Mission

WBAMC’s mission is to support Team Bliss and White Sands Missile Range by improving health and building readiness, and to also make extraordinary experiences ordinary and exceptional outcomes routine. The mission of the William Beaumont Army Medical Center’s General Surgery Residency Program is to produce superior, conscientious military General Surgeons who can practice independently in any environment.

Vision

Unrelenting pursuit of excellence as we care for Team Bliss and White Sands Missile Range and those we are privileged to serve. Anytime, Anywhere—Always.

Aims

Our program aims to create the conditions to allow each resident to leverage their unique talents to fulfill the promise of duty and expertise expected of our Nation’s servicemen and women. Our program seeks to demonstrate the following in our graduates:

Clinical Excellence

Residents must possess the knowledge, skills, and attitudes necessary to practice highly effective, safe, and reliable patient care.

Medical Educators

Residents at all levels teach other residents and students. Education in every environment is paramount to what our residents and faculty aim to accomplish throughout residency training.

Scholarship

Our program advances the profession of surgery through scholarship of discovery, integration, application, engagement, and teaching.

Readiness

Military physicians serve dual professional roles, as military Officers and physicians. We train to become a ready medical force prepared to serve those who serve in harm’s way.

Leadership

Physicians must be prepared to lead in modern healthcare organizations. We ensure residents have the clinical experience and expertise to lead as a surgeon in a variety of environments.

• The art and science of General Surgery at WBAMC is passed on through a variety of teaching modalities. These include formal staff and resident lectures, open forum large group teaching conferences, small group ward/Surgical Trauma ICU (STICU) teaching rounds and one-on-one clinical teaching, staff-to-resident and senior resident-to-junior resident in the clinic, on the wards, in the STICU and in the operating room.
• Residents are assigned readings each week from the SCORE curriculum, utilizing This Week in Score (TWIS), which is available online to all surgical residents. TWIS is a sequence of suggested topics over a 2-year cycle. The lectures are designed in such a way to unify and highlight the clinically relevant points of the topic covered.
• Wednesday morning is dedicated to Teaching Conferences. It is the one duty morning in the week which is clear of patient care responsibilities. All mandatory didactic lectures and conferences are scheduled on Wednesday to permit residents, regardless of rotation, an opportunity to participate.
• Throughout the week, there are additional education opportunities:
  • Monday, Tuesday, Thursday, and Friday: Residents, medical students, and staff hold morning report, reviewing previous day’s admissions and discussing treatment plans.
  • One morning per week: interns and medical students participate in curriculum specifically designed to augment their educational experience and technical ability.
  • Rotating basis: There are also scheduled presentations on Trauma-Critical Care topics and Journal Club articles.

Resident rotations take place at the primary home institution and a variety of military and civilian partner sites. We understand the challenges that occur when residents are away from their families, friends, and peers for extended periods and try to mitigate those through reasonable accommodation of time off requests, use of elective rotations, and more. Training to complete minimum standards as outlined by the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Surgery (ABS) require that our residents travel to sites that are best suited to accomplish those requirements. Residents on rotations away from WBAMC receive financial support for travel (flights or mileage), lodging, meals & incidental expenses.

Available electives:

• Plastic Surgery
• Cardio-Thoracic Surgery
• Trauma/Critical Care
• Vascular Surgery
• Pediatric Surgery
• Burns Surgery
• Community General Surgery
• Colorectal Surgery

Additionally, alternate/unique elective requests are considered by the Program Director on a case-by-case basis. Factors considered include sufficient advance notice to permit implementation of institutional training agreements and program level agreements, educational rationale for the rotation, support/vetting of rotation faculty, budgetary constraints, and more.

• Frequency of call for PGY-1 averages every fifth night.
• PGY-2 and three residents cover call two weekends per month and are free from clinical duty two weekends per month while on a surgery service at WBAMC.
• Chief and senior residents take home call on average of every four nights and are given two weekends per month completely free from clinical or call duty.

Combat Casualty Care Course (C4)

All PGY-1 residents attend the Combat Casualty Care Course (C4). C4 is a continuing medical education program designed to enhance the operational medical readiness and pre-deployment trauma training skills of tri-service, medical officers. Training includes a 3-day course designed to enhance medical readiness of physicians, physician assistants, nurses, dentists, and other medical specialties by providing training in field leadership that prepares medical officers with the knowledge critical in conducting Role I and Role II health care operations in an austere, combat environment.

