Mission

The mission of the SAUSHEC Gynecologic Surgery and Obstetrics Residency Program is to train confident and competent clinicians and surgeons, foster clinical inquiry through research and quality improvement, and develop the future leaders of military medicine, all while providing patient-centered, compassionate care to active-duty military women and dependent military beneficiaries.

Vision

Resident physicians are fully integrated into all aspects of patient care to include general obstetrics, benign gynecology, as well as all the represented subspecialty divisions (Maternal Fetal Medicine-MFM, Oncology-ONC, Reproductive Endocrinology & Infertility- REI, UroGynecology-UROGYN, Minimally Invasive Gynecologic Surgery-MIGS). At the time of graduation, our residents are prepared and fully capable to perform the full spectrum of obstetrics and gynecology care for active duty and dependent women. 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 general obstetrical and gynecologic care.
• Establish resident 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 resident 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 obstetrics and gynecology as well as military medicine.

We have department-wide didactics every Thursday from 8 a.m. - 12 p.m. During that time, we cover a core chapter in one of our textbooks with an associated lecture and quiz. We hold weekly pre-op conference to simulate oral boards, monthly morbidity and mortality conferences, simulations, quarterly journal clubs and curriculum in research, patient safety, and diversity, equity and inclusion.

In addition to our weekly didactic session, each division has additional dedicated time to education. For example, the benign GYN service has weekly lectures, pre-op conference and simulation time. The OB team has weekly OB emergency simulations, lectures and Neonatal Intensive Care Unit (NICU) multidisciplinary conference.

• PGY-1s will complete two months of OB days and two months of OB night float (broken into two 4-week blocks) at BAMC. They will spend two months doing Obstetrics at University Hospital. They will do two weeks of benign gynecology, one month of Reproductive Endocrinology & Infertility (REI), one month of trauma Intensive Care Unit (ICU) and two months of clinic.
• PGY-2s will gradually have more exposure to GYN. They will still have two months of OB days and two months of OB night float. They will have two months of Benign gynecology at BAMC, two months of Gynecology at Fort Cavazos and two months of Gynecology Oncology. They will spend one month on REI and one month doing clinic rotation.
• PGY-3s will have more exposure to subspecialty GYN care. They will have one month of Urogynecology and one month of Minimally invasive Gynecology. They will have two months of benign gynecology at BAMC and two months operating with civilian gynecologists here in town homing in on their surgical skills. They will spend one month at the VA doing additional gynecologic surgery. They will spend two months on OB days caring for the antepartum service working 1:1 with the Maternal Fetal Medicine (MFM) staff. They will complete one month of night float.
• PGY-4s will have one month of Urogynecology and one month of Minimally invasive Gynecology. They will have two months of benign gynecology at BAMC and two months of Gynecology Oncology. They will spend one month at the VA doing additional gynecologic surgery. They will spend two months on OB days. They will complete one month of night float. They will go to New Mexico for two weeks for Complex Family planning and spend an additional few weeks’ doing clinic.

There is opportunity in the 3rd and 4th year blocks to take a 1-month elective, in an area of interest such as Gyn Oncology.

Our program utilizes a night float system. Most residents will cover one weekend shift 3 weekends per month and have one golden weekend per month.

• Sunday-Thursday 5 p.m - 7 a.m.:  3-person team consisting of a Post Graduate Year (PGY)-1, PGY-2 and either a PGY-3 or -4 resident with no additional clinical duties.
• Friday night, Saturday (24 hours) and Sunday day: The remaining residents cover.

Military unique curriculum for the OB/GYN resident centers around readiness for the female service member. Ensuring a ready, female, fighting force translates into all aspect of obstetrics, gynecology and women’s health care.

One important impact that OB/GYNs have on the readiness of the female service member is prevention of unplanned or mistimed pregnancy and female specific health needs in preparation for deployment. Our program has a heavy focus on quality contraception for our active-duty patients with a special emphasis on Long-acting reversible contraception (LARC). Additionally, residents receive didactic training on the specific deployment needs for women such as menstrual suppression and avoidance of common female specific complaints (i.e. urinary tract infections, vaginitis, etc.). Our residents participate in the 2 walk-in contraception clinics at Lackland Air Force Base and Ft Sam Houston in collaboration with adolescent medicine, educating service women on menstrual suppression and contraceptive options. We led two US Army Medical Center of Excellence (MEDCOE) Women’s Support and Mentorship Groups with the female trainees at the MEDCOE this past academic year.

