Mission

To develop patient-centered Traumatologists and Surgical Intensivists that are leaders advancing evidence-based care for anyone in need.

Vision

For our graduates to be the desired trauma surgeon down-range, at the military treatment facility, and in civilian centers—sought after for guidance, mentorship, and leadership both as clinicians and experts in the system of trauma care.

Aims

Our program aims to focus on the key concepts of Knowledge, Quality and Leadership

Knowledge

The primary aim is to expand surgeons’ knowledge of surgical critical care that are uniquely qualified to serve our combat casualties in austere environments as well as civilians in our community.

Quality

Develop quality improvements in trauma and surgical critical care that will provide for medically optimized care for our wounded warriors and local community using continual performance improvement and quality-based research initiatives.  This evidence-based approach will optimize care for America’s warrior class both at home and abroad while provided local care in our community.  

Leadership

In the deployed environment, strong surgical leadership saves lives.  Our aim is to develop the next generation of surgical intensivist leaders through formal didactics, mentorship, faculty development and local partnerships in both the DoD and local community. (JTS/STRAC).  

Each year of the program is distinct and has unique didactic requirements. First year fellows will participate in the Trauma Institute of San Antonio (TRISAT) consortium didactic lecture series and reading compendium. These weekly multi-institutional lectures feature local physician leaders and experts giving leading fellow level discussions regarding topics within trauma and surgical critical care. Later in the year fellows will develop and give multiple lectures during this series to include individual talks and a pros-cons debate with a co-fellow. The reading compendium is a robust collection of articles and chapters assembled by topic that fellows will be expected to complete by the end of their first year. Additionally, while rotating within the Surgical/Trauma Intensive Care Unit (ICU) at Brooke Army Medical Center (BAMC), fellows will participate and occasionally lead daily noon lectures for the rotating residents. A journal club meets monthly with fellows from BAMC and University Hospital (other Level 1 trauma center in town) to discuss latest interesting journal articles. 

During the second year, fellows will complete the Acute Care Surgery curriculum through the American Association for the Surgery of Trauma (AAST). This offers weekly “Meet the Masters” teleconference series where national leaders and experts in the field hold a teleconference with fellows across the nation to discuss a topic within their field. There is an AAST reading compendium over acute care surgery topics that fellows will be expected to complete during their second year. Fellows will be expected to attend weekly Trauma Process Improvement Committee meetings, monthly Multi-Disciplinary Trauma Committee meetings, and are encouraged to call in for weekly Joint Trauma System teleconferences. 

Abbreviations

ICU = Intensive Care Unit
VA = Veteran’s Administration

The call schedule varies with each rotation and each year. First year fellows will take 12-hour shifts within the BAMC Surgical Trauma Intensive Care Unit (STICU) varying between days and nights.  Occasional 24-hour call shifts on University Hospital and McAllen rotations. During second year the fellows will participate in the staff physician call schedule at BAMC and again take 12-hour call shifts varying between days and nights. For McAllen and University Hospital rotations, 24-hour call shifts may be expected. 

Nearly all aspects of trauma critical care training are military relevant.  Our fellows will be exposed to training that prepares them for deployment trauma readiness. This training includes caring for civilian trauma, burn and Extracorporeal membrane oxygenation (ECMO) patients at the DOD’s only Level 1 trauma center.  Additionally, we have added opportunities for fellows to participate in the South Texas Regional Advisory Council (STRAC) meetings that review systems-level process improvement.  Systems domain knowledge is critical for setting up functional trauma care in a deployed environment.  Encourage participation in weekly Joint Trauma System (JTS) calls that review and discuss current cases that are being cared for in the deployed environment.  ASSET+ is a military adaptation of the American College of Surgeons Advanced Surgical Skills for Exposure in Trauma (ASSET) course that includes a performance evaluation.  This is a requirement for all deploying surgeons in all services.  Fellows are encouraged to not only take the course (which is cadaveric in nature and reviews all major vascular exposures needed in Trauma) as students but to become instructors by the end of their 2-year fellowship.  

• Ultrasound Course
• Continuous Renal Replacement Therapy (CRRT) course
• Extracorporeal membrane oxygenation (ECMO) Course available
• Advanced Surgical Skills for Exposure in Trauma (ASSET +) with potential to become instructor
• Advanced Trauma Life Support (ATLS) with expectation to become instructor

• Monthly animal trauma skills labs for residents and fellows
• Semi-annual opportunity for cadaveric lab

Fellows during both years of training will lead multi-disciplinary teams of physicians and ancillary staff in the emergency room, operating room, intensive care unit (ICU) and hospital wards in the care and acute resuscitation of traumatically injured and critically ill patients. Fellows will be encouraged to interface monthly with the South Texas Regional Advisory Council in developing policies and practices for the pre-hospital care and transfer of those traumatically injured.

