Mission

The CRDAMC Family Medicine Residency trains Family Physicians in a supportive team environment, provides evidence-based and patient-centered care to Soldiers, Retirees, and their Families, serves the Army and medical communities, assures wellness for all members of the team, and develops Army Medicine future leaders.

Vision

As the model Army Family Medicine Residency Program, we are the home of choice for patients, residents, students, faculty, and staff. The program develops ready Soldier Family Physicians with the values and abilities to provide medical readiness and outstanding patient care, and to excel in accomplishing the Army’s mission.

Aims

1. Patients: Provide Outstanding patient-centered care.
2. Education: Deliver quality education anytime, anywhere.
3. Outreach: Serve the local community, provide new knowledge to the medical community, and promote our program to students.
4. Wellness: Promote and facilitate physical, psychological, and spiritual wellness, for team members.
5. Leadership: Develop leaders and mentors.

"Patients First, Learning Always"

Morning Report

Monday through Friday from 7:40 to 8:10 a.m. Focused on case presentation for developing clinical reasoning, differential diagnoses, work up and management.

Continuing Medical Education (CME) Conference

Every Thursday from 8:10 a.m. to 12:10 p.m. we have didactic lectures. This varies week-to-week and includes lectures from residents, faculty and/or specialists and is designed to cover core topics for family medicine over the year. It also includes simulation half days (bimonthly), journal club, and longitudinal curriculums focusing on behavioral health, health care disparities, diversity, military unique curriculum, practice management, and professionalism. Quarterly we have a wellness event in lieu of CME conference.

Hospital Grand Rounds

The Family Medicine Residency hosts a monthly Grand Rounds which is the last hour of CME on Thursdays.

Longitudinal Experiences

Surgical Selective Experiences

ENT, Ophthalmology, Urology, Plastic Surgery

Medical Selective Experiences

Cardiology, Pulmonology, Gastroenterology, Neurology, Radiology, POCUS

Electives

The above, Operational Medicine electives, POCUS, plus many more!

Operational Medicine

Can be either a 4-week experience on Fort Cavazos (shadowing operational providers, field exercises, and doing Soldier care) or an elective (Burn ICU, Air Assault Course, Expert Field Medical Badge, Captains Career Course, Tactical Combat Medical Care Course, and more)

PGY2 and PGY3 residents cover inpatient medicine service call on Friday nights, and Saturday (day/night) on a rotating basis. Additionally, they do night float on inpatient medicine for 2-weeks at a time where they cover our inpatient team to include admissions. During night float, residents work 6 nights each week (Sunday to Thursday). All residents do two weeks of nights during their 4-week obstetrics rotation.

Our program has a longitudinal Military Unique Curriculum which incorporates individual lectures, simulation sessions, and other learning events which address pertinent topics throughout the year. All residents have Soldiers on their panel of patients. There is a dedicated Transition to Practice / Military Unique Curriculum rotation as the last block of residency, the first week of which is a capstone field exercise (Joint Emergency Medical Exercise, or JEMX), which is the world’s largest joint military medical exercise. Throughout training, residents will be expected to show, and will receive feedback on, professionalism, military bearing, uniform standards, height/weight/physical fitness standards, and other relevant topics. Residents are active-duty officers during training and are held to the relevant mandatory training requirements of all Soldiers.

Combat Casualty Care Course (C4)

10-day course that covers Tactical Combat Casualty Care (TCCC) topics and ATLS certification, usually done R1 year.

Joint Emergency Medical Exercise (JEMX)

One week course done during R3 year to help residents further prepare for operational medicines.

Life-Saving Certification Classes

Basic Life Support, Advanced Life Support, Pediatric Advanced Life Support, Advanced Trauma Life Support, Fetal Heart Monitoring Course, Advanced Life Support in Obstetrics, Neonatal Resuscitation, STABLE neonatal course

We have formal faculty-led simulation workshops as a group held bimonthly with our simulation center. Additionally, there is inpatient simulation for an hour each Tuesday while on the Family Medicine Inpatient Service, where the team will review life support codes or relevant inpatient procedures.

