Mission

The mission of the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Neurology Program is to train world-class physician-leaders who are ready to provide the highest quality, patient-centered neurologic care in the service of our nation.

Vision

Ensuring mission success by providing the highest quality neurologic care to our military members.

Aims

Military Readiness

Our graduates must be ready to serve effectively as both military officers and physicians, whether at home or abroad, in peace or at war.

Leadership Development

Leadership is a skill set which must be developed to succeed as both a physician and officer.

World-class Clinical Training

Our graduates must be able to practice the full spectrum of neurology upon graduation as they may not have access to academic centers or subspecialists.

Focus on High-Quality, Patient-Centered Neurologic Care

All that we do is centered on providing high-quality care to our patients.

We have resident-focused didactics Mon-Thurs from 8 – 9 a.m. On Thurs, we have additional clinic-wide didactics from 12 – 1 p.m. Topics include resident-led journal club, basic science lectures, faculty-led lectures, textbook chapter reviews, quality improvement and patient safety topics, military unique and leadership topics, and more. We also participate in Neurosciences Grand Rounds at UT Health San Antonio approximately twice monthly.

Our program has 13-block rotations, at a total of three local sites: Brooke Army Medical Center, University of Texas Health San Antonio and Audie Murphy Veteran’s Affairs.

Additional experience in any of the other subspecialty-focused rotations: 

• EEG/Epilepsy Monitoring Unit at UTHSA
• Neurocritical care at BAMC or UTHSA
• Research elective

Neurology residents in our program take “home call” for 24-hour periods. The number of call shifts vary between Post Graduate Year (PGY) levels, with more junior residents taking more call and more senior residents taking relatively less call. As an example, our PGY2 residents often take 6-7 call shifts in a 4-week block, while our PGY4 residents often take 1-3 call shifts per 4-week block. Our PGY4 (chief residents) additionally complete “backup” call responsibilities, during which they provide initial after-hours guidance to PGY2 and PGY3 residents. This creates additional opportunity for progression of clinical responsibility among our residents.

We have dedicated time in our didactics curriculum for military-specific topics (supervising enlisted personnel, Air Force Medical Corps career pathways, the readiness implications of neurology care, etc.) in addition to practice-specific topics (coding, clinic operations in a military setting, and more).

• SAUSHEC Neurology Bootcamp Course (PGY2)
• SAUSHEC Neurology Neurophysiology Course (PGY3)
• Smirniotopoulos Washington Neuroradiology Review (PGY3)
• Dr. Kenneth M. Earle Memorial Neuropathology Review (PGY3)

Optional Courses:

• J. Kiffin Penry Epilepsy Mini-Fellowship
• The Residents Course for Advancing Autonomic Medicine
• National Residents Scholarship Program (Epilepsy)
• Vanderbilt University Focus on Common Movement Disorders
• Vanderbilt University Neuromodulation Course
• American Epilepsy Society Epilepsy Workshop
• American Headache Society Resident Education Program

Each of the below simulations are intended to serve as both an educational and assessment method for “high-stakes” clinical scenarios in which our residents find themselves. The Status Epilepticus simulation occurs (without the residents’ prior knowledge) in a deployed combat setting.

• Acute Stroke
• Status Epilepticus (set in combat environment)
• Brain Death Evaluation & Delivering Bad News

Recognizing that our graduates are often asked to assume leadership roles during their initial assignments, leadership principles are regularly discussed in our conferences. We have dedicated time in our didactics schedule for broad leadership topics such as interpersonal communications and time management strategies. We have also held leadership book clubs in the recent past.

There are numerous opportunities for residents to exercise leadership within our program (as chief residents, as the resident representative for organizing various academic conferences, wellness representative, etc.) and across SAUSHEC (housestaff council representative, GME subcommittee memberships, etc.). There are also opportunities for us to send a resident representative to the Texas Neurological Society each year.

Research is emphasized. Under the guidance of a faculty advisor, residents are expected to plan, organize, and conduct their own research projects. Each May, residents present their research at the Neurology Education and Research Symposium (“Research Day”), now jointly hosted by the BAMC Neurology Department and UTHSA Neurology Department. Residents may present either a poster or an oral presentation, and resident presentations are complemented by presentations by a guest speaker on a research-focused topic. Separate from the BAMC/UTHSA Neurology Research Day, SAUSHEC hosts an annual Research Day competition (typically April) in which neurology residents may compete.

Residents have considerable latitude in selecting their research topics, ranging from case reports early on in residency to original projects collecting and analyzing prospective data for analysis as they progress. SAUSHEC requires all residents to complete a paper other than a case report, which is of publishable quality, at least once during their three-year residency. Preparing a formal paper on the material the resident presented at Research Day can fulfill this requirement. SAUSHEC has resources available specifically to support resident research, and our residents frequently deliver posters and presentations at the American Academy of Neurology Annual Meeting among other national and international conferences.

