Mission

The mission of the UTHSA/SAUSHEC Nephrology Fellowship Program is to train competent general nephrology specialists to meet the operational requirements of the Department of Defense and provide high-quality, modern kidney care.

Vision

We envision a fellowship that produces well rounded, innovative, and inquisitive military officers who will continue to improve kidney care delivery within the Department of Defense. Additionally, it is our goal to train and develop military officers who understand the importance of military readiness and the unique aspects of military medicine.

Aims

• Produce competent physicians capable of providing the full spectrum of the care of kidney disease.
• Establish fellow engagement in lifelong learning through practices such as critical assessment of the literature, familiarity with clinical practice guidelines, quality improvement initiative and clinical research.
• Educate fellows on the principles of medical professionalism and ethical patient care and maintain high standards for all program members regarding these integral components of excellence in medicine.
• Develop and foster leaders in both nephrology as well as military medicine.

We have department-wide didactics every Monday, Thursday and Friday from 1300-1400. These are divided into Monday Clinical Conference, in which we discuss a core clinical topic in nephrology lead by either a senior fellow or staff nephrologist; Thursday Grand Rounds where we often have invited speakers to discuss cutting edge research, kidney physiology topics, Kidney biopsy conference, Morbidity and Mortality (M&M) or board review; Friday Journal Club where we discuss the landmark clinical trials in nephrology as well as recent groundbreaking articles, learning how to critically appraise the literature. Fellows also have the opportunity to attend the annual National Kidney Foundation Spring Clinical meeting (PGY4s), and the American Society of Nephrology Kidney Week (PGY5s).

Each academic year consists of 13 four-week blocks. 

Abbreviations: 

• BAMC = Brooke Army Medical Center
• UH = University Hospital
• VA = Veteran's Affairs

There is opportunity in both years to take two 1-month elective, in an area of interest such as Interventional Nephrology, Onco-nephrology, Research, Nephrology-Critical Care, Point of Care Ultrasound (POCUS), Polycystic Kidney Disease (PKD) clinic, Home Dialysis, Kidney stone clinic, Transplant clinic, Vascular Surgery, Renal Pathology, Plasmapheresis, or Pediatric Nephrology.

We have a night float system covering University Health (UH) acute, UH transplant and Veterans’ Administration (VA) inpatient consult services. Night float runs Saturday – Thursday nights from 5 p.m. - 7 a.m. with no additional clinical duties, Friday nights are covered by one on-service day fellow allowing for accrediting body requirements for 1 day off per week on the night float rotation.

Each inpatient service team is responsible for new consults from 7 a.m. – 5 p.m. each day.

Unlike the other rotations, BAMC Consult coverage is different due to lower call volume overnight. The fellow on-service will -alternate weeks of Week A (on-call 24 hours/7 days x 7 total days, including weekend) with Week B (on-call Mon-Fri 7 a.m. – 3 p.m., with staff covering weekday night nights and entire weekend day/night). Week B fellow will have the weekend completely free of patient care responsibilities.

The program provides instruction on providing renal replacement therapy in austere conditions with service specific knowledge, skills and abilities required to function as military Nephrologists while deployed. This includes deployable dialysis modalities, dialysis troubleshooting and coordination across Joint Service Medical Platforms. Specific training regarding creation of improvised dialysis procedures without standard dialysis machines, dialysate solutions, artificial kidney reuse and rapid start peritoneal dialysis (PD) with improvised PD dialysate and continuous renal replacement therapy (CRRT) solutions are included. This instruction includes several real-world, military relevant examples for combat operations, pandemic, and natural disaster response. Specific training in point of care ultrasound (POCUS) use is provided with a focus on deployment readiness.

The program trains fellows with regards to medical standards (e.g., DODI 6130.03, AFI 48-123, AR 40-501), with emphasis on the Joint service waiver process, implications to retention/permanent change of station/deployment status, profiling, and medical board requirements. We review the Exception Family Member Program (EFMP) criteria and its implications.

