Mission

The SAUSHEC Transitional Year Program's mission is to provide the clinical experience, educational resources, and support that produces exceptional general medical officers and specialty residents who engage in the ethical and compassionate practice of medicine in military health care settings.

Vision

Across a variety of clinical experiences in the Defense Health Agency’s premier center for graduate medical education, SAUSHEC Transitional Year Residents hone their medical knowledge and practice to become competent and confident military healthcare system physicians who graduate to serve in general medical officer or categorical residency settings.

Aims

• Develop general clinical knowledge and procedural competence with a wide range of patient acuity.
• Produce competent physicians and military leaders capable of serving as a general medical officer or resident.
• Provide the highest level of clinical care with a continuous focus on patient safety and quality improvement.
• Generate an inclusive workplace where all members are respected and function as a team to achieve the mission.
• Foster resilience through healthy work-life balance, self-reflection, and professional development that will guarantee the longevity of our mission into the future.

The TY program has dedicated, protected program time for one afternoon each month, in which residents are excused from clinical duties to meet with their program leadership and have TY-specific education. The dates/times of these meetings will be provided at the beginning of the academic year. Each meeting will be comprised of a program meeting followed by didactics: medical, professional, and military topics. In addition, this is an opportunity to share experiences, troubleshoot issues, and learn from each other.

TY residents are also expected to attend resident didactics provided in each rotation they complete, as well as institutional grand rounds.

There are also two offsite retreats during the year (typically November and May). During this time, residents, and the Program Director (PD)/Associate Program Directors (APD) discuss issues with the program and areas for improvement as well as focus on team-building activities followed by time for resident-directed fellowship with family members encouraged to participate.

The Transitional Year Program consists of 12 months of training divided into 13 rotation blocks which each last four weeks. The immediate below list comprise the core seven rotations for all TY interns:

• Medical Intensive Care Unit (1 block): Caring for critically ill hospitalized patients.
• Internal Medicine Ward (2 blocks): Caring for hospitalized adult patients. (Ophthalmology Preliminary residents complete 1 block)
• General Surgery (1 block): Care of Trauma patients with surgical disease.
• Emergency Medicine (1 block): Ambulatory care of patients presenting to the emergency department with a required minimum of 140 hours of emergency experience.
• Pediatric Outpatient Clinic (1 block): Ambulatory care of sick/well children.
• Family Medicine or Ambulatory Medicine Outpatient (1 block): Ambulatory care of patients of all ages and minor procedure training.

Transitional Year Residents also complete additional elective rotations. See elective list below for opportunities.

• Allergy and Immunology
• Anesthesiology
• Burn Intensive Care Unit (Burn ICU)
• Cardiology
• Dermatology
• Endocrinology
• Otolaryngology (ENT)
• Gastroenterology
• Hematology/Oncology
• Infectious Disease
• Interventional Radiology
• Neurology
• Neurosurgery
• Obstetrics and Gynecology
• Ophthalmology
• Pain Clinic
• Pathology
• Plastic Surgery
• Physical Medicine/Rehabilitation
• Psychiatry
• Pulmonary
• Radiation Oncology
• Radiology
• Rheumatology
• Surgical Intensive Care Unit (SICU)
• Urology
• Surgical Specialties (Vascular, Cardiothoracic, Pediatrics, Trauma)

Transitional Year interns follow the typical call schedule for categorical interns on each rotation. There is little to no overnight call for interns at SAUSHEC. TY interns do not participate in “night float” rotations. However, there are scheduled night shifts during the Emergency Medicine rotation.

Transitional Year interns are trained in a broad range of clinical experiences which serve to qualify them for licensure and proceed to either further specialty residency training or assignment as general medical officers in the Army or Air Force. These unique experiences expose them to a wide range of patient demographics representative of the active-duty population as well as the dependents of active-duty members. They are exposed to a wide variety of trauma cases at initial presentation and following stabilization as inpatients, which prepare them for the deployed environment. They are also exposed to pre and post deployment evaluations during outpatient rotations at the Troop Medical Clinic or Air Force Flight Surgery Clinic. Experiences in Adolescent Medicine, Ophthalmology Clinic, Gynecology Clinic, Family Medicine, and Troop Medicine or Flight Surgery Clinics provide robust outpatient preparation for general medical officers’ future clinical experience. The MUC is woven into academics as well through the professionalism curriculum, journal club, and sessions led by physicians with personal experience in military-unique environments.

All TY residents complete the Institute for Healthcare Improvement Basic Curriculum as well as American Red Cross Basic and Advanced Life Support certifications.

All TY residents participate in a clinical procedure course with simulated exercises during intern orientation. Residents participate in team response and individual tasks on their respective rotations (Trauma, MICU, and Emergency Medicine) when these are part of the schedule.

There are multiple opportunities for interns to take on leadership roles within the program and hospital. At the beginning of the year, we will elect interns to serve in multiple positions to include: Housestaff Council representative, TY Program Evaluation Committee representative, Off-site coordinator, Work Environment/Work Hours, Research, Wellness, Quality Improvement/Patient Safety (QIPS), Diversity, Equity, and Inclusion, Military Readiness, Simulation, Professionalism, and GME subcommittee representatives.

