Mission

We will forge clinically excellent, mission-ready, and humanistic internists for the Air Force and the Army. We will become the top choice in residencies for Air Force and Army medical students interested in internal medicine.

Vision

Resident-centered military medical education to develop ready, patient-centered military internists.

Aims

Our program aims to create the conditions to allow each trainee to leverage their own unique attributes to become the best version of themselves while training to fulfill the promise of duty and expertise expected of our Nation’s servicemen and women. In particular, our program seeks to demonstrate the following in our graduates:

Clinical Excellence

First, above all else, an internist must possess the knowledge, skills, and attitudes necessary to practice highly effective, safe and reliable medicine. Internists are cognitive specialists – the physician’s physician. We pride ourselves on sound clinical reasoning, accurate clinical diagnosis, and high value care.

Medical Educators

Teaching is an essential element of our profession. We teach our patients how to optimally care for themselves. It is our responsibility to teach the next generation of clinicians, whether medic, medical student, or fellow physician. As with all responsibilities, we hold ourselves to the highest standards of excellence.

Scholarship

It is our duty to advance our profession through scholarship of discovery, integration, application, engagement, and teaching.  

Readiness

Military physicians serve dual professional roles, as military officers and physicians. We train to become a ready medical force to be prepared to serve those who serve in harm’s way. 

Leadership

Physicians must be prepared to lead modern healthcare organizations. No other health care professional has the professional formation, clinical experience, and expertise to lead as the physician does. Internists are particularly well-suited to this role because of their experience working in multi-disciplinary teams, holding ultimate responsibility for patient outcomes in a wide variety of situations (e.g. ambulatory, inpatient and consultative capacity).

The program runs three series of academic conferences daily. Trainees scheduled on non-ambulatory rotations attend a daily hour-long noon conference in the main residency conference room. This conference schedule provides a wide range of topics including high-yield board review, state-of-the art subspecialty updates, case-presentations, Morbidity & Mortality and patient safety reviews, Grand Rounds, and unique presentations. There is an academic half-day scheduled once per week.

Medical students and Post Graduate Year (PGY)-1 trainees attend academic half-day on Tuesday afternoons, PGY-2 and PGY-3 trainees attend on Wednesday afternoons. The academic half-day sessions (90 minutes) are typically conducted in small-group case-based learning format or focus on simulation training or procedure/Point of Care Ultrasound (POCUS) practice. Trainees scheduled on ambulatory rotations attend a daily morning report (40 minutes) in their assigned clinic either at Brooke Army Medical Center or Wilford Hall Ambulatory Surgical Center. Wednesday mornings during the ambulatory week consist of a half-day of problem-based learning sessions. Friday mornings during ambulatory week consist of a multi-disciplinary clinic meeting and evidence-based learning presentation delivered by a trainee who is scheduled on a rotating basis.

The SAUSHEC Internal Medicine Residency Program uses an X+Y academic schedule in which trainees are scheduled in alternating 4-week rotations of varying types followed by 1-week blocks of ambulatory time. Each 4-week rotation ends in a golden weekend (Sat and Sun off) prior to the start of the Y week of clinic. There is progressively more elective time added to the schedule as the trainee moves from the PGY1 to PGY2 and PGY3 years. Leave is authorized to be taken during elective, research, emergency medicine and neurology rotations. A general outline of the three-year curriculum follows:

Residents are authorized one month of elective time in the PGY-1 year, two months in the PGY-2 year, and three months in the PGY-3 year. Elective options include:

• Allergy/Immunology
• Anesthesia
• Bone Marrow Transplant
• Burn ICU/Step Down Unit
• Cardiology
• CCU at University Hospital (Advanced Heart Failure)
• Dermatology
• Endocrinology
• ENT
• Gastroenterology
• Hematology/Oncology
• HIV at University Hospital
• Infectious Diseases
• MICU at University Hospital
• Nephrology
• Ophthalmology
• Physical Medicine and Rehab
• Pulmonary Medicine
• Quality Improvement and Patient Safety
• Radiology
• Resident as Teacher
• Rheumatology
• Sleep Medicine
• Surgery and Trauma ICU
• Ultrasound (Point-of-Care)

The program does not use any 24-hour call in any of its rotations. All rotations are organized on day/night shifts of 12 hours or less in length. Required rotations (e.g. ward medicine, medicine intensive care unit, cardiac care unit, night float) consist of six days of duty and one scheduled day off per week. Clinic weeks, elective, research, and most other rotations consist of five days of duty and two days off per week.

