Mission

We provide the clinical experience, educational resources, and mentorship support that produces exceptional military Infectious Disease physicians who engage in the highest quality of ethical and compassionate practice of infectious disease.

Vision

Promote fellows to deliver state of the art healthcare, while maximizing resources for education and research and maintaining the highest standards of professionalism and efficiency.

Aims

• Provide a supervised training experience such that Army and Air Force ID fellows will acquire competency in infectious diseases with sufficient expertise to act as an independent consultant.  
• Mentor trainees toward proficiency of the graduate in the unique requirements of military-specific infectious disease.
• Develop trainees to become scholars and participate in original research in military-relevant infectious diseases and provided the skills to mentor future scholars.
• Ensure graduates are critical thinkers so they are prepared to serve as local, regional, and national leaders. 

Ultimately, a graduate from SAUSHEC ID fellowship will be a competent clinician in ID and possess the skills required to be a competent leader within and outside the military.

The didactic curriculum is based upon the core knowledge content specific to infectious diseases as outlined by the Internal Medicine Review Committee. Lectures are saved in electronic format upon a common server to which all fellows and staff have access for review. Core didactic sessions include both fellows and faculty members, include fellow-fellow and faculty-fellow interactions, occur weekly (Thursday mornings at Brooke Army Medical Center ID large conference room) and include:

Clinical Case Conference

In this weekly clinical conference, fellows present two clinical cases followed by a review of medical literature pertinent to questions raised by the case. On the fourth Thursday of the month, outpatient/urgent care cases are presented by the fellows, followed by a pediatrics case presented by pediatric ID faculty designed to afford fellows exposure to pertinent pediatrics ID problems. On the fifth Thursday of the month, when applicable, three fellows present challenging cases designed to “stump the staff” and maximize dialogue on diagnostics and management between faculty members. This fifth Thursday activity alternates with a fellow-led ID M&M which is designed to lead the service through a systems analysis of a safety event relevant to our practice. Depending on need, this Thursday may be designated for an alternate activity. Finally, the ordering of these conferences may be spaced or changed based on speaker availability. 

Journal Club

This conference occurs approximately once per month, each month two fellows are presented with a case and clinical question in infectious disease and are asked to select the article that best answers the clinical question. Each fellow presents the article in detail and explains the reason for choosing that article to answer the clinical question. (e.g. best treatment option for recurrent CDI) with an emphasis on analyzing the manuscript’s methodology. Journal Club will also take place under the form of “Quick Hits”.  Fellows will bring 1-2 articles to share at a Tuesday noon conference.  They will present a brief synopsis of their article and why it might be relevant to their colleagues and/or patient care.

Research/Quality Improvement (QI) Conference

Occurs approximately once per month, with 20 minutes given to a fellow and 20 minutes to a second fellow and/or faculty member. These conferences are designed to provide exposure to the program’s ongoing projects as well as to provide valuable feedback to the investigator. Content includes research or QI projects at any stage of development from conceptualization through presentation of mature data.

Core Lecture

10-15 Core lectures are presented during the first month of each academic year in order to maximize new fellow exposure to common infectious disease problems seen early in training (e.g. “Clinical Microbiology”, “Latent Tuberculosis”, “Selection of Antimicrobials”). Core lectures then continue on a monthly (4th Thursday) basis, around topics outlined in C.2.a-m. When appropriate, the core lecture will focus on topics unique and/or relevant to a military Infectious Disease provider (i.e. infection control in the deployed setting, malaria prophylaxis and treatment, Chemical, Biological, Radiological, and Nuclear (CBRN)). Core lectures are also assigned to various additional formats including guideline reviews, reviews (by attendees) of recent national or international meetings’ content, and jeopardy-style or other game styled contests.

Basic Science Lectures

Basic science topics around content outlined in C.2.a-m. are reviewed on the 3rd Thursday of the month, and lectures are given by senior fellows and faculty. Twice a year, these lectures occur in debate format where either two senior fellows or two faculty are assigned to debate opposing sides of a controversial topic in ID, followed by an open discussion of the topic by staff and fellows.

