Mission

The SAUSHEC Pediatric Residency Program will train, educate, and equip the next generation of competent and confident military pediatricians. We will create exceptional military leaders and compassionate physicians who are able to provide worldwide care for all children and who are ready to support the medical mission of our nation's military.

Vision

The premier program to shape exceptional officers and compassionate physicians, sharpened to support our nation and all children.

Aims

Global Pediatricians

Produce clinically competent general pediatricians that excel in patient care and communication around the globe in all military treatment settings.

Lifelong Learners

Nurture a value of lifelong learning, continued teaching, and scholarly growth/productivity.

Commitment to Safety

Encourage continual assessment of medical care systems, empower graduates to institute quality improvement and patient safety initiatives in all clinical environments.

Compassion and Advocacy

Develop compassionate pediatricians, participating in pediatric care on a global scale through advocacy and voluntarism in the community or through humanitarian assistance.

Operational Readiness

Sharpen medical and leadership skills that prepare and train for military readiness and operational assignments that directly support military missions.

Growth and Resiliency

Cultivate skills that maximize resiliency and overall physician wellness through personal insight and growth and connect to medical and military communities.

Our program has dedicated, protected morning conferences Monday through Friday from 7:30 to 9 a.m. During that time, we typically have a 30-minute patient case presentation and learning discussion led by a senior resident, followed by a 60-minute formal lecture led by faculty. Also, residents engage in noon continuity clinic (CC) didactics with their CC team prior to afternoon clinics.

Through the academic year, residents will present Continuity Clinic Lectures, an hour-long didactic session reviewing updated, summary information on common general pediatrics medical topics that is developed with mentoring from a faculty general pediatrician. Residents also lead monthly journal club and introduction to biostatistics sessions for their classmates and faculty. On Fridays, we typically host special seminars including concentrated board review; department-wide Patient Safety Reviews; Leadership Sessions derived from LEAD 2.0 curricula; Social Determinants of Health Capstone Cases co-led by 3rd year residents and faculty; Grand Rounds Presentations; Simulation Curriculum in the Sim Center; interdepartmental Morbidity and Mortality Conferences; Class Advisor Meetings; and PGY-3 Quality Improvement Project presentations.

Military Pediatric Specialties

Cardiology, gastroenterology, endocrinology, infectious diseases, neurology, pulmonology, genetics, hematology/oncology, nutrition, child abuse, developmental-behavioral pediatrics, psychology, allergy/immunology

Military Specialties

Peds radiology, peds ophthalmology, peds surgery, peds orthopedic surgery, peds otolaryngology, peds dentistry, sleep medicine, sports medicine

Civilian Specialties

Peds nephrology, peds procedural gastroenterology/hepatology, peds rheumatology, peds palliative care, peds transplant medicine

Other

Research elective; Quality / Process Improvement elective; Institution Quality Improvement / Patient Safety elective; Pediatric Advocacy, Resident Education, and Newborn Training (PARENT) elective. Additionally, any inpatient or outpatient required rotation can be taken again as an elective if the resident desires.

Inpatient services utilize a night shift schedule, with a PGY-1 and PGY-3 covering the ward, PICU, and emergency department consults, and a PGY-1 and PGY-2 covering the NICU and newborn nursery. On-service day PGY-2s and PGY-3s will cover a 24-hour shift on either Fridays or Sundays, and Saturdays are typically staffed by cross-cover senior residents from outpatient rotations. If there is an on-service day PGY-1, they cover Saturday and/or Sunday day shifts. Sign out occurs at 6 a.m. and 5 p.m. Monday - Friday, and 7 a.m./5 p.m. on weekends.

Most PGY-1s will be on call twice per month; most PGY-2s and 3s will be on call once per month.

We utilize a jeopardy system to call in coverage if a resident is unable to work an inpatient shift due to illness or unanticipated emergency. Residents can expect to be on a rotating jeopardy schedule about 5 days per month.

