Mission

To train exceptional musculoskeletal radiologists with top-notch skills as clinicians, collaborators, researchers, educators, and military officers who are prepared to lead radiology teams in garrison and at deployed sites.

Vision

Through continuous innovation, provide a learning environment that achieves or exceeds that of the best civilian musculoskeletal radiology fellowships.

Aims

• Expose fellows to a high volume of musculoskeletal imaging studies coupled with high quality teaching from a diverse cadre of musculoskeletal radiology faculty.
• Introduce fellows to a breadth of image guided musculoskeletal procedures ensuring enough volume to attain procedural proficiency and acquire confidence to teach these procedures.
• Foster interdisciplinary collaboration through fellow attendance and leadership at interdisciplinary conferences and participation in interdisciplinary quality improvement projects and scholarly activity.
• Promote opportunities for the fellow to develop skills as an educator through faculty mentoring and fellow teaching of residents, medical students, and imaging technologists.
• Produce fellows who are exceptional military medical officers through mentoring in areas of resiliency, military readiness, followership, and leadership.

Fellows participate in morning case conference given by one of the MSK faculty with corresponding lecture topics that follow the written curriculum.  A quarterly journal club is performed with journal articles chosen by faculty and presented by fellows during the weekly academic session performed in conjunction with the weekly musculoskeletal imaging conference.  This weekly multidisciplinary imaging conference is performed in conjunction with the Orthopedic Oncology, Musculoskeletal Pathology, and Musculoskeletal Radiology sections of the respective departments.  This conference consists of 15-25 cases that are reviewed for the purpose of triage, surveillance, and management decisions.  Given the high number of bone and soft tissue lesions presented within this conference, it is informally termed “weekly tumor board.” A formal tumor board is also held once per month with a typical full tumor board compliment adding medical oncology and radiation oncology to the discussion of select patients (usually 5-6 patients). Arthroscopy conference occurs every 2-3 months in coordination with the Orthopedic Surgery Department residency program. A Rheumatology conference is also held on a quarterly basis to discuss complex and interesting cases, using a multidisciplinary approach.

Ten months of the 1-year training program are spent on the musculoskeletal radiology services at Brooke Army Medical Center, a military tertiary referral center and level one trauma center, and Wilford Hall Ambulatory Surgical Center, a large outpatient primary and subspecialty clinic which services the Lackland Basic Training Program. There are two months of elective rotation time.

Rotations: 

• Radiographs, Orientation • Procedures, Musculoskeletal Computed Tomography
• Research
• Musculoskeletal, Magnetic Resonance Imaging (3 blocks)
• Procedures, Musculoskeletal, Magnetic Resonance Imaging (2 blocks)
• Spine, Pediatric Radiology, Nuclear Medicine
• Radiographs
• Radiographs, Musculoskeletal, Magnetic Resonance Imaging
• Elective 

Vacation

Each fellow is permitted to take vacation as needed throughout the academic year as long as it does not exceed more than 10 workdays during a given rotation block, with a total of 20 workdays permitted as leave throughout the entire academic year.

There are two months of elective rotation time which can be scheduled on various radiology services such as emergency, pediatric, ultrasound, neuroradiology, interventional radiology, and non-radiology services such as orthopedics, rheumatology, and pain management.

Elective Choices

May be subdivided into mini-rotations:

Site 1

Positron Emission Tomography (PET) and bone scans in nuclear medicine; Musculoskeletal ultrasound with rheumatology; Emergency Radiology time during regular hours or after hours; Pediatric Radiology with Pediatric Radiology service

Site 1 or 2

Image-guided spine procedures in pain clinic; Computed Tomography & Magnetic Resonance Imaging (MRI) with neuroradiology; Procedures in Interventional Radiology; Orthopedic Surgery operating room & clinic time

There is no mandatory call for MSK Fellows.

The fellowship program emphasizes support of the military mission and military health system. Providing imaging services to redeploying wounded warriors, Joint Base San Antonio (JBSA) Lackland military basic trainees and the large Fort Sam Houston military medical training population provides military unique imaging experience. Wartime injuries, military training injuries, musculoskeletal stress injuries and civilian trauma are commonly encountered. Brooke Army Medical Center (BAMC) is the DOD’s only level 1 trauma center and provides exposure to complicated injury patters including penetrating injuries and blunt trauma which simulate many battlefield injuries. The most military-relevant of these traumatic mechanisms of injury include ballistic trauma and high velocity motor vehicle collision trauma. Additionally, BAMC’s status as a tertiary combat treatment hospital provides exposure to imaging and image guided treatment of combat musculoskeletal injuries including blast injury and amputations.  In this vein, the fellow will become familiar with a variety of complex prostheses and reconstructive hardware/techniques.