Noon Conferences

These occur at noon on Tuesdays throughout the academic year and are designed to supplement fellow education as well as give senior fellows additional opportunities to develop resident-oriented lectures. These smaller conferences include fellows and residents on an ID rotation at BAMC and typically one fellow presenting per session and the presence of at least one clinical faculty. In addition to standard lectures on topics outlined in C.2.a-m., topics included are board review-style question and answer sessions, microbiology plate rounds at the BAMC clinical microbiology laboratory, and infection control simulation exercises. Once per month, a fellow will give an assigned lecture from our military unique curriculum as an opportunity to broaden and enhance their knowledge of the operational components of Infectious Diseases in the military. Topics for these lectures will be assigned to the fellows by program leadership.

City-wide ID conference (“Bug Club”)

Occur monthly, off-site, throughout the non-summer months. Each fellow presents 1-2 cases per year to University of Texas Health San Antonio (UTHSA) fellows, UTHSA and SAUSHEC faculty as well as all other ID specialists in the city. Presentations are based upon clinical questions and include an expansive review of the literature.  This is a formal grand rounds presentation for 30 minutes.  Fellows will discuss their selected case with the staff on the case as well as the learning points and objectives they plan to review.  Presentations are required to be reviewed by staff prior to their presentation and should be turned in at a minimum of 1 week prior to presentation.  A senior fellow will be assigned to make the schedule of fellow presenters.

Q Stream Quiz

The quiz is based on themes outlined in C.2.a-m with questions developed by the Program Director, faculty, and/or senior fellows. The quiz is especially targeted at knowledge content for which fellows may not receive as much direct clinical experience (e.g. “Immunodeficiencies other than HIV”, “Solid Organ Transplants”, “HIV issues in Pregnancy”, “Military ID”). Additionally, emphasis will be placed on topics pertinent to operational military medicine. Quizzes include multiple-choice questions which are uploaded to a spaced interval education website providing for immediate feedback on answers as well as explanations to these questions. This format includes repeat presentations at spaced intervals for right and wrong answers until the question is answered correctly repeatedly. Fellows are expected to complete all Q stream quizzes with mastery of the material.  This may run intermittently over the two-year fellowship.

Faculty Development

Approximately quarterly the program holds a Faculty Development session on topics chosen by the fellows and/or faculty. These topics are chosen in order to develop the teaching, mentoring, and leadership skills of the attendees, as well as to promote and maintain a shared mental model of educational culture and best practices. These are typically developed and delivered by faculty although occasionally senior fellows may develop a session with faculty oversight. As fellows are considered to be junior faculty members, and given their eventual role in GME in the military health system, they are expected to attend and contribute. Attendance at additional faculty development activities offered by the sponsoring institution are encouraged.

Elective rotations include: 

• Bone Marrow Transplant
• Burn Intensive Care Unit Consults
• Solid Organ Transplant
• Clinical Educator

Fellows take call every other day while on inpatient consults.  It is rare that an overnight consult results in the fellow having to come into the hospital and typically a fellow may receive anywhere from 0-1 calls a night on average.

The military-unique knowledge and skills required in this specialty include understanding of and ability to manage deployment and travel related infections, emerging infections, diseases of pandemic potential and bioterrorism agents, management of outbreaks, infections and outbreaks associated with trainee health, infectious complications of combat trauma and infection prevention and stewardship in the deployed setting. ID is consistently the most tele-consulted specialties from deployed healthcare workers. The ID fellowship program previously published its military unique curriculum in Military Medicine 2019 Oct 1;184(9-10):509-514, but key aspects are cited/updated below for SAUSHEC.