Military pediatricians have always supported military families and directly contribute to the operational support mission by maximizing a service member’s family readiness – his or her family’s readiness to adapt rapidly to a deployment, temporary duty, or permanent change of station in a healthy way. Pediatricians can build the member’s confidence and trust that their child will receive skilled, compassionate care. If the member must be away – perhaps suddenly – our community provides medical support for the family remaining behind. If the family must relocate away from their known, stable community, skilled pediatricians provide top-notch, worldwide medical care which will ensure that children have reliable medical access. General and specialty pediatricians uniquely enable families with children enrolled in the Exceptional Family Member Program to remain operationally ready at smaller duty stations. They can also identify children and families that are at high medical risk and require re-assignment to larger military treatment facilities to provide complex or chronic care. These qualities enable the service member to focus on the garrison or deployed mission and contributes to member retention through consistent family support for the health, wellness, and development of their child.

Trained pediatricians also provide comprehensive medical care to the adolescent and young adult patient – the average age of more than half of active-duty soldiers is under 25. Our training requires two separate adolescent rotations (one more than ACGME requirements) during the three-year program to better equip residents for this exposure and participate in active-duty sick call, troop medicine appointments, and Nexplanon placement training for long-term contraception.

When opportunity arises, we aim to embed our residents in international pediatric and neonatal critical care air transport team (CCATT) missions to gain first-hand knowledge of the real-word medical and logistic complexity required for medical transport of critically ill infants and children. Our residents participate in the Neonatal Transport Course to gain classroom and simulation familiarization of the basics of ground and air neonatal transport.

We dedicate time for every senior resident to participate in the week-long Tactical Combat Medical Care (TCMC) course, and ensure graduates are competent in their service-specific operational medical skills and procedures through Army Individual Critical Task List (ICTL) and Air Force Comprehensive Medical Readiness Program (CMRP) requirements.

Throughout the academic year, we provide protected monthly didactic sessions through LEAD 2.0 curriculum to discuss professional and leadership development. Residents can choose electives through the Flight Medicine Clinic at nearby Randolph Air Force Base, or the Aerospace Medicine Primary Course at Wright-Patterson Air Force Base, OH.

In the last month of PGY-3 year, our soon-to-be graduates have a unique Transition to Practice month, entirely focused on transitioning to operational Air Force and Army Pediatrics. As part of this rotation, all our residents complete the Military Medical Humanitarian Assistance Course. They also participate in panels highlighting setting up a military primary care practice and learn nuances of business of medicine to optimize the effectiveness of their future military hospitals and clinics.

Many faculty in our program have had rich experiences in military missions: operational deployments, humanitarian assignments in response to Operation Allies Refuge, vaccine administration missions, medical staff at National Training Center (NTC), MAP assignment to a line unit while at BAMC, Soldier Readiness Unit staff, and prior assignments as flight surgeons or battalion/brigade surgeons.

We train residents daily with mission readiness in mind. We seek out opportunities to enrich critical thinking and staff management with lessons from staff who have served as department/clinic chiefs or flight commanders. We invite discussions and didactic lessons from those who have operational deployments to share with residents and medical students. We work alongside pediatric surgeons in the MTF to coordinate inpatient and outpatient care for shared patients - this exposure to surgical thinking offers a collaborative viewpoint and provides rudimentary familiarization to prepare medical officers to respond to the 11% of combat casualties that will likely be children in the operational setting. We cultivate curiosity and operational planning during daily morning didactics by intentionally asking “how would we manage this patient in a resource limited setting?” As a department and GME program, we aim to build military readiness into the fabric of our culture, and when new opportunities are available, we incorporate those and adjust to fit our pediatric model to build better responses for training exercise, mass casualty events, and humanitarian aid.

Residents must keep up-to-date certifications in Basic Life Support, Pediatric Advanced Life Support (PALS), and Neonatal Resuscitation Program (NRP). Residents will become PALS instructors and complete the PALS Instructor Course during residency. They will also complete S.T.A.B.L.E. Course, the Neonatal Transport Course, the Military Medical Humanitarian Assistance Course, and the Pediatric Fundamentals of Critical Care Skills course. All of these are funded through the hospital.