The program has a military unique curriculum whose purpose is to provide residents with the knowledge, skills, and attitudes necessary to be able to care for active-duty personnel and their dependents upon graduation at their first duty station or when deployed in austere environments. The curriculum focuses on the following core elements of military unique medicine:

• Preventive care (medically ready force)
• Ambulatory care (troop medical clinic)
• Consultative care (telemedicine)
• Inpatient care (field hospital)
• Emergency triage and stabilization (battlefield and Role 1 care)
• Critical care (CCAT and Role 3 care)

Our curriculum combines didactics, small-group experiences, simulation, and practical experiences to help prepare our graduates to be ready to provide care from the battlefield to the Intensive Care Unit (ICU). These educational elements are organized in four domains:

• Deployment readiness
• Leadership
• Garrison care
• Officership

Examples of specific military unique curricular elements include:

• Fundamental Critical Care Support Course
• Fundamental Critical Care Support: Resource Limited Course
• Critical Skills for Expeditionary Medicine Course
• Transition to Practice Course
• Strategic Trauma Readiness Center Course
• Combat Casualty Care Course (C4)
• Sick Call rotations at Troop Medical Clinics on Army and Air Force installations
• Sports Medicine clinic rotations
• Surgical/Trauma ICU rotation required for PGY-3 residents (also available as elective rotation)
• Two different Point of Care Ultrasound (POCUS) elective rotations available for PGY-2 and PGY-3 residents
• Numerous military unique curricular didactics including topics such as sports medicine, special warfare, military finance, military profiling for medical officers, medical retention standards, flight medicine, military utilization panel presentation
• Simulation sessions on trauma care, procedural skills
• Military Tropical Medicine course with optional international rotational experience
• Field Hospital Trauma Management Course
• Basic Leadership Airman Skills Training
• Air Force Operational Medicine 101 and 102 Course
• Tactical Combat Medical Care Course (TCCC)
• Expeditionary medicine international rotations (in AY 2023-24, IM residents rotated to Djibouti, Honduras, Solomon Islands)

• All residents are required to maintain Basic Life Support (BLS) and Advance Life Support (ALS) certification throughout residency. These courses are available at Brooke Army Medical Center (BAMC) and Wilford Hall Army Medical Center (WHASC).
• Army residents complete Combat Care Casualty Course (C4) training prior to graduation.

Brooke Army Medical Center has a state-of-the-art simulation center on site. The Internal Medicine Residency Program uses the simulation center as part of its didactic program throughout residency training. Common examples of the use of simulation include critical care and trauma scenarios and procedural skill training, including common internal medicine procedures such as:

• Central line placement
• Arterial line placement
• Thoracentesis
• Paracentesis
• Chest tube placement
• Lumbar puncture
• Arthrocentesis
• Point of Care Ultrasound (POCUS)

The program provides a robust opportunity to develop leadership skills throughout residency training. These opportunities range from formal lectures to small group discussions to experiential learning. Opportunities start from the first day of training and increasing levels of responsibility are nurtured in a progressive nature over the 36 months of residency. Some examples include:

• Opportunity to lead ward or Intensive Care Unit (ICU) team on a regular basis 
• Opportunity to lead residency committees
• Opportunity to serve as a Junior chief
• Quality improvement projects
• Scholarly projects
• Residency sponsored community service projects

The SAUSHEC Internal Medicine Program believes that it is a physician’s duty to advance our profession through scholarship of discovery, integration, application, engagement, and teaching.  To that end, the program strives to ensure that each graduate possesses basic knowledge, skills, and experiences in research and scholarly endeavors. Furthermore, the program aims to provide a rich array of opportunities and mentorship to participate in research projects across the full spectrum of medical specialties and in medical education and quality improvement. 