Our institution and program place a large focus on quality improvement and patient safety (QIPS). We have a QIPS Faculty Champion who works with residents to meet graduation requirements and to foster interest and involvement in Healthcare Safety Reviews. Our residents also complete Institute for Healthcare Improvement (IHI) open school certification when they start residency. Patient Safety Reviews involving Neurology patients are reviewed quarterly in our department. Additionally, we encourage and support our residents’ completion of the Healthcare Safety Review (HSR - formerly Root Cause Analysis) certification course and their involvement in subsequent institution HSRs.

The military neurology community has well-established relationships with the American Academy of Neurology (AAN) and American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). In addition, all Graduate Medical Education subcommittees (including Diversity, Equity, and Inclusion; Wellness; Military Readiness; and more) at SAUSHEC have resident representatives, and residents are encouraged and supported to serve in these roles.

Within our department, we have leadership opportunities for administrative chief resident, chief resident of academics, and chief of wellness.

• Brooke Army Medical Center (BAMC)
• Audie Murphy Veterans Affairs (VA)
• University of Texas Health San Antonio (UTHSA)

Third and Fourth year medical students rotating through the neurology service will have exposure to 3 weeks of inpatient neurology consults as well as 1 week of outpatient neurology. During inpatient weeks, students will be responsible for pre-rounding on their assigned patients daily, attending daily morning lectures, and presenting their patients during table rounds each day. As a level 1 trauma center, rotators can expect to see a breadth of neurologic pathology, including acute strokes, altered mental status/encephalopathy, status epilepticus, peripheral nervous system disorders, and more. During their outpatient week, rotators will be assigned to a resident or attending clinic to interview, examine, and evaluate patients in the outpatient setting. There is also an opportunity to participate in a neuromuscular multidisciplinary clinic on the first Tuesday of each month, during which students will see complex neuromuscular disorders such as amyotrophic lateral sclerosis, myotonic dystrophy, and various myopathies.

During this rotation, there is a structured curriculum each day, a reading list for self-directed learning, and an opportunity to deliver a brief presentation on a neurology topic of the rotator’s choice. Students applying to the neurology residency will also take a written test at the end of the rotation.

Interested students may submit rotation requests via dha.jbsa.brooke-amc.list.saushec-neuro@health.mil. While we make every effort to accommodate learners, we do try to limit the number of applicants rotating concurrently; therefore, please request your rotation as early as possible, especially for requests during peak months of June – September.

Medical student applicants from Health Professions Scholarship Program (HPSP) or Uniformed Services University for the Health Sciences (USUHS) are encouraged to complete an interview rotation at BAMC, during which they will spend several weeks working with the inpatient consult team and also gain exposure to outpatient clinic. In our candidates, we value potential for academic success, but also work ethic, ability to function well in a team, and many other factors which demonstrate potential for long-term success as a military officer and neurologist.

To schedule an interview, please contact dha.jbsa.brooke-amc.list.saushec-neuro@health.mil.

Program graduates take the American Board of Psychiatry and Neurology (ABPN) adult neurology board written exam. This exam is offered annually, typically in September following residency graduation. Applications to take the board exam must be submitted by February of PGY4 year.

To be eligible to take specialty board exams, graduates must complete residency training by July 31st and provide proof of an active, unrestricted medical license by September 1st. Additional information can be found here: American Board of Psychiatry and Neurology Neurology.

BAMC is a core clerkship site for the Uniformed Services University, so we frequently have medical students rotating with us on their core Neurology clerkship. Our residents are their primary teachers. In addition, during June – October, we have several 4th year medical students rotating for audition rotations. Transitional year interns, Psychiatry interns, Internal Medicine residents, Pain fellows, and other learners rotate through our department.

Our residents are invited to provide quarterly didactic education to the Internal Medicine during their residency academic time. Our residents are also key to executing a standardized didactic curriculum aimed at education of the visiting interns and residents rotating on our inpatient team. There are multiple additional teaching opportunities available, including for senior residents to proctor lumbar puncture simulations for both staff and residents to maintain their readiness requirements, among others.

All of our faculty are board certified in Neurology. Some of our faculty have additional subspecialty training in: 

• Epilepsy
• Neuromuscular
• Neurophysiology
• Neuroimmunology
• Neuroophthalmology
• Critical care
• Movement disorders
• Sleep Medicine

We have a robust mentorship program. Overview details include: 

• Each resident has an assigned faculty mentor that meets with them at least twice annually to monitor progression of training requirements and to provide mentorship
• The program director and/or associate program director meet with each resident twice annually to provide mentorship
• All of our faculty have an open-door policy and frequently engage in informal mentoring

Our program designates a resident to serve as the Chief Wellness Officer (CWO) for the program. The CWO has protected academic time approximately once monthly for both residents and faculty to do various activities. Additionally, the program allows resident team-building offsites approximately quarterly. These offsites are funded by contributions from the residency morale and welfare fund.