We have monthly sessions in the BAMC Simulation Center with a structured curriculum going through three scenarios or procedures that align with our monthly academic themes. The Simulation Center offers high fidelity simulations and audio/visual support with trained staff, and our intensive/critical care pediatricians facilitate simulation morning teaching, cases, and codes along with our chief residents. Furthermore, our NICU and PICU rotations routinely include unit-specific simulations in their rotation curriculum, and these are run by our faculty neonatologists and critical care pediatricians.

Simulations also include role-playing scenarios that residents are likely to encounter in patient care and interprofessional work. We include simulations and role-playing tasks related to disclosure training, breaking bad news, iPass/Sign-Out practice, compassionate feedback, peer support training, and resident supervisor training.

Our mission and vision explicitly aim to shape competent medical officers who are eager to embrace leadership responsibilities. Leadership principles are regularly discussed in our educational sessions and intertwined with expectations on all rotations of growing personal ownership of patientcare that rises in responsibility from reporter to interpreter, to manager, to educator.

We discuss professional and leadership identity formation through our LEAD 2.0 Curriculum. Many of our Grand Rounds host speakers who draw on a wealth of medical and military experience to highlight applied leadership in military pediatrics. We invite residents to participate in program administration as representatives for their class on our Program Evaluation Committee and take an active role in program activities such as medical student recruiting, social event planning, wellness committee events, annual resident retreat planning, and end-of-year graduation celebration planning. We encourage residents to seek additional leadership opportunities through the SAUSHEC Housestaff Council and the various SAUSHEC Subcommittees.

Each resident is required to work with our Associate Program Director for Research to design a clinically-focused study or author a case report and create a manuscript that is ready for submission for publication. The Associate Program Director-Research guides residents over the course of training through that process and connects residents with dedicated research mentors. All residents easily meet this requirement, and many enjoy successful publication and presentation of their work prior to graduation.

Residents who demonstrate steady advances in their scholarly work through our biannual Quality Improvement and Research Committee will get 4 hours per month of reserved scholar time which can be used to further their projects (meetings with mentors or collaborators, literature or data review, manuscript drafting, etc.)

Residents can pursue a research elective for four weeks, developed in conjunction with the APD-R, with concrete research goals and objectives, to put considerable concentrated effort into their work.

Avenues for presentation residents have used in the past include:

• American Academy of Pediatrics (AAP) National Conference and Exhibition
• AAP Section on Uniformed Services National Meeting
• San Antonio Military Health and Universities Research Forum (SURF)
• Pediatric Academic Societies National Meeting
• Conference on Military Perinatal Research (COMPRA)
• Society of Critical Care Medicine
• North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)
• SAUSHEC Research Day
• BAMC Patient Safety Week

Residents complete Institute for Healthcare Improvement (IHI) open school certification at the beginning of residency. Each resident is required to work with our Associate Program Director for Quality Improvement and Patient Safety to design a meaningful quality improvement (QI) or patient safety (PS) initiative and present their work to the department at the end of their PGY-3 year. Often, this work is also submitted for publication or presentation as QI/PS research. The Associate Program Director(APD)-QIPS guides residents over the course of training through that process and connects residents with dedicated mentors. All residents easily meet this requirement, and many enjoy successful publication and presentation of their work prior to graduation.

Our program dedicates time every month for department level Patient Safety Review of all patient safety reports from inpatient and outpatient spaces in the department and hosts collaborative discussion about patient safety. Our APD-QIPS coordinates with hospital QIPS staff to provide the Intro to A3 Thinking course in the fall of the academic year. All residents are encouraged to participate in root cause analysis (RCA) courses when available, as well as participate in actual RCAs when they arise.

Residents who demonstrate steady advances in their scholarly work through our biannual Quality Improvement and Research Committee will get four hours per month of reserved scholar time which can be used to further their projects (meetings with mentors or collaborators, literature or data review, creating a presentation, etc.)

Residents can pursue a QIPS elective for four weeks, developed in conjunction with the APD-QIPS, with concrete project goals and objectives, to put considerable concentrated effort into their work.