We offer the ability to participate in education of non-nephrologist use of CRRT and oversight of CRRT use by Non-nephrologists in the hospital setting

The program offers a Nephrology/Critical Care pathway for interested fellows to support the generation of more Critical Care Air Transport Team (CCATT) Qualified physicians.

Fellows are required to maintain active certification in Advanced Cardiac Life Support, Basic Life Support, and opiate training for the entirety of training.

We have ample simulation curriculum. All fellows are trained in vascular access and hemodialysis catheter placement in the simulation lab prior to attempting on patients. Supplemental training at both the Brooke Army Medical Center simulation lab as well as the VA medical center simulation lab are available on request.

Recognizing that our graduates are placed in leadership roles in their initial assignments, leadership principles are regularly discussed in our conferences. We are also fortunate to have faculty that teach leadership courses that are available to all our resident and staff physicians.

There are numerous opportunities for residents to hold leadership positions within our program (positions such as chief fellow, Morbidity and Mortality (M&M) coordinator, biopsy conference coordinator) as well as within UTHSA GME (house staff officer, membership on GME subcommittees, etc). Our program has been successful in sponsoring and supporting our fellows in national leadership positions to include the American Society of Nephrology Workforce Committee.

There is a research requirement to graduate which includes participation in scholarly activity. This includes anything from presenting a case report at a regional or national conference to writing a research protocol for submission to the Institutional Review Board (IRB) and authoring a publishable-quality manuscript. Research opportunities range from bench research with cell cultures, animals, and molecular genomics to randomized clinical trials in human subjects. The UTHSA staff have grant funding, statisitions, and multiple Doctoral Level researchers to assist in fulfilling this requirement.

There are ample opportunities to attend conferences to present research, ranging from local – UTHSA SURF to international – American Society of Nephrology (ASN) Kidney Week.

Our Institution and program place a large focus on quality improvement and patient safety (QIPS).

Fellows are invited to lead or participate in departmental-level quality improvement projects to make our patient care better for the generations to follow. Residents are encouraged to submit patient safety reports which are reviewed during academics. All residents will have the opportunity to participate in root cause analysis (RCA) exercise and are encouraged to participate in actual RCAs when they arise.

We sponsor all fellows to become Assistant Professors with the Uniformed Services University of the Health Sciences. All fellows are invited to our faculty development sessions which earn credit towards USUHS academic certificates. Fellows are encouraged to attend local, regional, national conferences regularly.

• Brooke Army Medical Center
• University of Texas Hospital San Antonio
• Audie Lee Murphy VA Hospital in San Antonio
• STAR Vascular Access Center
• Texas Diabetes Institute

Our program offers elective rotations on the Brooke Army Medical Center inpatient consult service. Medical students interested in scheduling a rotation 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-nephro@health.mil.

Program graduates take the American Board of Internal Medicine (ABIM) Nephrology Certification exam. This exam is offered annually in November. To become fully board certified, applicants must take and pass the exam. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the ABIM by the 31st of October of the year they wish to take the exam. Exam details can be found on the ABIM website.

Fellows are expected to teach medical students, residents and junior fellows with increasing levels of responsibility as their training progresses. Fellows routinely take part in Internal Medicine didactics, learning labs and bedside teaching.

Fellows are offered opportunities to teach first year medical students on their Nephrology/Reproductive health educational blocks. In addition, they are supported to attend regional and national meetings for teaching opportunities.

All of our faculty are board certified in Nephrology. Some of our faculty have additional subspecialty training in Interventional Nephrology and Nephrology/Critical Care.

We have a robust mentorship program.

• Each class has an assigned faculty mentors that meets with them on a quarterly basis at a minimum for check in and provide mentorship
• Mentors and mentees meet quarterly following a guide about topics to cover focusing on research, military and career goals.
• Junior faculty are paired up with senior faculty for mentorship.

The fellowship meets monthly to discuss wellness issues. We have a social chair who sets up recuring events for the fellows and several times a year we meet as fellowship to promote comradery.

We have quarterly wellness events where residents have the opportunity to socialize outside of work. Our department also hosts regular Holiday parties, welcome picnics and graduation banquets.