Leadership Professional Development topics are included throughout the three years of training, including CME lecture series, workshops, and the Family Medicine / Health Systems PGY-3 rotation. Within the residency, talks/discussions are provided longitudinally during academics, including sessions on military unique experiences and professionalism topics. PGY-2 and PGY-3 residents are selected for leadership roles in the residency to include Chief Resident, Continuing Medical Education (CME) Coordinator, Wellness Coordinator, Dining out planner, Officer call planner, Student Experience Coordinator, Physical Training Coordinator. Additionally, residents have the opportunity to participate in Resident Council and other hospital committees, to include the Graduate Medical Education Committee.

As future family medicine attending physicians, our residents will be expected to manage patients’ acute and chronic medical conditions across the lifespan and in several different clinical environments (office visits, inpatient, nursing home, sporting event side lines, and emergency room). It is imperative to develop the ability to critically evaluate the medical literature and apply it in the appropriate clinic settings. This skill will help foster a positive attitude towards lifelong learning which is required in the ever-changing field of medicine.

Scholarly activity is broadly defined (not just randomized controlled trials) to include continuing medical education lectures, leading a journal club discussion, morning reports featuring a well thought out clinical question, case report presentations and write ups, peer reviewed articles, quality improvement projects, and book chapters.

PGY1 Residents

Our PGY1s receive introductory research didactics, evaluating a clinical question, and professional writing for publication. They are required to work with their advisors to select a clinical question, draft and submit a response for publication of Help-Desk Answer to Family Practice Inquiry Network, and present their response as a presentation at CRDAMC Research Day.

PGY2 Residents

Our PGY2s receive didactics on quality improvement (QI) and process improvement (PI) through the Institute for Healthcare Improvement. They are required to plan a QI/PI project to take place that year, working either individually or in teams. They usually will meet the American Board of Family Medicine QI requirement as well. They are required to lead at least one journal club this academic year

PGY3 Residents

Our PGY3s receive didactics on writing case reports. They are required to write a manuscript for a case report and submit an abstract for presentation at a local, regional, national, or international conference.

All Residents

All residents are required to include a clinical question in each of their morning reports and show their literature review of primary and secondary sources and their analysis. They are also required during both PGY2 and PGY3 year to lead a journal club research article review. They are required to achieve at least 10 scholarly activity points throughout the course of their residency which is generally easily achieved through completing the aforementioned required activities.

Each year we have multiple ongoing resident-led team-based process improvement (PI)/quality improvement (QI) projects within our clinic that often include our nursing teams. Additionally, the hospital has a PI/QI committee where residents can be involved with patient safety and improvement initiatives throughout the hospital. Our senior residents also present a patient safety conference at the end of each family medicine inpatient-team or night float rotation to help pass on lessons learned and best practices.

We provide a collaborative and rigorous learning environment that engages students, residents and staff in a dynamic partnership to foster the development of well-rounded Family Physicians through a safe and collegial atmosphere emphasizing evidence-based practice, selfless service, excellence, and professionalism.

We encourage and promote help-seeking behavior, mindfulness, self-awareness through varied educational opportunities and both informal and formal feedback. We view feedback as a gift and encourage that mindset in our residents. We value development of personal well-being, and healthy family and social connections. As such, we work diligently with each resident individually who may from time to time develop scheduling conflicts and we encourage early communication from them including proposed solutions to help us carefully balance their learning needs, patient needs, and their personal and social well-being.

We require our residents to develop individual learning plans (ILPs) the beginning of their intern year and update them annually at minimum in consultation with their assigned advisors and any mentors they have selected. We conduct and mentorship ‘speed dating’ event annually for our resident to foster their select of mentors that can guide them in their desired professional path. Residents are required to self-assess semi-annually where they are with their Accreditation Council for Graduate Medical Education Family Medicine milestones. Our residents meet as often as monthly with their assigned advisors to develop officer evaluation report support forms, decide on future elective rotations, and revise their ILPs.

