Mission

Develop premier general surgeons with technical proficiency, excellent clinical judgment, and leadership skills in service to the country.

Vision 

Top-tier leaders in combat casualty care and education. Clinically and technically excellent military surgeons, prepared to provide excellent surgical care in any environment.

Aims

• Develop surgeons that are capable of independent competent surgery in the deployed and garrison setting 
• Develop leaders that will shape surgical care during future conflict 
• Provide the military and the US with highly trained general surgeons ready for independent practice or extended training in fellowship 
• Promote military relevant surgical research to help save lives on the battlefield or humanitarian missions

All Residents

Monday: *Main Academic day*

• Surgical Council on Resident Education (SCORE) topic focused didactic
• Morbidity & Mortality (M&M)
• Mock orals/simulation
• Breast Cancer Tumor Board (BC4)

General & Vascular Surgery Teams

• Tuesday: Cold Case Conference-preoperative conference with mock orals component
• Wednesday: SCORE topic didactic, A team robotics lab
• Thursday: Surgical Oncology Tumor Board or Multi-disciplinary Conference
• Friday: Patient Care Conference or Technical Skills Conference

Trauma Surgery Teams

• Every morning 7 days per week: Morning Report-review all overnight calls and films, discuss complex patients
• Thursdays: Monthly Trauma Skills Labs

Research Year

No clinical duties required, does help with backfilling some calls if other residents have leave or emergency situations. Research resident may participate in military unique opportunities such as humanitarian surgical missions.

Abbreviations

UTHSA = University of Texas San Antonio

Elective Rotations are set up for preliminary surgical interns to prepare them for future medical career field.

• Night Float occurs:
  • PGY1: 2 blocks
  • PGY2: 2 blocks
  • PGY4: 1 block
  • PGY5: 1 block of night call Sunday-Thursday

• Emergency General Surgery (EGS) will cover daytime Emergency General Surgery Call Monday-Friday and 24-hour Trauma/Emergency General Surgery call every Friday night
• Trauma Blue & Green Teams will alternate admitting service 7 days per week and cover a 24-hour call every Saturday night (alternating weeks on Blue/Green)

Throughout the year there are presentations on faculty experience in an austere environment. There are also opportunities to participate in Army and Air Force Surgical Missions. We have sent residents to Honduras, Dominican Republic, and Ghana. These missions have flexibility and typically occur during the research year.

• PGY1: Advanced Trauma Life Support (ATLS) will be taken during June orientation
• PGY3: Advanced Surgical Skills for Exposure in Trauma (ASSET) will be taken at the end of Post Graduate Year (PGY) 3 in preparation for PGY4 Trauma chief year.
• PGY5: ASSET + will be taken during PGY5 year

Our program has a robust simulation program and includes the following: 

• Robotics Curriculum
• Open Skills Curriculum
• Fundamentals of Laparoscopic Curriculum
• Fundamentals of Endoscopic Curriculum
• General Surgery Cadaver Curriculum
• General Surgery Simulation Curriculum
• Trauma Skills Cadaver Curriculum
• ASSET & ASSET +

Our program values leadership and offers multiple opportunities throughout residency including: 

• Lead 2.0 implemented throughout the year
• Mentorship Curriculum for PGY1 & 2: 
  • Chief Resident (PGY5) Leadership roles with Faculty Mentor
  • Administrative Chief Resident-Air Force Associate Program Director mentor
  • Academic Chief Resident-Army Associate Program Director mentor
  • QIPS Chief-QIPS Assistant Program Director mentor
  • Recruitment and Wellness Chief- Program Director mentor
  • Simulation Chief-Simulation Assistant Program Director mentor
• Mentorship Program for Research Residents

Our residency program has created a robust research curriculum with exceptional research opportunities including:

• Established funding sources for research through the Institute of Surgical Research and 59th Medical Wing
• Established labs with focus in Surgical Oncology, Vascular Surgery, Trauma, Critical Care, Burn, Plastics and Reconstructive Research, Surgical Quality Outcomes and Surgical Education
• Residents conducting research at the University of Texas Houston Postdoctoral research fellowship in Cardiothoracic Surgery, Extracorporeal Membrane Oxygenation (ECMO) at Columbia, Pediatric Surgery at University of California at Davis.

