Mission

Develop leaders in military orthopedics by delivering outstanding musculoskeletal care and fostering a spirit of inquiry through professional development, education, and research.

Vision

Selfless surgeons leading the Department of Defense in musculoskeletal education.

Aims

Graduates of this program must be competent and innovative orthopaedic surgeons and leaders. To that end, graduate surgeons must be:

• Capable of general orthopaedic practice 
• Able to practice in a deployed/austere environment 
• Competitive for subspecialty fellowships 
• Well-versed in ongoing research efforts to save lives and limbs on the battlefield 
• Able to preserve and optimize function for servicemembers 
• Active in promoting orthopaedic advances
• Pioneers in improving orthopaedic education

The program's objective is to cultivate leaders in military medicine and encourage involvement in advocacy, research, and national committee work.

Academics occur weekly on Wednesdays from 7 a.m. – 11 a.m. The curriculum focuses on essential topics in orthopaedics. Faculty surgeons provide expertise during core-topic lectures whiles residents facilitate discussion with case-based presentations and peer-to-peer instruction. Quarterly Visiting Professors provide in-depth knowledge and experience over a two-day visit. Journal club is conducted monthly.

The program incorporates simulation and sawbones/cadaver labs regularly. Common components:

• Built-in team training with team specific curriculum
• Peer-to-peer teaching
• Surgical indications conference
• Morbidity & Mortality conference monthly
• Surgical simulation Labs
• Surgical cadaveric skill sessions
• Comprehensive Competency-Based Education--direct observation of surgical and clinic performance with extensive structured feedback. Innovative quantitative determination of resident skills pioneering education beyond ACGME and American Board of Orthopaedic Surgery (ABOS) requirements.

There is an opportunity to focus certain rotations on a desired subspecialty of orthopaedics. One such rotation is the PGY-5 The San Antonio Orthopaedic Group (TSAOG) rotation. This private practice multi-subspecialty group offers exposure across all avenues of orthopaedic practice and is focused based on resident interest.

Additional time for focused subspecialty rotations at established or even novel training sites is possible based on interest. Examples of previous outside rotations pursued in the last 72 months include Spine at Mayo Clinic, Trauma in Dallas, and Research at Emory.

Overnight call coverage starts as an intern based on rotation. Intern call is mentored by a junior resident (typically PGY-2) and overseen by a senior resident (PGY-4 or PGY-5).

The bulk of primary junior call at BAMC is during the PGY-2 year. During this year, call is based on the rotation and is typically once per week. This is in house call as a primary consulting provider for the Department of Orthpoaedics.

Senior call is taken as a PGY-4 and PGY-5. This “Chief” call is home call and involves the management and mentorship of junior residents and primary emergent surgical treatment for the Department of Orthopaedics.

Service members need musculoskeletal care to prepare for deployment. Orthopedic injuries are some of the most common seen on deployment. We teach residents how to treat deployed servicemembers, especially those who are injured during war. In this inter-war period, we are able to maintain our skills caring for high energy injuries due to BAMC’s status as a Level One Trauma Center. We are also a tertiary referral center for severely injured due to the Institute of Surgical Research (ISR) and Center for Intrepid (CFI). We teach our residents lessons regarding definitive Musculoskeletal (MSK) care and the proper evaluation and transfer prior to arrival at a center such as ours. As one of few “critical wartime specialties” the military relevance of orthopaedic care is inherent. We cover damage control orthopedics with a cadaver lab focused on those critical skills with external fixation, fasciotomies, debridement principles, and vascular approaches. Several of our faculty are instructors in the Combat Orthopaedic Trauma Surgery Plus (COTS+) pre-deployment course. We also have our faculty share lessons learned during deployment during a military focused day of didactics in July. This covers different deployment experiences including conventional and special operations, humanitarian, and covers everything from preparation to reintegration. We also hold a quarterly leadership journal club.

• Disclosure Training
• TeamSTEPPS
• Intern boot camp
• AO Basic
• AO Advanced
• Musculoskeletal Oncology Course

The program utilizes the following simulation activities:

• Dedicated simulation labs for incoming interns that cover all American Board of Orthopaedic Surgery (ABOS) Basic Skills Modules (“Drill Camp” and “Boot Camp”)
• Dedicated Arthroscopy and Arthroplasty skills lab that each require one day of instruction in May of intern year
• Microscope for suture skills
• Focused Microvascular Training (MAYO Microvascular Course) is available based on interest during PGY-3/4 year
• Monthly cadaver labs*
• Local arthroscopy simulation program
• "Sawbones" labs to work on fracture treatment
• Simulation Curriculum - the Director of Surgical Simulation has developed a curriculum to foster planned, well-curated subspecialty instruction along with enough support for senior residents to mentor junior residents through simulated surgical cases

*The department chair makes sure to excuse residents from clinical duties when the monthly labs are scheduled on “non-academic” days.