We understand the high public trust bestowed upon us as physicians and military officers. As such, we must carefully protect this public trust of both professions. We clearly define our standards for professional behavior in our residency handbook. We have a zero-tolerance policy for sexual or physical harassment. Our residents participate in all required equal opportunity, sexual harassment and assault prevention, resiliency trainings provided by our military hospital staff. We have a military unique curriculum and practice management curriculum that provides opportunities to residents to develop their leadership and officership skills.

We enroll our residents in a behavioral health program from which they can opt-out if desired. This includes individual counseling sessions with a qualified practitioner as often as quarterly. The goal is to mitigate stress-related problems before they coalesce into significant psychological symptoms. They are given protected time to attend these sessions.

Finally, we strive to ensure our faculty (both core and adjunct) model appropriate officership and professionalism. As such, we view these assigned roles as a privilege. We screen potential faculty candidates carefully for commitment to teaching, professionalism, and well-rounded experience. We have a formal faculty development curriculum which provides many leadership and academic and scholarly activity development opportunities through live workshops, virtual didactics, mentorship, and scholarly activity opportunities. We require feedback from students and residents for our faculty. We value this feedback and regularly use it to guide our faculty and educational culture towards one that is adaptive to change, responsive to needs, and centered on supporting well-being.

• Brooke Army Medical Center, San Antonio, Texas (Trauma)
• McLane Children’s Hospital, Temple Texas (Inpatient Pediatrics, Pediatric ER)
• Baylor Scott & White Memorial Hospital, Temple, Texas (Urban ER)
• Central Texas VA Medical Center, Temple, Texas (Inpatient Cardiology)
• Additional educational experiences available at: Baylor Scott & White, McLane Children’s, Central Texas VA, BAMC, and CRDAMC for electives

Our program has third-year clerkship rotations for students from the Uniformed Services University. In addition to this we offer two or four-week elective and audition rotations. Students spend the vast majority of their rotation working closely with staff and resident family physicians in an outpatient setting seeing patients of all ages. Students are also exposed to several outpatient procedures (including vasectomies, long-acting reversible contraceptive devices, joint injections, and minor skin procedures), sports medicine clinic, and they typically spend one week on the Family Medicine Inpatient Service (FMIS). Finally, students receive didactic training through multiple modalities: daily morning report, weekly half day Thursday continuing medical education workshops, simulation activities, and lectures by various residents and staff. 4th year students are also required to present a morning report while rotating with us. We also offer a Sub-Internship Rotation and electives in Family Medicine Obstetrics  or Sports Medicine.

Unique Opportunities at CRDAMC:

• Sports medicine workshops
• Point of Care Ultrasound training
• Bucketball Thursday mornings
• Officer Call (social outing) with faculty and residents the last Friday of each block
• Interactions with the Family Medicine Obstetrics Fellows

We genuinely value diversity and equity, and fairness in our interview process. Virtual interviews carry the same weight as in-person interviews and are strongly encouraged for anyone considering Army Family Medicine! We typically schedule in-person interviews towards the end of audition rotations. The interview consists of one with the Program Director and another with a panel of faculty and residents. All interviewees are asked the same questions to ensure consistency.

Family Medicine Residents take the American Board of Family Medicine (ABFM) board exam. This exam is offered twice per year, and family medicine residents usually take it during April of their R3 year. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the ABFM and be on track for graduation within three months of the usual 30 June date for completing residency. For those off-cycle or extended in residency beyond 3 months, there is an exam period in October.

Visit the ABFM website for information about the certification process and board eligibility. Additionally, the ABFM resident resources section has additional information. 

Our upcoming senior residents (PGY2/3s) receive didactics in teaching and leadership to help prepare them to take on roles as supervisors and teachers of junior residents and students. Our senior residents coordinate and run morning reports and Thursday morning continuing medical education (CME) sessions. Our residents have requirements unique to each academic year for conducting morning reports, CME talks, and journal clubs. They are required to work with a faculty member in developing their presentations. We value feedback received by students, especially during exit interviews, and use this feedback to guide our senior residents’ leadership and teaching skills.