Students progress through the phases of Tactical Combat Casualty Care (TCCC):

• Care Under Fire
• Tactical Field and Tactical Evacuation Care
• Roles of care
• Point-of-injury to Role II scenarios
• Lanes simulate mission-oriented medical scenarios of Village Stability Operations, Mass Casualty events,
• Military Operations on Urban Terrain, and a simulated Role II facility utilizing simulator technology.
• Students encounter combat scenarios in varying roles of leadership and team organization and participate in the planning, rehearsals, and execution of the medical mission.

After successful completion of C4, students receive the National Association of Emergency Medical Technicians TCCC Certification. The NAEMT TCCC course is the only TCCC course endorsed by the American College of Surgeons.

Transition to Practice Course

Introduces residents to many aspects of military life as a health care provider. This course is provided prior to graduation and encompasses a variety of military-specific topics.

Military unique curricular didactics

Topics related to military finance, physical profiles (MedPros), medical retention standards, evaluation boards, and more.

Cadaver and labs

Provided to facilitate hands-on training in support of didactic lectures related to military trauma and battlefield injuries.

• Residents are required to attend training and maintain certification in Basic Life Support (BLS), Advanced Life Support (ALS), Advanced Trauma Life Support (ATLS), and Pediatric Advanced Life Support (PALS) throughout residency.
• Mandatory training related to service in the Armed Forces and regulatory requirements of patient care environments is necessary periodically. Many of those sessions require attendance at face-to-face training, others are available in an online format.
• Senior residents attend Advanced Surgical Skills for Exposure in Trauma (ASSET+) Course. ASSET uses human cadavers to teach surgical exposure of anatomic structures that when injured may pose a threat to life or limb. The one day cadaver-based course follows a modular, body region approach. Each section begins with a short case-based overview, followed by a hands-on exposure performed by students under the guidance of faculty.

WBAMC has a state-of-the army simulation center that is always available to residents and faculty. Procedural techniques are developed with use of surgical simulation laboratory and curriculum to ensure basic competency prior to operating on patients. The General Surgery Residency Program uses the simulation center as part of its didactic program throughout residency training. Common examples of the use of simulation include critical care and trauma scenarios and procedural skill training, including common clinical and surgical procedures such as:

• Knot Tying, Basic Suturing
• Central line and arterial line placement
• Ventilator basics
• Chest tube placement
• Lumbar puncture
• Percutaneous Endoscopic Gastrostomy (PEG)
• Laparoscopic skills
• Ultrasound

The American Board of Surgery mandates, as a residency graduation requirement, successful completion of Fundamentals of Laparoscopic Surgery (FLS), Fundamentals of Endoscopic Surgery (FES), 100 basic laparoscopic procedures, and 75 advanced laparoscopic procedures. Use of simulation trainers plays a key role in preparation for the FLS and FES examinations. WBAMC GME and the residency program purchase and provide testing vouchers for FLS and FES at no-cost to the resident.

The program provides opportunity for residents to develop leadership skills throughout residency training. These opportunities range from formal lectures to small group discussions to experiential learning. Opportunities with increasing levels of complexity and responsibility are nurtured in a progressive nature. Some examples include:

• Opportunity to lead surgical team on a regular basis
• Opportunity to participate in and lead committees
• Quality improvement projects

Residents in research year are encouraged to apply for and attend the Army Medical Department (AMEDD) Captains Career Course(CCC). CCC is an Officer Advance Course (OAC) taught at Fort Sam Houston, Texas that provides graduate level leadership training for Officers in the AMEDD. The AMEDD Captains Career Course is designed to train officers to lead company or equivalent-sized organizations and serve successfully in U.S. Army staff positions. Graduates are prepared for subsequent assignments by learning the leader, tactical, and technical tasks, including the supporting knowledge and skills necessary to support joint operations across the full spectrum of military operations.