We have a panel of pediatrician medical officers in leadership positions who host monthly LEAD 2.0 leadership development curriculum, and our mentorship program gives additional opportunity for individualized leadership guidance and career development. Faculty Development sessions through the program and/or institution also aim to give faculty additional training in creating professional learning environments for housestaff. SAUSHEC Subcommittees have resident representatives, and our residents are encouraged to seek out opportunities for participation based on their professional healthcare interests. Beyond our institution, the American Academy of Pediatrics has a Section on Uniformed Services, as well as Uniformed Services East and West Chapters; residents have opportunities to volunteer for junior leadership roles in those organizations.

• Brooke Army Medical Center (BAMC), Fort Sam Houston, Texas
• Wilford Hall Ambulatory Surgical Center (WHASC), Lackland Air Force Base, Texas
• University Hospital, San Antonio, Texas
• Christus Children’s Hospital, San Antonio, Texas
• Methodist Hospital, San Antonio, Texas
• Westover Hills Medical Home, San Antonio, Texas
• Randolph Air Force Base, Texas
• Carl R. Darnall Army Medical Center (CRDAMC), Fort Cavazos, Texas

• Because of high demand for 4th Year Medical Student rotations, we schedule on a first-come, first-served basis. See contact information to schedule a rotation.
• All 4th year student must have completed a basic clinical pediatric clerkship prior to a 4th year clerkship or sub-internship. All students must be on active-duty orders AND/OR have a Memorandum of Understanding (MOU) / Training Affiliation Agreement (TAA) in place between your school and our hospital. 3rd year student rotations not already arranged through the GME office will not be accepted.
• Medical student rotations are typically four weeks in length and can be a mix of inpatient and outpatient medicine (if desired) divided by week. Sub-internships on the pediatric ward, NICU, or newborn nursery are four weeks, are popular, and fill quickly. Rotating medical students on sub-internships should expect to approach intern-level responsibilities by the end of the rotation. Other rotation exposure options include general pediatrics clinic at BAMC or WHASC; Adolescent Medicine at the Jennifer Moreno Troop Medicine Clinic; Genetics; Infectious Diseases; Hematology/Oncology; Cardiology; Developmental-Behavioral Pediatrics; Endocrinology; Gastroenterology; Neurology; and Pulmonology.
• Medical students are expected to come with solid knowledge of history-taking and physical exam skills and fundamental pediatric medical knowledge from prior 3rd year clerkships. Students will be allowed to participate in the care of pediatric patients under the direct supervision of residents and faculty pediatricians. We encourage students to schedule at least one evening, night, or weekend inpatient call on the ward, nursery, or NICU, even if they’re rotating on an outpatient clinic. Each student will present a Visual Diagnosis case during morning didactics to the entire program, and guidance is available from the chief residents.
• During the rotation, our leaders will host a program overview session, tour of the hospital, and tour of our civilian partner institutions, and then host a lunch with residents. Residents host evening social events through the month.
• To schedule a rotation, email: 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-peds@health.mil.

• Interviews are offered during application season from July through mid-October. Each applicant will have three separate interviews: one with the Program Director, one with the service-specific Associate Program Director, and one with the Chief Residents.
• If the student is on an active duty tour, we require Service Dress Uniforms for the Program Director (PD) and Associate Program Director (APD) interviews. If not on an Active Duty for Training (ADT), then Business Formal attire is appropriate. For interviews with Chief Residents, the Uniform of the Day is appropriate.
• Students are invited to come for an in-person one-day interview if not rotating with us. Virtual interviews are offered to students who are unable to come in person.
• To schedule an interview, please contact our program coordinator at dha.jbsa.brooke-amc.list.saushec-peds@health.mil and prepare an updated CV and Letter of Interest.

Program graduates take the American Board of Pediatrics (ABP) General Certifying Examination in October after graduation to become board-certified. This exam is offered annually. For residents who require an extension in training, residents must graduate no later than September 30th to sit for their board exam in October of the graduation year. The ABP’s policy establishes a seven-year limit to the time that can lapse between a pediatrician’s successful completion of training and achievement of certification – after that time, a candidate is no longer board-eligible.