We help facilitate our residents who have interest in academic and health care leadership in attending optional in-person faculty development rotations hosted by Uniformed Services University of the Health Science (USUHS) at CRDAMC, and virtual leader and educator development rotations hosted by Madigan Leader and Educator Development Fellowship.

Currently family medicine faculty within the residency have the following subspecialty training:

• Hospitalist
• Sports Medicine
• Point-of-Care-Ultrasound
• Obstetrics
• Faculty Development
• Geriatrics

Additionally, we also have a clinical pharmacist who is adjunct faculty and supports our residents in clinic.

Our program assigns advisors to each resident upon beginning the program and they are expected to meet monthly (dedicated time is provided for this) to ensure they are meeting residency requirements and their individual professional goals. Additionally, we have a separate mentorship program with a “mentorship match” once a year to assist residents with mentors either in our program or beyond who may have shared interests or goals. We acknowledge the importance of mentors for each step of career development and strive to support our residents in finding a mentor to do so.

We have a formal wellness curriculum which includes both formal (scheduled) and informal (periodic and ad hoc) social gatherings and are based on the recognition that social relationships are central to healthy human functioning and are a potent resource for the mitigation of stress, vulnerability to burnout, as well as the prevention of anxiety and depressive symptoms/disorders. Formal events include an annual Dining Out, monthly Officer Call, hail & farewells, ad hoc gatherings (baby showers, game nights), and holiday parties. Wellness activities include a variety of scheduled events that are designed to address the topical areas within well-being, such as camaraderie, activity/fitness, nutrition, sleep, spiritual practices, etc... These include:

Wellness Activities (Quarterly)

Afternoon wellness-based activities with the residents and faculty at a local venue off-post. Often paired with a didactic wellness activity. Examples include hiking, healthy cooking, skeet shooting, rock climbing, painting, and recreational/fun events.

Didactics/Wellness (Quarterly)

Includes reflective practice small group sessions, didactic lectures, article review, art interpretation, and podcast/video discussions. Topics include, but not limited to: Burnout, Sleep Hygiene, Financial Skills, Shame in Medicine, Moral Injury, Boundary Setting, Humanism in Medicine, Medical Ethics, Work-life Balance, Medical Mistakes, Music as a Wellness Practice, Mental Health, Physical Activity, Leadership Styles, Community Engagement.

Intern Process Group (Weekly)

A process (Balint) support group for Interns to discuss their rotations, supervisors, personal stress level, and their current adjustment to the demands of residency training; extends for the duration of Intern year.

Weekly Group Sports (Weekly)

Residents and faculty play the competitive game Bucketball in place of physical training calisthenics.

Annual Retreat (Annual)

All residents, faculty, and their families spend a fun weekend together engaged in a variety of recreational events, which typically includes joint meals, swimming, hiking, softball/kickball, competitive games, a talent show, karaoke, and activities for children, among other things.

Recognitions/Awards (Monthly/Quarterly)

Regular awards for residents to recognize their efforts in patient care, taking initiative, and medical student teaching (e.g. “Go-Getter Award” and “Heart of a Family Doc Award”). Also includes awarding of an Family Medicine Residency coin for noteworthy achievements.

Off-Site Promoting and Enhancing Wellness (PEW) Day (Annual)

Occurs off-site and is an entire day dedicated to resident well-being. Consists of guest didactics, faculty led didactics, small group discussion, group activities, policy updates, and completion of the wellness program needs assessment.

Additionally, we have an Opt-Out Behavioral Health program, which is a primary/secondary prevention program for residents with the goal of mitigating stress-related problems before they coalesce into significant psychological symptoms. It provides for an individual counseling session with a qualified practitioner, at a frequency (up to monthly) chosen by the resident. Participation is voluntary, however time off is provided to attend the session and for either the morning or afternoon (4 hours) on the day of the consultation.

Retreats

We have a resident-led retreat in the beginning of each academic year for all residents, their families, and faculty.