Return to duty and fitness for duty following pregnancy is also a key component of readiness of the female service member. We emphasize the importance of quality postpartum care (as this is a prime time for contraception) including the provision of immediate placement of LARCs in our postpartum populations. There are also many potential pregnancy complications that can impact a women’s long-term health including hypertensive disease, gestational diabetes and postpartum depression. Scholarly activity is ongoing in our department in all these areas in an attempt to identify rates of these complications in our active-duty population and ensure appropriate screening and management of these conditions is occurring in order to hopefully limit the impact on future health and readiness concerns.

From a gynecology perspective, readiness of the female service member also focuses on health maintenance and disease prevention. Areas of focus with regards to health maintenance include aspects such as cervical and breast cancer screening and immunizations. Twice-monthly interdisciplinary conferences regarding management of abnormal pap testing helps us utilize most up-to-date guidelines regarding screening and treatment and ongoing quality improvement projects have helped to increase the breadth of vaccines available to our patients in the Women’s Health Clinic. Quality improvement projects implementing point of care human papillomavirus infection (HPV) vaccination in the clinic and while inpatient postpartum have shown improved uptakes.

Gynecologic readiness also centers around expediting recovery from surgical procedures. We emphasize minimally invasive surgical techniques whenever possible to decrease recovery and risks of post-operative complications. Additionally, our department has been an institutional leader with regards to implementation of the ERAS (Enhanced Recovery After Surgery) protocols. These evidence-based interventions improve surgical outcomes for all our patients and in turn return our Soldiers and Airmen to duty faster.

Many of our faculty have deployed and been stationed at overseas remote locations including recent deployments in support of operation Afghan Refugee. At every pre-op conference and morning report, discussion centers around what one would do differently if stationed at a remote location or deployed.

Our department, to include faculty and senior residents, participate in military surgical simulations with a forward Surgical Team. The training is in Spring Branch, Texas, about 45 minutes from BAMC. The Army sends all forward surgical teams to this course to prepare for deployment. We teach the obstetrical emergencies portion monthly.

It is required that residents pass Fundamentals in Laparoscopic Surgery (FLS) or Essentials in Minimally Invasive Gynecology to be eligible to sit for certification boards. This is funded by SAUSHEC. Our residents take this exam during their PGY-3 year and we have had a 100% pass rate.

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 academic chief, administrative chief, quality improvement and patient safety chief, program evaluation committee resident representative) as well as within SAUSHEC GME (house staff officer, resident membership on all GME subcommittees, etc). Our program has been very successful in sponsoring and supporting our residents in national leadership positions to include American College of Obstetrics and Gynecology (ACOG) Armed Forces Division (AFD) representatives and American Medical Association (AMA) leadership positions.

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.

There is a research requirement to graduate which includes writing a research protocol for submission to the Institutional Review Board (IRB) and authoring a publishable-quality manuscript. We have an Assistant Program Director of Research that guides residents through the process. All residents easily meet this requirement, and many exceed it.

We have a longitudinal research curriculum. Each intern will identify a case report by the end of their intern year and present it at our annual research day in May. We encourage them to submit this case report to the annual American College of Obstetrics and Gynecologists Armed Forces District (ACOG AFD) meeting. In order to be funded to attend, a manuscript must be written. Residents also get dedicated research time: one week during PGY-2 year (for research protocol writing), 10 days throughout PGY-3 year (for data collection and publication submission), and a program wide “research week” in May to encourage residents to continue to pursue research throughout residency.

There are lots of opportunities to attend conferences to present research. The Program Director sends out a weekly “PD Blast” communication and always include research opportunities and conferences accepting submissions.

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

We have an Assistant Program Director of QIPS. Residents complete Institute for Healthcare Improvement (IHI) open school certification when they start residency. Residents then form teams to work on departmental-level quality improvement projects, ideally with all resident levels and staff, so that after graduation, projects can continue. Residents are encouraged to submit patient safety reports which are reviewed quarterly during academics. All residents will participate in a simulated root cause analysis (RCA) exercise and are encouraged to participate in actual RCAs when they arise.

The military OBGYN community is very well established in the American College of Obstetricians and Gynecologists (ACOG). The Armed Forces District of ACOG has lots of opportunities for residents to serve as leaders and grow professionally. In addition, all committees at SAUSHEC have a resident representative and residents are encouraged 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
• Carl R. Darnall Army Medical Center
• University of Texas Health San Antonio
• VA Hospital in San Antonio
• Methodist Hospital System
• Wilford Hall Ambulatory Surgical Center
• Christus Santa Rosa Alamo Heights Hospital
• Southwestern Women’s Options

Medical students will be assigned to two services during their 4-week rotation, each two weeks long. The options include: Labor and Delivery days, Labor and delivery nights, Maternal Fetal Medicine, Clinic, Benign Gynecology, Minimally Invasive GYN Surgery, UroGynecology, Reproductive Endocrinology and Infertility and Gynecology Oncology. The gynecology surgical specialties will participate in inpatient rounds, assist with surgeries, and see clinics with the residents.