• Residents currently perform a research year between their PGY-1 and PGY-2 years, exceptions for special circumstances are approved by the Program Director
• Residents are required to participate in research endeavors throughout residency training, even those who do not participate in a formal research year.
• A minimum goal of one submitted manuscript for publication and/or podium presentation at a regional or national conference is the program standard.
• At the beginning of each academic year, a formal discussion of ongoing research projects is performed by the Research Director with all residents actively involved in research. Plans for future projects are discussed.
• Research Director and/or staff mentors guide residents through the research process. Residents are encouraged to meet regularly with staff preceptors for advice and to learn: formulation of experimental design, project development, data analysis, statistical methods, and use of information technology in research. Follow-up meetings are scheduled to ensure that residents are actively participating. Research progress is reviewed at regular intervals.
• Research topics are periodically discussed at Journal Club meetings.
• Residents are encouraged to submit abstracts for consideration to academic meetings and conferences. WBAMC GME and the residency program provide financial support to residents to present their scholarly work at academic meetings and in peer-reviewed publications.
• Opportunities are afforded to present research and data to residents and staff for critical evaluation and research education.

Our program strives to provide highly reliable, safe, and effective care for our patients while providing high quality medical education for learners who train in our institution. We practice a continuous quality improvement lifecycle to meet these goals and we aim to instill these habits in our trainees.

• Residents are assigned to numerous hospital-level committees including the process improvement committee, the GME process improvement subcommittee.
• Alternating residents participate in risk management meetings.
• Residents participate in root-cause analysis cases, including resident performing in leadership roles in root-cause analysis cases where they have the opportunity to brief findings to the hospital command team.
• All residents participate in weekly department morbidity and mortality conference, where each case has an educational and patient care improvement focus.

Graduates of WBAMC General Surgery Residency Program are highly sought after for assignments across the Department of Defense and the Defense Health Agency, including leadership and command roles. Our residents/graduates have been highly competitive for fellowships in many specialties including trauma-critical care, surgical oncology, vascular surgery, plastic surgery, and others. Residents training in our program have the advantage of working with and developing professional relationships with subspecialty programs at WBAMC and at our civilian partner sites, expanding their medical knowledge base as well as their network of support and mentorship.

The program provides funding opportunities and support for residents to perform, publish, and present research and scholarly work. Residents have typically been able to attend at least one professional conference during residency with many trainees attending more than one conference over their time in training. Our residents have given national lectures, research, and clinical podium presentations for organizations such as the American College of Surgeons (ACS), Society of Gastrointestinal and Endoscopic Surgeons (SAGES), and others.

Primary institution:

•  William Beaumont Army Medical Center, El Paso/Fort Bliss, Texas
  

Partner Institutions:

• Sierra Providence Health Network (The Hospitals of Providence), El Paso, Texas
• Hospital Corporation of America (HCA), Del Sol Medical Center, El Paso, Texas
• HCA, Las Palmas Medical Center, El Paso, Texas
• El Paso Children's Hospital, El Paso, Texas
• Texas Tech University of the Health Sciences – El Paso (University Medical Center), El Paso, Texas
• Evans Army Community Hospital, Fort Carson, Colorado
• Chandler Regional Medical Center, Chandler, Arizona
• John Peter Smith Hospital (Tarrant County Health District), Fort Worth, Texas
• Methodist Specialty & Transplant Hospital, San Antonio, Texas
• Valleywise Healthcare (Arizona Burn Center), Phoenix, Arizona
• Brooke Army Medical Center (U.S. Army Institute for Surgical Research), Joint Base San Antonio, Texas

• Whether rotators are civilian, Uniformed Services University of the Health Sciences (USUHS), Health Professions Scholarship Program (HPSP), Physician (MD/DO), or Physician Assistant (PA), we want everyone to have an educational and rewarding experience while rotating at WBAMC.
• Rotators will be assigned to one of two General Surgery teams (East or West) or the Vascular Surgery team (changing teams is possible if rotation duration permits).
• Rotators can be afforded the opportunity to observe or participate in surgical subspecialty care, however experiences will vary based on case availability.
• Rotation requests may be submitted within 12 months of the intended rotation month by sending a request to the email address provided on this webpage. Rotations may require an institutional training agreement be completed, which can take months to draft and obtain all signatures. It is highly advised to plan early to allow for administrative delays.
• Rotators who have requested information or submitted documents to WBAMC GME and have concerns or additional questions are encouraged to call the residency program at 915-742-0730 for assistance.
• Rotators who are not on Active-Duty Training (ADT) orders can ask to utilize free on-site sleep rooms while at WBAMC. The rooms are provided free-of-charge for non-ADT students. Rooms contain a bed, desk, chair, refrigerator, microwave, and linens. Some have shared restroom areas, while others have an individual space. Rooms are convenient, clean, and safe. Reservation requests are on a first-come, first-served basis by coordinating with the WBAMC GME Office.
• Rotating students are limited to an 80-hour workweek (averaged over 4 weeks) as required by our accrediting body. Rotators will have at least one day off in seven (averaged over four weeks). Flexibility of schedule can be used when interesting cases or exceptional educational opportunities present. Rotators are encouraged to monitor hours and communicate concerns to their assigned team leadership.