• Inpatient and outpatient consultation blocks include instruction in the management of infectious complications of combat trauma and burn patients.
• Fellows gain competence in the long-term management of patients with orthopedic infections after trauma, including combat trauma, in their continuity clinics.
• Formal didactics include core lectures on orthopedic infections with a focus on combat trauma; burns; travel and tropical medicine; military requirements in HIV care; latent tuberculosis with a focus on military specific risk factors and systems; infections in military trainees, deployment-specific infection control, and numerous others. We also address infections that impact medical readiness such as HIV, viral hepatitis, tuberculosis and other chronic infections.
• Fellows develop and deliver at least one lecture on operational infectious diseases per academic year to further develop their teaching portfolio. Fellows attend the lectures prepared by their peers.
• Fellows & faculty participate in a formal faculty/leadership development course administered by the program; topics include mentorship, Army and Air Force professional development, communication, negotiation, conflict resolution, emotional intelligence, and others.
• Fellows participate in simulation exercises designed to advance competence in outbreak management, infection control and antibiotic stewardship.
• The curriculum also includes a military specific multiple choice spaced interval examination through Q-stream.
• Fellows are required to attend the USU military tropical medicine course, which includes a 4-week didactic session and a 2-3 week overseas mission (operations have resumed after a period of virtual education during the pandemic). Post-pandemic we have caught up all of our fellows that still needed to have a field mission exercise as part of their tropical medicine experience including those that had graduated.
• Our fellows are offered opportunities to develop teaching experience through lectures given at Defense Institute for Medical Operations (DIMO) Conference, and others. They routinely participate in overseas teaching with DIMO or U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) educating international providers about bioterrorism agents and pandemic infections. Both Army and Air Force fellows now attend the Biocontainment Course at Center for the Sustainment of Trauma and Readiness Skills (CSTARS)-Omaha – a world leader in transporting patients with potentially highly pathogenic infectious diseases.
• In the fall of 2022, first ever experience bringing a fellow on Pacific Partnership 2022: operationally focused, multi-national, combined Tri-service military experience with the US Navy. One senior fellow and faculty member participated in the “fly-in” for the Philippines portion of the mission where they were able to interface with host-nation healthcare leaders and partners at an extremely high level. Planning is in place to make this a recurrent experience for 2024.
• We have fellows tour Joint Base San Antonio (JBSA) Lackland Air Force Base trainee health facilities with the surveillance and preventative medicine team to better understand the way ID is involved in military basic training.
• For the 2023-2024 academic year there will be an opportunity to participate in tele-health consultation with foreign nation partners that are currently experiencing conflicts and combat trauma related infections to better understand how consultative advice and the experiences learned during Operation Enduring Freedom/Operation Iraqi Freedom can be applied to different theaters that are currently active.

• Centers for Disease Control-sponsored Sexually Transmitted Disease Intensive Course
• Society for Healthcare Epidemiology of America (SHEA) Annual Fellows Course in Healthcare Epidemiology
• Uniformed Services University Military Tropical Medicine Didactics and Field Course
• National Jewish Non-Tuberculous Mycobacteria Course
• Center for the Sustainment of Trauma and Readiness Skills (CSTARS) Omaha Nebraska Principles of Biocontainment Course

The fellows participate in an Objective Structured Clinical Exam (OSCE) during their orientation to the ID fellowship which provides simulated patient experiences to help them prepare for a busy infectious disease clinic.

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.

Research activities are a vital component of the ID fellowship, serving to advance fellows’ knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care. All fellows will devote 10-12 months (for 2-year fellows) and up to 22-24 months (for 3-year fellows) to research activities. The ID Service is dedicated to maintaining an environment of scientific enquiry and scholarship with an active research component. Scholarship is defined by the following:

• Peer-reviewed funding;
• Publication of original research or review articles in peer-reviewed journals or chapters in textbooks;
• Publication or presentation of case reports of clinical series at local, regional, or national professional and scientific society meetings; or
• Participation in national committees or educational organizations.

Fellows participate in research and other scholarly activities; protected time is set aside from inpatient consultative months (though continuity clinic remains ongoing through research blocks) and efforts are made to facilitate research, including provision of space, funding and other practical resources. A mentor is chosen within the 6 months of the onset of the fellowship. All fellows are required to demonstrate evidence of recent research productivity through publication (manuscripts or abstracts) in peer-reviewed journals, or abstracts presented at international/national specialty meetings.