BAMC and WHASC are core clerkship sites for students from Uniformed Services University and University of Texas Health Science Center. Residents frequently have opportunities to teach and supervise 3rd and 4th year students. Our general pediatric clinics commonly host transitional year interns, nurse practitioner students, physician assistant students, and medics in advanced training, all of whom may work alongside resident pediatricians.

Residents are engaged in daily, formal, program-level teaching. Interns are responsible for crafting an hour-long Continuity Clinic lecture with guidance from staff pediatricians. Upper-level residents offer case-based presentations nearly every morning with specific learning objectives and educational pearls and facilitate noon continuity clinic team discussions in general pediatric clinics. PGY-2s are responsible for preparing and teaching Journal Club sessions. PGY-3s are responsible for preparing and teaching Social Determinants of Health capstone sessions. Residents are engaged in daily informal education and “chalk talks” on their rotations with their faculty and other learners. Residents are assessed on their teaching skills and given constructive feedback to polish their public presentation and organization skills. They are also encouraged to join program Faculty Development sessions to build their education, teaching, supervision, and evaluation skills.

Pediatricians are commonly called on to assist with school-based health clinics, parent-focused education classes, and local/regional specialty meetings for non-physicians. When opportunities arise, we aim to give resident pediatricians a platform as rising subject matter experts.

Our pediatric subspecialists are embedded in the subspecialty clinic and inpatient units. Pediatric ward and nursery attendings come from a mixed pool of general and specialist pediatricians. We work closely with our sister SAUSHEC GME fellowship programs (Neonatal and Perinatal Medicine, and Adolescent and Young Adult Medicine) – many of their fellowship faculty are also engaged as residency faculty, and their faculty and fellows commonly teach, train, and supervise our residents.

We have a strong mentorship program that connects residents with faculty mentors in multiple avenues:

• Each class has a faculty Army and Air Force Class Advisor that follows the class over all three years of training and meets monthly with the class for check-ins, coaching, class-specific information, and aggregate feedback to the program. Class advisors also check-in on residents when they’re rotating on nights or away rotations.
• Each resident is paired with an individual faculty or fellow mentor in the program, based on the mentor’s interests and skills, and chosen by the resident from our mentoring catalog. Mentor/mentee pairs meet periodically and are encouraged to create specific mentoring goals.
• Residents are strongly encouraged to seek out multiple mentors for different aspects of personal and professional development – many faculty are available to be mentors for research, clinical skills, military career development, operational experiences, and family balance.

Our curriculum is run by a wellness committee made up of residents and chief residents. We have monthly resiliency morning sessions that focus on personal development around topics of self-care, reducing burnout and compassion fatigue, and developing a growth mindset to embrace the challenges that come in a professional career. Sessions also include sports/field days, teaching kitchen, small group discussions, hands-on activities, advocacy, volunteer work, personality testing, or other activities. Universally, these involve the chief residents and the residents only. Additionally, over the past four years, we have incorporated medical student wellness with weekly gatherings to encourage the inclusivity of the program with visiting medical students.

We continue our long tradition of a program house system. The residents are divided into four smaller houses, with a mix of all training levels. Events within the academic year (research, journal club, noteworthy patient care, etc.) earn house points, spurring fun competition between houses. We also utilize our GroupMe app to have competitions such as fitness challenges and gratitude challenges.

We encourage residents to seek behavioral health support when needed to avoid or mitigate provider burnout and compassion fatigue. We normalize this practice in our program through class advisors, morbidity/mortality conference, and typical case reports. We provide time for resident medical and mental health appointments, and we support self-care and peer-support.

Resident and faculty social outings continue to be strong. We have had citywide resident scavenger hunts after offsite planning meetings; in-person or virtual trivia nights; and social food/drink nights during medical student application season. Residents typically have an annual retreat, Boondoggle, where faculty provide support for inpatient services so all residents can participate over a weekend in teambuilding and wellness activities. The program hosts an end-of-year Roast celebration and farewell to celebrate the graduating residents, as well as Intern Orientation events to support new arrivals in June. Through the year, the Department of Pediatrics hosts staff meetings, holiday parties, and resident appreciation events to build connections between residents, faculty, and department staff.