic year as part of self-reflection in planning for the coming academic year. Fellows and faculty also can attend wellness talks delivered by the internal medicine program at their noon academics conferences, these are advertised by the program director. Fellows can also participate in the SAUSHEC Wellness Committee if desired.