While on labor and delivery, the medical students will see triage, assist in vaginal deliveries and cesarean deliveries and assist with post-partum rounds. Medical students are expected to have knowledge of pelvic anatomy, common gynecology complaints, relevant history taking, and physical examination skills. When participating in surgery, the student will also be expected to scrub in, safely maintain a sterile field, and have a basic understanding of the applicable anatomy. The students will be allowed to participate in the care of OBGYN patients under the direct supervision of residents and faculty surgeons. Each student will be asked to take one weekend call. Every Thursday the students will participate in our weekly department academics. Each student is asked to put together a 10-minute presentation on an OBGYN topic of their choice; guidance is available.

To schedule a rotation, e-mail: usarmy.jbsa.medcom-bamc.mbx.saushec-clerkship@health.mil. 

For additional info, or if there is no response from the above e-mail, contact: dha.jbsa.brooke-amc.list.saushec-obgyn@health.mil. 

Interviews are offered every other Thursday from July – mid October. Each applicant will hear an overview of the program given by the Program Director, followed by a tour of the hospital by one of the residents. Then each applicant will have two 30-minute interviews; each interview will have one resident and one staff. Lunch is provided and is an opportunity to engage with the residents. That evening, the residents host a social event off site.
During an audition rotation, students will be assigned an interview date during that 4-week period. Medical students are invited to come for an in-person one-day interview even if not rotating.

Virtual interviews are offered if students are unable to come in person.

To schedule an interview, e-mail the program coordinator dha.jbsa.brooke-amc.list.saushec-obgyn@health.mil.

Program graduates take the American Board of Obstetrics and Gynecology (ABOG) board exam in order to become board-certified. It is a 2-part exam. The qualifying exam (written exam) is offered once a year in mid-July after graduating residency. After graduating, the certifying (oral) exam must be completed within 8 years. Typically, cases are collected for one year, followed by oral boards in October – December of the following year. It traditionally takes 2 years from graduation to become board-certified.

BAMC is a core clerkship site for the Uniformed Services University, so we always have 2nd and 3rd year medical students rotating with us on their core OBGYN clerkship. Residents are their primary teachers. In addition, throughout June – October we have several 4th year medical students rotating for audition rotations.

PA students, transitional, emergency medicine, anesthesia, and internal medicine interns also rotate through our department.

As we are the expert in women’s health, we have lots of opportunities to interact with the enlisted female service members and teach about women’s health. We do this when we cover the walk-in contraception clinics and through fairs/town halls with the US Army Medical Center of Excellence on Joint Base San Antonio (JBSA) - Fort Sam Houston.

More than half of our faculty are subspecialist-trained, which allows lots of mentorship directly to our residents since we have no fellows to compete with. Subspecialties include: Maternal Fetal Medicine, Reproductive Endocrinology & Infertility, Urogynecologists, Minimally-invasive Gynecologists and Gynecologic Oncologists.

We have a robust mentorship program.

• Each class has two assigned faculty mentors that meets with them quarterly for check in and provide mentorship
• Each resident is asked to select a mentor by January 1st of their intern year. The Program Director sends out slides with information about each faculty to include their interests, desires, background, and interns select a mentor.
• Mentors and mentees meet quarterly following a guide about topics to cover focusing on research, militate and career goals.
• Junior faculty are paired up with senior faculty for mentorship as well.

The SAUSHEC Gynecologic Surgery and Obstetrics residency program implemented a themed team competition for the 2022-2023 academic year, “GYN of Thrones”. Residents and staff were divided into five families, modeled after Game of Thrones© to compete for the “Throne of Hysteros.” Points were awarded for participating in program activities, receiving kudos for patient care, and demonstrating clinical excellence. This was very well received and we have continued this into the next academic year.

In addition, our residents have two team building retreats over the course of the academic year (two days each in October and June) and also had wellness activities facilitated by our Wellness Chief sporadically throughout the course of the academic year.

A recent study published in Obstetrics and Gynecology reported that the number one entity which residents found to benefit their wellness was control over their time. For this reason, for the past 4 years we have opted to focus our wellness “curriculum” on Wellness Time. Once every eight weeks in lieu of Thursday department wide conference the residents will have the entire day dedicated to wellness. Optional wellness activities will be facilitated by the program and/or the Wellness Chief Resident or the residents may opt to participate in activities on their own. This is also a time when residents may complete routine health maintenance or other necessary activities as they desire.

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