The program has a scholarship requirement for graduation. Categorical residents at graduation are expected to:

• Complete one evidence-based (PICO) presentation during an ambulatory week on a clinical topic of their choice
• Complete a graduation paper that fulfills the requirements outlined in the SAUSHEC Graduation Paper policy
• Complete a minimum of 10 scholarly activity points. Residents can earn scholarly activity points by completing any number of a wide variety of scholarly activities that are specified on a menu provided by the program.

The program provides financial support to residents to present their scholarly work at academic meetings and in peer-reviewed publications. Our program’s trainees have a robust track record of award-winning performance for scholarly achievement at the local, regional, national, and international level.

Modern health care institutions are complex adaptive systems. 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 unique dedicated Chief of Residents and 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 Patient Safety Report review conference in which we review key Patient Safety Reports that were submitted in the hospital in a multi-disciplinary setting as well as a monthly Morbidity and Mortality Conference. Most 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 30 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.

Graduates of the SAUSHEC Internal Medicine Residency Program are universally sought out for assignments across the Department of Defense and are highly competitive for fellowships in all specialties. Residents training in our program have the unique advantage of being able to work with and form relationships with the subspecialty programs which are all represented at Brooke Army Medical Center. 

The program provides ample funding opportunities and support for residents to perform, publish, and present research and scholarly work. Residents have typically been able to attend at least one professional conference during residency with many trainees attending more than one conference over their time in training. Our residents have given national lectures, research, and clinical podium presentations, presented workshops at national meetings, and served on specialty society leadership boards for groups such as the American College of Physicians, Society of General Internal Medicine, Infectious Disease Society of America, American College of Cardiology, American College of Gastroenterology, American College of Chest Physicians (CHEST), Society of Critical Care Medicine, Society of Hospital Medicine, and many others.

• Brooke Army Medical Center 
• Wilford Hall Ambulatory Surgical Center
• University of Texas Health Science Center at San Antonio

Our program offers rotations to fourth year medical students interested in applying to internal medicine. Rotations are typically four weeks long (can be split into two-week blocks) and can be requested in a variety of clinical environments (see table below). During the busiest times of the year (June through October), we may ask students to split a four-week rotation between two clinical learning environments (e.g. ward medicine and a subspecialty) in order to accommodate as many learners as possible. 

Students interested in arranging a rotation should start by reviewing the “Medical Student Information” tab located at the following webpage: Rotation Info. Rotation requests may be submitted within 9 months of the intended rotation month by sending the rotation request form (located on the webpage linked above) to the email address provided on the webpage. 

Third-year medical students may be able to be accommodated on a space-available basis to the above rotations. To inquire about this possibility, please contact dha.jbsa.brooke-amc.list.saushec-im@health.mil.

Interviews are offered from May through October 15th annually. Interested applicants can schedule an interview virtually or in person by contacting dha.jbsa.brooke-amc.list.saushec-im@health.mil.

Program graduates take the American Board of Internal Medicine (ABIM) Certifying Examination. This exam is offered annually in August.  All Internal Medicine physicians who have met the standards for Board Certification in general internal medicine are considered Board Eligible for a period of seven years. During this period of board eligibility, the candidate may apply for the certifying examination in internal medicine. To be eligible to take this exam, graduates must complete all pre-requisites required by the American Board of Internal Medicine by August 31st. For more details, see ABIM Website.