Interns will complete a single project sufficient to meet the SAUSHEC Graduation Paper requirement. This is a written literature review based on a medical question formulated from a patient encountered or discussed during a rotation. Interns will review the relevant literature and provide at least 3 single spaced typewritten pages of an evidence-based answer to the question. Interns will submit their completed project with a blank evaluation form to the rotation attending at least one week prior to the end of the rotation so its contents can be reviewed, and feedback can be provided.

This requirement may also be satisfied by submitting to the Program Director an academic paper (for example, case report, poster presentation, abstract for oral presentation, or journal publication) prepared during the intern year at least 14 days prior to the deadline.

Each intern will also give a 20-minute presentation on an educational topic of their choosing on at least one rotation (also of their choosing).

SAUSHEC requires Quality Improvement Patient Safety (QIPS) training and performance of QIPS elements in a point-based system for graduation.

SAUSHEC TY QIPS requirements are:

1. IHI Open School Training and Completion of IHI Basic Curriculum – At the start of SAUSHEC GME training, you will complete the IHI Open School Basic Curriculum.
2. Morbidity and Mortality (M&M) – A QIPS Presentation. Morbidity & Mortality (M&M) is a tool designed to teach and evaluate the ACGME core competency of systems-based practice (SBP). Mistakes and unforeseen outcomes while practicing medicine will always happen. It is important for new physicians to understand that mistakes happen, admit the mistakes that occur in patient care, their roles in the event, realize how mistakes occur, and use lessons learned to make sure they and others do not repeat the same mistake again. Each intern will prepare a presentation outlining their role in a medical error, near miss, or unforeseen outcome and an analysis of this mistake. This will be formally presented to the group during designated didactic meetings.

TY Interns at SAUSHEC are encouraged to participate in professional development activities offered locally that interest them. Examples include the SAUSHEC Root Cause Analysis Course, Peer Support training, Research training, the Critical Skills for Expeditionary Medicine course, and the Uniformed Services University Military Medical Humanitarian Assistance course.

All TY rotations occur within SAUSHEC, which includes:

• Brooke Army Medical Center
• Wilford Hall Ambulatory Surgical Center
• Jennifer Moreno and McWethy Clinics on Joint Base San Antonio (JBSA) Fort Sam Houston
• Reid Clinic on JBSA Lackland

There are no medical student rotation opportunities as TY is not a clinical department. Medical students who are only applying to the Transitional Year (PGY-1 only) program are encouraged to meet in person or virtually with the Transitional Year Program Director to discuss the program.

Rotation opportunities and scheduling during the first months of the TY program will be individualized for each intern’s career goals.

Medical students who apply to categorical residency programs (i.e., Ophthalmology, Diagnostic Radiology) should apply through those programs and request placement in the Transitional Year internship.

Residents who intend to proceed as general medical officers or are undecided about a specialty are encouraged to apply for a PGY1 position with the Transitional Year Residency. Contact the program directly at dha.jbsa.brooke-amc.list.saushec-ty@health.mil to arrange an interview if you are applying to TY as your only residency.

There is no specialty board examination for the Transitional Year Internship. Transitional Year residents must have a passing score on United States Medical Licensing Exam (USMLE) Step 3/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 3 to graduate from the program.

Interns rotating with medical students are expected to teach in that role. Each intern teaches the program during their Morbidity & Mortality (M&M) presentation. Interns may also participate in extracurricular teaching, if they are inclined or have prior training such as via Medic-X, Root Cause Analysis Course, and life support training.

Can be discussed with the Program Director on an individual basis.

The current TY leadership team is comprised of physicians with training in Internal Medicine/Infectious Disease, Pediatrics/Adolescent Medicine, and Gynecologic Surgery and Obstetrics/Surgical Oncology.

Core Faculty for the Transitional Year include physicians trained in General Surgery/Trauma, Dermatology, Ophthalmology/Plastic and Reconstructive Surgery, Pediatrics, Family Medicine, Diagnostic Radiology/Neuroradiology, and Emergency Medicine.

Each intern is assigned a TY program leadership member as an advisor at the start of the academic year. Additionally, the Program Director will make any requested introductions between an interested intern and another Program Director or program of their choice. Interns interested in Quality Improvement Patient Safety (QIPS) may work directly with the TY Assistant Program Director for QIPS. We also directly link our interns with potential research projects in the Trauma department.

At monthly didactics the residents and program leadership have purposeful time for camaraderie and open-ended question and answer sessions with program leadership to discuss any ongoing concerns that affect wellness and well-being. Questions can be professional or personal in nature. In addition, the program hosts a potluck near the end of orientation for residents and family members/significant others to promote early connections between residents and families. The TY program holds off-site events every Fall and Spring. The Fall event is the Leadership Reaction Course at Camp Bullis, and teams have the chance to work together to solve course obstacles in a relaxing, non-judgmental atmosphere. Following the course, the class convenes for a social event with food and fellowship that includes friends/families if the class desires. The spring off-site allows the residents and their families to celebrate the conclusion of the intern year along with a summative program feedback session from the residents.