Mission

The mission of the SAUSHEC Rheumatology Fellowship Program is to provide the clinical experience, educational resources, and mentorship support that produces exceptional rheumatologists who engage in the ethical and compassionate practice of medicine. The fellowship is focused on educating clinical rheumatologists and teachers prepared to care for all adult patients, with the additional goal of preparing fellows to care for active-duty patients both at home and abroad.

Vision 

We aspire to prepare fellows to be leaders in medicine and professionalism throughout their careers, prepared to practice in any part of the world, dedicated to providing compassionate care based on evidence-based, data-driven, and clinical experiences.

Aims

• Produce competent physicians who will be leaders in rheumatology.
• Educate fellows on the philosophy of lifelong learning.
• Produce compassionate fellows who engage in voluntarism in the local and global community.
• Produce clinical teachers prepared to teach the field of rheumatology to fellows, residents, and medical students.
• Promote and mentor scholarly activity and research in the field of rheumatology.
• Provide training in rheumatologic musculoskeletal ultrasound to enhance the diagnosis and treatment of musculoskeletal conditions.
• Produce military leaders with a desire to serve and protect.

The two-year fellowship requires fellow attendance at the following, scheduled sessions:

Thursday Afternoon 

Rheumatology Review Series

A twice weekly, one hour learning session wherein the rheumatology faculty and fellows (and rotating residents and students) review a specified topic in rheumatology. The Review Series is based on a 2-year schedule of topics that covers the rheumatology basic sciences and clinical sciences.

Journal Club

A monthly academic session wherein the fellows each present a summary and critique of one or more pre-selected journal articles from the rheumatology medical literature.

SAUSHEC/University of Texas Health Science Center, San Antonio (UTHSCSA) Combined Rheumatology Conference

A quarterly, two-hour conference wherein rheumatology faculty and fellows from SAUSHEC and UTHSCSA collectively review clinical cases presented by a fellow from each institution. Each case presentation includes a thorough review of the literature specific to the presented case.

Military Specific

A quarterly, one hour learning session covering military unique and leadership topics.               

Friday Morning

Radiology Rounds

A weekly, one hour conference wherein rheumatology faculty and fellows (and rotating residents and students) review various radiographs, ultrasound, MRI, CT, Nuclear Medicine, and Conventional Angiographic images relevant to rheumatology clinical practice. At least once each quarter, Radiology Rounds includes faculty and fellows from the Musculoskeletal Radiology Department.

Clinical Case Conference

A weekly, one-to-two-hour conference wherein rheumatology faculty and fellows (and rotating residents and students) review inpatient cases. This conference culminates with an evidence-based medicine literature review topic presented by the rheumatology on call fellow, typically related to a recent rheumatology consultation.

Clinicopathology Rounds

A semi-annual, one-hour academic session in collaboration with one or more pathology faculty to review pathology specimens specific to rheumatic diseases. Commonly reviewed specimens include renal, muscle, salivary gland, lung, and skin biopsies. The tissue reviewed is typically biopsied from patients in the care of the rheumatology faculty and fellows.

• Rheumatology rotations are 2-week blocks for a total of 26 per academic year.
• Fellows are scheduled for two half-days of clinic per week during inpatient consult and elective rotations.
• Fellows are scheduled for three half-days of clinic per week during research rotations. Second year fellows see an additional one half-day of musculoskeletal ultrasound clinic per week.
• Off-site refers to pediatric rheumatology rotation with a pediatric rheumatologist outside of BAMC.

Vacation

Taken throughout course of the year when schedule and workload permit. Each fellow may take up to 4 weeks of vacation each academic year during research rotations.

1st Year Fellows

• Physical Medicine and Rehabilitation/Pain Management - 4 weeks
• Musculoskeletal Radiology - 2 weeks
• Orthopedics - 4 weeks
• Introduction to Rheumatology - 2 weeks

2nd Year Fellows

• Pediatric Rheumatology - 6 to 10 half-days

The inpatient service patient load is variable, with several new consultations per week.  The inpatient fellow also sees urgent outpatient consults.  Fellows take inpatient consult calls for two-week blocks at a time.  First year fellows will have approximately 10 blocks, or 20 weeks, of inpatient consults.  Second year fellows will have approximately six blocks, or 12 weeks, of inpatient consults.  Fellows do not remain in-house overnight or on weekends.  Outside of normal duty hours, fellows will answer calls from home and report to the hospital as needed. 

The rheumatology specialty prepares fellows to become experts in non-surgical musculoskeletal medicine and leaders in the military health system.  Our military unique curriculum includes training in the most commonly encountered medical problems in active-duty patients as well as leadership skills needed to become outstanding Air Force officers.  