Our program requires residents to participate in research. Each graduate has a requirement to have a publishable research manuscript ready by graduation. Case reports, while valuable, do not count toward this requirement. The goal is that residents participate and contribute to research throughout the entire research process (hypothesis development, Institutional Review Board (IRB) submission and approval, data collection, data analysis, statistics, manuscript writing and editing processes) before graduation.

Local, regional and national resources exist through the U.S. Army and U.S. Air Force as well as civilian entities. Several established grants are available for funding projects. Additional research funds are available on a case-by-case basis.

All residents participate with quality and process improvement throughout all five years of residency. These include regular scheduled monthly Morbidity & Mortality as well as quarterly quality improvement (QI) and process improvement (PI) functions. Courses for additional training in the QI/PI process are available, as are opportunities to participate in root cause analysis (RCA) and other military specific processes throughout residency.

Professional Development is a process that is seamlessly incorporated throughout the curriculum. Our job as physicians is only part of our responsibility. Officership and professional military education are important to understanding the patients we serve and the system through which we care for them. Throughout residency, there are numerous opportunities for formal education such as Captain’s Career Course (CCC), Tactical Combat Casualty Care (TC3 if needed), etc.

• Brooke Army Medical Center (Primary Site), San Antonio, Texas
• Wilford Hall Ambulatory Surgical Center, San Antonio, Texas
• The San Antonio Orthopaedic Group, San Antonio, Texas
• University of Texas Health San Antonio, San Antonio, Texas
• U.S. Air Force Academy (USAFA) Hospital, Colorado
• Rady Children’s Hospital, San Diego, California

Medical students are encouraged to rotate with us! Uniformed Services University of the Health Sciences 3rd year medical students may rotate with us as part of their elective option during their surgery clerkship. Sub-intern and elective rotations are available for 4th year medical students. If you are interviewing, please join us between June and September. Please email us six months prior to your anticipated rotation to allow for us to coordinate with you: dha.jbsa.brooke-amc.list.saushec-ortho@health.mil.

Prior to interviews, we ask for a copy of your Curriculum Vitae (CV) and personal statement. Interviews are conducted during your rotation with us, but we can coordinate a telephone interview if you cannot visit us. At a minimum, you will interview with the Program Director, Associate Program Director, and core faculty members. We look for a variety of characteristics in our applicants, including fund of knowledge, scholarship, and professional citizenship. We also listen closely to our residents’ experience with each applicant, especially their ability to work well within the team. For more information on interviewing, please contact: dha.jbsa.brooke-amc.list.saushec-ortho@health.mil.

Program graduates take the American Board of Orthoapedic Surgery (ABOS) exams after graduation. During residency, the Orthopaedic In-Training Examination (OITE) is part of the preparation for this process. This ABOS exam is two parts. The first part is a written exam, offered annually, and performed within a few weeks of successful residency graduation. To become fully board certified, successful part 1 applicants then proceed to step 2. Step 2 is an oral in-person examination completed after a period of case collection (typically 6 months) and submission. This exam is completed approximately 2 years into practice. After successful completion of step 1 and 2, fully trained surgeons are ABOS board certified orthopaedic surgeons.

BAMC is a clerkship site for USUHS, so we frequently have 3rd year medical students rotating with us as an elective option during their surgery clerkship; our residents are their primary teachers. In addition, throughout June – September, we have several 4th year medical students present for audition rotations. Physician Assistant (PA) students and transitional, anesthesia, and internal medicine interns/residents also rotate through our department and provide opportunities for near peer teaching.

• Adult Reconstruction
• Foot and Ankle
• Hand, Upper Extremity and Microvascular Surgery
• Hand to Shoulder
• Musculoskeletal Oncology
• Pediatric Orthopaedics
• Spine
• Sports Medicine
• Trauma

Our program strongly believes in the importance of strong mentorship throughout the residency process as well as throughout practice as a lifelong learner. Mentorship is a personal decision and based on an individual fit. Mentor-mentee relationships are encouraged and formalized throughout residency for program participants (residents and teaching faculty). Additional outside mentor-mentee relationships are also highly encouraged.

Residents meet regularly for program sponsored morale events (minor league baseball, lake activities, pickleball, bowling) and for department journal clubs. We have had visiting professors to discuss well-being, leadership, and balance. We have given lectures and readings on recognizing signs of burnout and are vigilant in watching out for our residents. We have a quarterly morale day when residents can participate in team activities.