General Recommendations for Student Rotators

• Integrate into the surgical team.
• Follow individual patients throughout their hospital stay.
• Ask questions regarding patient management.
• Be enthusiastic!
• Make an effort to be present in the operating room to see the induction of anesthesia, preoperative preparations, and the performance of surgical procedures.
• Volunteer to write history and physicals, brief op notes, post-op orders, progress notes, and to present patients on morning or afternoon rounds with the approval of the team’s Chief Resident.

Student Responsibilities

• Attendance is required at: all lectures and educational conferences, including morning report and skills laboratory (intern curriculum sessions and cadaver lab)
• Notification to assigned team and program office in case of illness or emergency that precludes student’s timely arrival or presence during rotation.
• Academic presentation - a 5-minute professional talk, focused discussion, and PowerPoint presented during morning report on a subject of rotator’s choice related to surgery. The goal is to assess student’s ability to present a topic in a concise manner.
• Mid-rotation feedback session with Clerkship Director (at or near midpoint of rotation)
• End of rotation feedback with Clerkship Director (during final week of rotation)
• Recruitment interview with Program Director (HPSP and USUHS only) (after academic presentation)

In-Person Rotators

• We welcome HPSP 4th year and USUHS (3rd and 4th year) students to schedule rotations with our program. A final outbrief and interview with the Program Director during the final scheduled week are required for HPSP and USUHS rotators. Rotators will be asked about rotation experience at WBAMC, future training goals, motivation for pursuing surgery, and more. The purpose of this discussion is to ascertain if students are interested in matching at WBAMC and joining our program (and the reverse from the program’s perspective) or if they are be more interested in being at another training location for a variety of reasons. All surgery programs in the Defense Health Agency provide exceptional outcomes and tremendous educational experiences for their trainees, so we support applying (and hopefully matching) to the location of the student’s choice.
• We encourage rotators to have individual discussions with faculty, residents, and staff as schedules permit. Those conversations are often highly informative. Because our faculty have trained and worked at many military and civilian medical facilities, they can offer unique insights and provide advice about locations, the match process itself, life during residency, military obligations, and more.

Remote Interviews

• We are happy to assist with scheduling one or more remote interviews for candidates, whether by telephone or via Zoom or MS Teams link. We have historically done remote interviews late in the recruitment season, but feel free to contact us at any time. We will add requests to our contact list and reach out when our interview schedule is available.

• In preparation and practice for the General Surgery Qualifying Exam, all residents take the American Board of Surgery (ABS) In-Training Exam (ABSITE) annually at no-cost. The program purchases testing vouchers and conducts the exam at WBAMC on the last Saturday in January each year. Residents who are at rotations away from WBAMC will be provided with contact information for a program at or near their rotation location where the test can be administered to them.
• Successful completion of both the General Surgery Qualifying Exam (GSQE) and General Surgery Certifying Exam (GSCE) is required for board certification in general surgery.
• The GSQE is an eight-hour, multiple-choice exam held once per year on a single day in July at computer-testing centers across the U.S. Application deadline is in May, dates vary.
• The GSCE is an oral exam consisting of three consecutive 30-minute sessions, and is held twice per year.
• Upon completion of general surgery residency training, a surgeon will have no more than seven academic years following graduation to achieve certification in general surgery, i.e., pass both the GSQE and GSCE. The seven-year period starts immediately upon completion of training. Only one exam opportunity will be offered in each year of the seven-year period. Candidates must apply immediately after training to receive the full number of exam opportunities.
• In select cases, the Program Director has the option to recommend residents to apply for and take the GSQE at the end of clinical PGY-4. As with program graduates, those residents must complete all prerequisites required by the ABS.
• Prerequisite information, testing dates and registration deadlines are available on the ABS Website.

Teaching is required for trainees in our program. Residents have opportunities to practice and hone their skills as educators from the outset of training in both formal and informal settings.