• Diagnosis and treatment of musculoskeletal problems to include but not limited to tendinitis, bursitis, sport medicine injuries, arthritis, neck pain, low back pain, disk disease, gouty arthritis, and joint infection.
• Musculoskeletal Ultrasound with proficiency to ultrasound small, medium, and large joints for diagnosis and treatment of inflammatory arthritis, infection, rotator cuff/tendon tears, and bursitis.  
• Corticosteroid/steroid injections for soft tissue injuries (ie. tendinitis/bursitis/trigger finger) or arthritis of small, medium, or large joints.
• Medical profiles and medical evaluation board summaries.  
• Leadership and officership lecture series to include military customs and courtesies, deployments, chain of command, promotions, performance reports, and relevant leadership topics presented by senior leaders.

Second year fellows have the opportunity to complete the requirements for the Musculoskeletal Ultrasound Certification in Rheumatology (RhMSUS) during fellowship.  Fellows will see a dedicated ultrasound/procedure clinic one half-day per week. They also have the opportunity to attend one institution funded off-site Ultrasound course.

Our faculty includes several senior ranking officers who have extensive experience deploying to combat zones and on humanitarian missions.  The rheumatology fellowship places an emphasis on developing military leaders, and we incorporate leadership development into our military unique curriculum.  

For the last several years each of our fellows has published at least one article in peer reviewed journals detailing their fellowship research findings.  Fellows have many opportunities to be involved in clinical research, in particular musculoskeletal ultrasound studies, as well as collaborative research with other specialties.

Each of our fellows participate in quality improvement initiatives.  Fellows attend the SAUSHEC Root Cause Analysis course. Subsequently, there are opportunities for fellows to participate in formal institution Root Cause Analyses.  There are many opportunities for involvement on institution-level quality improvement committees.

Our fellows rotate exclusively at Brooke Army Medical Center.

We love having medical students and residents rotate with us in the BAMC rheumatology clinic!  Trainees will gain exposure to a broad range of rheumatologic disorders in the outpatient rheumatology clinic and have the option to participate in the musculoskeletal ultrasound clinic once a week. Based on case availability, trainees will be taught arthrocentesis skills, supervised by faculty. In addition, students and residents can accompany the on-call fellow to evaluate inpatient rheumatology consults. Participation in the twice weekly academic conferences is required.

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-rheum@health.mil. 

Interested applicants are highly encouraged to contact the program to schedule a one-to-four-week rotations. The benefit of rotating with us allows the applicant to spend time with the fellowship, participate in our educational program, and meet with staff and fellows. Formal interviews will take place either virtually or in person, depending on current guidance from the American College of Rheumatology. 

If you would like to schedule an interview with our program, please contact dha.jbsa.brooke-amc.list.saushec-rheum@health.mil.  

Program graduates take the American Board of Internal Medicine (ABIM) rheumatology certification exam. This exam is offered annually.  The information provided on ABIM's website and in ABIM's print publication, Policies and Procedures for Certification.  To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the ABIM by October 31 of the year of examination. Additionally, at the time of application, graduates must be previously certified in internal medicine by ABIM.

Fellows have the opportunity for academic appointment as a Teaching Fellow in Medicine affiliated with the Uniformed Services University of the Health Sciences (USUHS).

Resident and medical student education is an important component of our program, and we have trainees rotate through the rheumatology clinic continuously throughout the year.  Rheumatology fellows have progressive opportunities to teach medical students and residents as they advance in fellowship training.   

All SAUSHEC rheumatology faculty are American board of Internal Medicine (ABIM) board certified in Internal Medicine and Rheumatology.  Two faculty members are Musculoskeletal Ultrasound Certification in Rheumatology (RhMSUS) certified.

Each fellow will have a faculty research mentor work with them on research and quality improvement projects.  Our program also takes pride in mentoring our junior faculty.  We want our fellows and graduates to continue their leadership in rheumatology, whether they are in the military or civilian practice.

We incorporate a monthly wellness activity into our academic schedule.  Some of our favorite recurring wellness activities include potlucks, Arthritis Foundation 5K Jingle Bell Run, therapy dog visits, and coffee conversations!

Additionally, BAMC and Joint Base San Antonio offer a wealth of Well-Being and Mental Health Resources.  These resources are printed and distributed to the fellows.  The program director and faculty encourage fellows to take advantage of free classes and activities (marriage retreats, parenting classes, emotional support, etc) occurring throughout the Joint Base San Antonio region.