Support is provided for trainees to attend a scientific meeting (typically IDWeek) during their fellowship. Attendance at additional meetings is encouraged and financially supported when possible, particularly for those who are selected for presentation of their work.

Each year the fellowship is required to develop and execute a quality improvement project.  Past projects have included addressing vaccine disparities, Mpox vaccination programs, and rapid HIV screening in patients presenting with STI’s.

Aside from the professional development planned in the curriculum, fellows also have an opportunity to widen their development as military officers participating in Medical Humanitarian missions, development through IDWeek participation, as well as research portfolio development.

• University of Texas Health Sciences Center San Antonio
• Texas Center for Infectious Disease
• Audie Murphy Veterans Affairs Hospital

Medical students rotating on the Infectious Disease Service at BAMC will have the opportunity to see a broad variety of Infectious Disease syndromes in the largest military treatment facility in the Department of Defense. The student will spend the majority of their time on the inpatient consult service where they will have the opportunity to work closely with the ID Fellow and Faculty while evaluating patients with a wide variety of Infectious Disease complaints including but not limited to: bone and joint infections, trauma-related infections, infectious endocarditis, HIV/AIDS, device related infections (including cardiac devices), rickettsial infections, Tropical Medicine infections (including malaria, dengue fever), mycobacterial infections (including tuberculosis), Fever of Unknown origin/ID mimickers, and Fever in returning travelers. 

BAMC is unique in the DOD due to its co-location with the Institute for Surgical Research Burn Center, as well as having a Bone Marrow Transplant unit, and a significant Extracorporeal Membrane Oxygenation (ECMO) service, which ultimately provide unique opportunities to evaluate infections in immunocompromised hosts.  While this is primarily an inpatient consult service rotation, there are opportunities to spend 1-2 half-days in the outpatient ID clinic seeing patients presenting for travel medicine consultation, latent tuberculosis, sexually transmitted infections, HIV, Pre-exposure prophylaxis for HIV, Non-tuberculous mycobacterial or fungal infections, tick-borne or arboviral infections, bone and joint infections, and/or suspected/unknown infectious syndromes. 

The student will be expected to attend ID conference academics on Tuesdays at noon, and Thursday mornings from 7:30 – 9:30 a.m.  They may also have the opportunity to attend San Antonio city-wide ID Grand Rounds depending on the month of the rotation (typically October-April). Medical students interested in scheduling a rotation should contact: usarmy.jbsa.medcom-bamc.mbx.saushec-clerkship@health.mil.  

Since the pandemic both the San Antonio and Walter Reed programs have agreed that interviews should be primarily virtual so as to avoid over burdening trainees with the cost of traveling for interviews; however, this is not mandatory and should an applicant wish to travel to visit a program they are more than welcome to do so.  Interviewees should plan to interview at both Walter Reed and San Antonio if they are Army applicants. 

Interested applicants may contact dha.jbsa.brooke-amc.list.saushec-id@health.mil to set up an interview.

Program graduates take the American Board of Internal Medicine (ABIM) Infectious Disease Board. This exam is offered annually.  To become fully board certified, applicants are eligible to take board certification exam six months following graduation. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the ABIM Internal Medicine by the end of their fellowship training.  Infectious Disease boards are taken after fellowship.

There are numerous teaching opportunities during ID fellowship including the opportunity to hone your teaching craft while completing a clinical educator elective, participating in a wide variety of didactics with varied learners through the year, as well as participating in the USU Faculty Development Teaching certificates.

Some faculty have additional subspecialty training in ID-Critical Care.

Each fellow is assigned a research mentor for the entire fellowship who also typically serves as their clinical coach and mentor.

Our fellowship promotes wellness through social activities including fun runs, morale days, blocked academics time, as well as through close engagement with fellows to identify red flags or evidence of occupational health. We believe wellness transcends lectures and outings. We are committed to transparency within the program, keeping our fellows up to date during times of change and stress, and allowing for fellows to provide input to making real time changes into their work environment and workflow.