Teaching is considered a core competency for trainees in our program. Trainees have opportunities to practice and hone their skills as educators from the outset of training in both formal and informal settings. Some examples of teaching opportunities available to all trainees in our program include:

• Interns and residents teach third- and fourth-year medical students on ward, intensive care unit (ICU) and elective rotations throughout the academic year
• Residents participate in teaching interns in both the inpatient and ambulatory setting throughout the academic year
• Medical Student Lecture Committee: a resident-run committee that organizes and delivers lectures on medical topics to rotating medical students throughout the academic year
• OMFS History and Physical Exam Course: Internal Medicine residents help run the history and physical exam course annually for the Oral and Maxillofacial Surgery Residency Program
• All residents are scheduled to develop and present two evidence-based medicine presentations (using the PICOT format) during the ambulatory phase of the curriculum over the course of their residency training
• Residents have the opportunity to design and deliver other educational sessions in lecture or small group format throughout the academic year
• Residents have the opportunity to participate in small group virtual teaching of MS1 and MS2 students at the Uniformed Services University of the Health Sciences
• Any trainee may sign up to earn a Certificate in Health Professions Education from the Uniformed Services University while in residency training
• Senior residents may participate in a two or four week-long Resident as Teacher Elective

Residents in the SAUSHEC Internal Medicine Program are assigned a faculty mentor by the program. The program attempts to match a mentor based on the resident’s service affiliation and specialty interest. Residents are free to choose additional mentors on their own. Assigned faculty mentors meet with their resident mentees twice per year. The goals of this program are to help the mentee address their personal, military, and professional (clinical) goals including a review of relevant career pathways within the military, the trainee’s curriculum vitae and individualized learning plan.

Faculty supporting the Internal Medicine Residency program have a wide range of subspecialty representation, including:

• Cardiology:
  • Cardiac Electrophysiology
  • Cardiac Imaging
  • Interventional Cardiology
• Endocrinology
• Gastroenterology:
  • Hepatology
  • Advanced Endoscopy
• Geriatric Medicine
• Hematology/Oncology
• Hospice/Palliative Medicine
• Infectious Diseases
• Nephrology
• Pulmonary / Critical Care
• Rheumatology
• Sleep Medicine

Residents in the SAUSHEC Internal Medicine Program are assigned a faculty mentor by the program. The program attempts to match a mentor based on the resident’s service affiliation and specialty interest. Residents are free to choose additional mentors on their own. Assigned faculty mentors meet with their resident mentees twice per year. The goals of this program are to help the mentee address their personal, military, and professional (clinical) goals including a review of relevant career pathways within the military, the trainee’s curriculum vitae and individualized learning plan.

Our program takes resident well-being and work-life balance seriously. Our schedule is structured to balance the provision of robust clinical training with reasonable time away from the workplace. Residents receive one day off in every seven days on inpatient rotations (e.g. wards, ICU) and two days off in seven on outpatient and elective rotations. A golden weekend (i.e. consecutive Sat and Sun off) is scheduled after every four week block. PGY-1 trainees are authorized 21 days of days away from training while PGY-2 and PGY-3 trainees are authorized 28 days away from training per year. All trainees are authorized 12 weeks of parental leave in accordance with DOD policy should they wish to utilize it during training (birth parents get an additional six weeks of convalescent leave after delivery).

The program maintains a jeopardy system that provides coverage in the event a trainee is ill, has a personal emergency, or other issue that prevents them from reporting for duty on any given day. 

The program and institution have a rich array of resources available for trainees to help support their health and wellness including a peer support program, behavioral health resources, financial planning resources, chaplain services, and military and family life counseling.

Finally, our program has a series of events designed to promote camaraderie among our team. For example, every Fifth Friday, residents on ambulatory or elective rotations are excused from clinical duties to participate in a fun, out of the workplace event. Residents maintain a social committee that is very active in planning year-round activities outside of the workplace that help build the sense of family that our program is known for. Our program hosts an annual fitness competition, Kudos Committee to recognize good deeds and small acts of kindness, an annual intern welcome picnic, holiday party, and end-of-year banquet all to serve to bring us together to celebrate our successes, our friendships, and each other.