As a Level 1 trauma center, the department has an active research component. Fellows are required to be actively involved in at least one research project. Many fellows participate in multiple active protocols and are encouraged to develop new protocols. Fellows will have the opportunity to present at national conferences to include American College of Surgeons (ACS) and American Association for the Surgery of Trauma (AAST).  

Fellows are expected to review and/or develop multiple clinical practice guidelines during their fellowship. Additionally, fellows are expected to participate in at least one Root Cause Analysis committee during their two years. During the second year, fellows are expected to attend weekly Trauma Process Improvement Committee meetings when on the Trauma/ACS rotation.

Fellows have the ability to interact and develop connections with leaders at multiple trauma credentialed hospitals participating in the South Texas Regional Advisory Council. Through interactions with the Joint Trauma System fellows will be able to meet and interact with leaders in the care of combat wounded for the US military and potentially other worldwide military leaders. 

Through Trauma Institute of San Antonio (TRISAT) lectures fellows will interface with experts and leaders at other major trauma centers in San Antonio and Houston. Additionally, through these lectures they will develop lectures and the skills needed to lead a high-level discussion on interesting topics within trauma and surgical critical care. Through the American Association for the Surgery of Trauma (AAST) Meet the Masters lecture series they will have weekly teleconferences with experts and leaders in the field of trauma surgery. 

• Brooke Army Medical Center, Fort Sam Houston, Texas
• University Hospital, San Antonio, Texas
• McAllen Medical Center, McAllen, Texas
• Audie L. Murphy VA Medical Center, San Antonio, Texas
• Peripheral Vascular Associates, San Antonio, Texas

Ample opportunity exists for interested general surgery residents to come rotate at Brooke Army Medical Center on the trauma service or Surgical Trauma Intensive Care Unit (STICU) service. We had recent success with a 4th Year Surgery resident rotating on the trauma team, fulfilling a chief resident role. Other opportunities exist for intern or mid-level residents as well.

For those interested in interviewing for the fellowship, please contact: dha.jbsa.brooke-amc.list.sausehc-surgcc@health.mil.   

Acute Care Surgery/SCC Fellowship Points of Contact: 

• Program Coordinator: 210-916-5371
• Program Director:  210-916-3157

Program graduates take the Surgical Critical Care boards offered through the American Board of Surgery (ABS). This exam is offered annually.  To become fully board certified, applicants are eligible to take board certification exam two months following completion of their first year of fellowship. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the American Board of Surgery by the end of their first year of fellowship.

To be eligible for this exam, applicants must:

• Accredited Program: Have satisfactorily completed a one-year training program in surgical critical care accredited by the ACGME.
• Training Time: Have acquired no fewer than 48 weeks of full-time training in each year of the training program.
• Case Log: Submit a report of your critical care experience during the fellowship for ABS approval. Cases must be from the fellowship and verified by the program director.
• New Case Minimums: New case number requirements were implemented for surgeons who complete training in the 2019-2020 academic year and thereafter. These surgeons will be required to have met the new case requirements by the time of their application to the Surgical Critical Care Certifying Exam.
• Medical License: Have a currently registered full and unrestricted license to practice medicine in the U.S. or Canada.  Applicants are required to immediately inform the ABS of any conditions or restrictions in force on any active medical license they hold.
• Ethics: Adhere to the ABS Ethics and Professionalism Policy.

Ample opportunities exist for teaching with BAMC and most other off-site rotations. Fellows are encouraged to teach and lead a team of residents in both the ICU setting and acute trauma teams. 

• Active Duty and Civilian Trauma / Surgical Critical Care Surgeons
• Multiple Medical Intensivists
• Neuro-Critical Care Intensivists
• Vascular Surgeons
• Neurosurgeons
• Burn Surgeons
• Anesthesia Critical Care Intensivists

Currently the department is piloting a trauma interest group with semi-formal quarterly meetings. In this relaxed setting informal and open discussion will be encouraged. Participants will include students and physicians in all levels of training. Through this setting we aim to develop a semiformal mentorship program to help guide fellows and residents as they begin their careers as surgeons and military physicians.