• Senior residents lead surgical teams at many rotations. During those periods, the resident is expected to teach and mentor junior residents as they guide them through preparations for duties in the clinic setting, the operating room, on the ward, and the intensive care unit.
• Chief residents develop and lead American Board of Surgery Surgical In-Training Exam (ABSITE) preparation learning and study activities throughout the month of January.
• Interns and residents teach 3rd and 4th year medical students on wards, in clinic, in the operating room and ICU throughout the academic year
• Residents participate in teaching interns in both the inpatient and outpatient settings throughout the academic year.
• Residents prepare and present a Trauma-Critical Care lecture during each academic year.
• Residents research and present a Journal Club article, then guide the discussion and answer questions regarding the presentation.
• Chief Residents provide ad hoc lectures to junior residents, medical students, and other learners.
• Chief Residents lead cadaver lab or lab activities.

Residents have the opportunity to design and deliver educational sessions in lecture or small group format throughout the academic year. They may be asked to provide lectures for Physician Assistant, nursing, and other staff on surgical topics that are appropriate for their level of training and experience.

WBAMC faculty are trained in the following subspecialists: surgical oncology, colorectal surgery, trauma-critical care, minimally invasive surgery and bariatrics, vascular surgery, plastic surgery, urology, otolaryngology, oral & maxillofacial surgery.

• Residents are encouraged to develop mentor relationships with one or more faculty members at WBAMC or at one of our participating sites. Mentors should be trusted individuals who can provide sound and honest advice and feedback to
  trainees.
• All WBAMC General Surgery Program leadership and faculty have open door policies. Faculty offices are conveniently located in the clinic areas and all are available for consultation or advice.
• The desire of the residency program is to assist residents address personal, military, and professional (clinical) challenges.
• For residents who are identified to be below program standard in any of the Accreditation Council for Graduate Medical Education core competencies, the Program Director assigns a faculty mentor to assist in development of an enhanced study/reading plan or other individualized method to best facilitate success. This mentor will meet with the resident periodically and provide guidance on best practices to ensure resolution and remediation of any issue area.

• Our rotation and duty day schedule has been reworked repeatedly and is now structured to help residents balance the requirements of robust clinical training with reasonable time available outside the workplace.
• Residents are permitted up to 28 days of leave or absence per academic year. Special situations (illness, incapacitation, family planning, etc...) may require flexibility in training and can be addressed directly with the Program Director for consideration.
• The U.S. Army, Defense Health Agency, and our facility provide a wide array of resources for trainees to support their health and wellness including excellent comprehensive healthcare, dental and optometry services, peer support programs, behavioral health resources (including anonymous referral to a non-DOD counselor/provider if requested), financial planning resources, multi-faith chaplain services, and military and family life counseling.
• WBAMC offers a dining facility, a coffee shop, an Exchange Shoppette, and numerous vending options. The program enhances those with a resiliency room space in the clinic area where snacks and more are available at any time. The resiliency room is also a space where residents can close the door to take a brief breather, conduct private conversations, or make personal telephone calls.
• Residents have a personal workspace at WBAMC, either in the resident work room (located in the Admin Building) or in the Chiefs’ offices in General Surgery or Vascular clinics.
• Residents have access to lockers or cabinets in which to store their personal items securely.
• Residents have access to refrigerators and microwaves for use in storage and reheating of personal food and beverage items.
• Each clinic space offers a dedicated area where teams huddle while seeing patients in clinic to review treatment plans, consult with faculty, review online information, complete notes, and more.
• Residents are provided with a laptop computer, monitor and other equipment to permit easy access to Genesis (DHA’s electronic medical record system) and other online resources.
• Residents can request a government cell phone which can permit remote access to email and other information services.
• The Department of Surgery purchases surgical loupes for residents upon arrival at WBAMC. While the loupes remain the property of the U.S. Army, they remain with the surgeon throughout his/her career and are provided free-of-charge.
• The program purchases and provides resident and faculty access to the SCORE curriculum and TrueLearn question bank. Other online educational and research resources are available through the WBAMC Medical Library also.
• Residents are provided with scrubs, lab coats or cover gowns, and other personal protective equipment as needed. Items are furnished by the institutions where they work, WBAMC and our partner facilities.
• Residents gather on Wednesday mornings to do physical activity in some form. This is often team sports or similar.
• During months with 5 Wednesdays, residents and faculty get together for a team-building experience on the third Wednesday. Activities can range from paintball to horseback riding, pickle ball to painting and typically include a group meal. Research residents make reservations and other arrangements. Nearly all residents are released from patient care responsibilities on those dates to ensure maximum engagement.