MSK Fellows complete and maintain Basic Life Support (BLS) certification.

Image-guided interventional simulations are an optional component available during elective time as desired.

Leadership curriculum is reviewed as a part of the military relevant curriculum readings and discussion.  Leadership and officership are also emphasized and evaluated daily in interacting with faculty, colleagues, technologists, and patients. Radiology leadership topics are also discussed quarterly through the use of the American College of Radiology (ACR) Radiology Leadership Institute (RLI) content.

Program requirements include producing a manuscript of publishable quality, which is reviewed and graded by the fellowship Program Director.  This is the only research requirement.  However, we encourage all fellows to participate in annual radiology meetings by presenting Case of the Day, educational exhibits, poster presentations, and/or podium presentations.  Meetings that have been attended in the past include Radiology Society of North America (RSNA) Annual Meeting, American Roentgen Ray Society (ARRS) Annual Meeting, and Society of Skeletal Radiology (SSR) Annual Meeting.

Fellows are required to participate in and write-up a quality improvement/ patient safety (QIPS) project.  The fellow will choose a project and work on the project with at least one of the core faculty members, culminating in a QIPS write-up that is maintained in their portfolio.  Publishing a project in a peer reviewed journal is optional and encouraged, but not mandatory. They may participate in other quality improvement initiatives such as additional projects and root cause analyses.  The Diagnostic Radiology Morbidity and Mortality (M&M) Conference is held monthly and attended by faculty and fellows.

In addition to didactic topics, multidisciplinary conference participation, and journal club presentations, the fellows also have an opportunity to participate in radiology department meetings, are members of the Program Evaluation Committee (PEC) and participate in Diagnostic Radiology resident education and supervision.

• Brooke Army Medical Center (BAMC)
• Wilford Hall Ambulatory Surgical Center (WHASC)

The musculoskeletal radiology section and fellowship are under the umbrella of the Diagnostic Radiology Departments at BAMC and WHASC.  Rotations through the sponsoring SAUSHEC Diagnostic Radiology Residency Program will expose potential resident applicants to the program.  Medical Students interested in scheduling a rotation should contact: usarmy.jbsa.medcom-bamc.mbx.saushec-clerkship@health.mil.

All resident and staff applications from Air Force, Army, and Navy are welcome and encouraged to apply. A component of the Joint Service Graduate Medical Education Selection Board process will include scheduled interviews with the SAUSHEC MSK Radiology Program Director and the applicant’s Service Radiology Consultant. The applicant curriculum vitae should be provided to the Program Director.  An interview may be scheduled through the Fellowship Program Coordinator.  Applicants are evaluated on their professionalism, communication skills, maturity, demeanor, attitude, aptitude for musculoskeletal radiology, and potential for success as a military medical officer. Interested applicants may speak directly with the program director to find out additional details about the academic and experiential merits of the program. Interested applicants may contact the program to schedule an interview: dha.jbsa.brooke-amc.list.saushec-rads-msk@health.mil.

There is no specialty board exam for Musculoskeletal Radiology.

Fellows play an important role in diagnostic radiology resident education. Although always directly supervised, fellows are expected to demonstrate a progressive ability to run the musculoskeletal radiology service. A large part of this is participating in educating residents on interesting cases, approach to exam interpretation, anatomy review, image order protocoling, procedure demonstration, and eventually procedure supervision (with faculty oversight). The fellows are evaluated at every step in a progressive fashion commensurate with their training level/experience.

Fellows will also teach rotating nurse practitioner students, physical therapy students, medical students, rotating interns, and categorical orthopedic surgery interns at the workstation on a regular basis.  The fellows play a significant role in the education of all rotators through the musculoskeletal section.

This is a subspecialty fellowship with the fellow being staffed solely by musculoskeletal radiologists.

Each fellow is assigned a faculty mentor who meets formally with the fellow at least twice per year.  However, the fellow will have direct informal mentoring by all faculty daily.  We are committed to assuring that our fellows succeed, and mentor sessions focus on areas of interest and opportunity that are unique to each fellow experience.

Faculty and fellows meet every 2-3 months to discuss topics related to well-being such as burnout, professionalism, career, finances, and work/like balance.  These typically center around an article or lecture.