If a resident has a significant interest in research that would benefit their ability to match into a competitive surgical fellowship, a two-year research year is an option with respective military service branch approval.

Education: 

The weekly Trauma Quality Improvement (QI) coordination meeting happens and the Trauma Chief resident plays a crucial role in preparation. There is a weekly Morbidity & Mortality (M&M) conference in which residents present two cases weekly. The residents in their professional development year are now sitting on the Quality Improvement Patient Safety (QIPS) subcommittee with two in chair positions for working groups, they are each participating in a QIPS elective to lead their own project. The disparities working group now has a surgical resident representative with hopes to expand focus on disparities projects.

Notable Current QI Projects:

• Radiation Safety – Monitoring of all general surgery residents for radiation exposure and is collecting data on the dosage and adherence to monitoring. There is a change in the physical workspace and education as a result. There are plans to expand this initiative to other residencies.
• Multidisciplinary limb salvage – Multiple residents participate in an interprofessional and multidisciplinary collaboration targeting improving care pathways for diabetic foot wound patients in the institution in partnership with orthopaedic surgery/undersea and hyperbaric medicine/infectious disease and expanding to emergency medicine.
• Increase of Abdominal Aortic Aneurysm (AAA) screening – Multiple residents auditing adherence to guidelines and capturing appropriate patients for screening in surgical clinics with opportunity to expand to partner with primary care providers.

QI Awards:

• A PGY-5 resident received a Restoral grant to develop and implement a robotic surgery training curriculum – improving patient safety with robotic surgery.
• A faculty member was a finalist for the QIPS Faculty of the Year.

• PGY1: Advanced Trauma Life Support during Orientation
• PGY3: Participation in ASSET
• PGY6: ASSET + 

• Fort Cavazos General Surgery & Gastroenterology
• University of Texas at San Antonio Health System Vascular, Transplant and Trauma ICU
• Colorectal Associates
• General Surgery Associates
• San Antonio Pediatric Surgery Associates
• Dell Seton Cardiothoracic
• North East Methodist Acute Care Surgery

To apply for MS4 sub-internship as an interview rotation please contact: dha.jbsa.brooke-amc.list.saushec-surg@health.mil and include a CV and personal statement.

If you are on rotation an interview day will be scheduled. If you would like a virtual interview, please contact dha.jbsa.brooke-amc.list.saushec-surg@health.mil.

Program graduates take the American Board of Surgery (ABS) certifying and qualifying examination to become board certified. The qualifying exam (written) is offered annually in July and the certifying (oral boards) is offered virtually in October. The qualifying examination (written boards) has an option to be taken following the PGY4 year and we support this option for SAUSHEC residents. To become fully board certified, applicants are eligible to take board certification exam seven years following graduation. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the American Board of Surgery.

There is graduated responsibility as the resident progresses through the program.

• PGY1: will be first call for floor calls
• PGY2-4: function as mid-levels and will take first call on consultations from the Emergency Department and inpatient consults
• PGY5-6: function as the team leader of their respective teams
• PGY6:  final year residents also have roles as chief residents 

Our program offers several chief resident roles including:

• Administrative
• Academic
• Quality Improvement and Patient Safety
• Wellness and Recruitment
• Simulation

Residents will give presentations during morning report throughout the year.

• Pediatric Surgery
• Surgical Oncology
• Vascular Surgery
• Minimally Invasive Surgery
• Cardiothoracic Surgery
• Colorectal Surgery

The program has a formal mentorship program for PGY1 & 2 residents as well as research mentors during research year.

Our program established a chief resident role for Wellness committee in our program. Monthly events are hosted throughout the year as well as weekly events during the medical student interview season.