Mission

SAUSHEC neonatal-perinatal medicine fellowship will train uniformed pediatricians to become neonatologists that successfully balance compassionate family-centered clinical practice with the ever-changing science of our field for our military’s most vulnerable patient population.

Vision

SAUSHEC Neonatal-Perinatal Medicine Fellowship will train uniformed pediatricians to become neonatologists that successfully balance compassionate family-centered clinical practice with the ever- changing science of neonatology for our military’s most vulnerable patient population.

Aims

• Focus on excellent clinical practice first with strong curriculum, education, and multiple locations to maximize experiential learning.
• Military Unique Curriculum with emphasis on leadership, transport medicine, global health and officership to ensure that fellows are well prepared to take on military leadership roles after graduation.
• Provide mentorship in key areas of clinical investigations and continuous process improvement to assure that fellowship graduates are well poised to contribute to military scientific advancement as well as patient safety.
• Specific focus on health, wellness, resiliency, and ethics to assure that fellows contribute maximally to the ready force.

Didactics

Tuesday (1 p.m. – 4 p.m.): Weekly didactic conference

• These sessions can include lectures, simulation, fellow presentations, and other academic opportunities
• Attendance is mandatory, unless on leave or excused by the program director

Friday (7:30 a.m. – 8:30 p.m.): Case-based morning report

The BAMC fellow on service is responsible for concisely reviewing the unit census; then either the BAMC fellow or another on-service fellow will present a case for discussion.

Post Graduate Year (PGY)-4, PGY-5, PGY-6 Required Presentations

Annual Clinical Controversy

Provide an in-depth literature review on a current neonatal clinical controversy and state how this review will affect future practice for the fellow.

Annual Morbidity and Mortality Case Presentation

Present the clinical case, provide relevant education, and identify if there were areas to improve.

Annual Journal Club (with University Hospital)

Select a contemporary article, review relevant background, discuss the research design, and identify strengths/weaknesses of the article along with how it will impact your practice.

Annual Research/Quality Improvement Presentation

Present an annual update for any ongoing research and quality improvement project(s).

Additional Presentations

Friday-case Based Didactics

See above regarding Friday case-based morning report.

Pediatric Residency Morning Report

Fellows are assigned a morning report topic for the SAUSHEC pediatrics residency.

Patient Safety Report (PSR) Reviews

The BAMC fellow on service will review submitted PSRs and give a presentation on them to the Department of Pediatrics.

Journal Club (with other military fellowships)

The fellowship will host one of these journal clubs per year. A senior fellow is assigned as team lead and then coordinates the responsibilities of this journal club amongst other fellows.

Brooke Army Medical Center serves as the primary teaching hospital and medical home.

Other SAUSHEC Rotations:

• MFM rotation: Work with BAMC maternal-fetal medicine specialists with a focus on learning more about the prenatal evaluation and management of high-risk pregnancies

Outside Rotations:

• Christus Children’s: Focuses on practice in a high volume, level IV NICU with Extracorporeal Membrane Oxygenation (ECMO) in the unit
• University Hospital: Focuses on practice in a high volume, level IV NICU at a civilian teaching hospital
• North Central Baptist: Focuses on the delivery and management of low birthweight babies.
• Methodist Children’s: Focuses on clinical management of a high volume and high acuity private NICU.

Service block expectations/focus by training year:

PGY4:

• (First half of year): become acclimated to the information systems in use at BAMC while developing skills needed to be a practicing neonatologist
• (Second half of year): become proficient at running a GME team while developing skills needed to be a practicing neonatologist

PGY-5:

Become a clinical team leader, including emerging teaching skills for other learners, while honing skills as a practicing neonatologist; starting to take on some of the responsibilities of the attending, to include reviewing all resident notes.

PGY-6:

Run a military NICU team independently, with help and oversight readily available; this includes being responsible for all tasks that would normally fall to the attending, to include writing addenda on all resident notes.

The program has one 4-week elective during both PGY5 and PGY-6. Options include:

• Delivery/Peripherally Inserted Central Catheters (PICC)/Procedures rotation at University Hospital
• Cardiac Intensive Care Unit (ICU) at University Hospital
• Anesthesia (Airway) rotation at Christus Children’s
• Quality Improvement and Patient Safety (QIPS) at BAMC
• North Central Baptist*
• Methodist Hospital*

*Counts as clinical service time.

A new elective rotation can be pursued but requires notification of program director/associate program director at least 6 months ahead of time.

The fellow call schedule is maintained by a third-year fellow assigned as schedule coordinator.

Minimum number of calls per year:

• PGY-4: 54
• PGY-5: 50
• PGY-6: 46

Additional call schedule details include: 

• If on a BAMC Call Block, one call will be a 24-hour call on a weekend.
• If on an outside call block, one will be a weekend. Up to 1 outside call block is authorized per academic year.
• In general, Monday nights have no fellow on call to allow for participation in Tuesday didactics.
• Optional call shifts for unique clinical opportunities such as Extracorporeal Membrane Oxygenation- ECMO, therapeutic hypothermia, extreme prematurity, etc…are available. An order of priority exists and fellows must continue to adhere to duty hour restrictions. These call shifts are designed so that fellows are not excluded from exceptional learning opportunities and are not mandatory.

• Military unique curriculum for the neonatal-perinatal medicine fellowship centers around neonatal transport. When neonates born to military service members outside of the United States are not able to receive adequate care locally, the DOD maintains neonatal air transport teams which can transport these neonates to an appropriate level of care.
• All fellows complete a neonatal transport course in their first year of training. Fellows then teach at least one module of the transport course in subsequent training years. Our fellows also have the opportunity to participate in the planning and execution of multiple transport experiences via ground, fixed wing, and rotary modes of transport. This is tracked as a readiness skill as well as a critical piece of their learning for the care of neonates.
• Additionally, in serving the global mission in caring for neonates around the world, members of fellowship faculty serve as remove advisors available for neonatal consultation. When consults are received, fellows are included in clinical discussions to help gain skills in telephone/virtual consultation. Senior fellows also have an opportunity to serve as a primary consultant, with faculty backup.

Neonatal Transport Course (unless completed as a resident): This is a two-day course designed to introduce fellows to unique world of military neonatal transport medicine though a combination of didactics and simulation-based training.

We have a strong and growing simulation curriculum. The on-service fellow at BAMC participates in a weekly simulation involving neonatal resuscitation or high-acuity low occurrence events. Annually, fellows have an opportunity to participate in a neonatal transport simulation which includes an air transport component on a military aircraft. Lastly, the program maintains an Extracorporeal Membrane Oxygenation (ECMO) lab every fellow completes once during their three-year fellowship. The fellowship has a dedicated simulation director who continually works to optimize this curriculum, plans on publishing neonatal simulation cases, and plans to conduct novel research in this field.

Recognizing that our graduates are placed in leadership roles in their initial assignments after fellowship, leadership principles are regularly discussed in our didactic sessions. The fellowship has integrated with the SAUSHEC Pediatric Residency Curriculum, which utilizes the LEAD 2.0 curriculum developed by Uniformed Services University of the Health Sciences. SAUSHEC offers faculty development in leadership which our fellows are encouraged to attend. Furthermore, the SAUSHEC GME environment houses multiple subcommittees which our fellows are encouraged to be a part of, which provide opportunities to develop as hospital and GME leaders.

It is an ACGME requirement for each fellow to design and conduct a scholarly project under the guidance of the program director and a designated mentor. As mentioned in the above program description, our fellows have access to a wide variety of research opportunities at BAMC and through local civilian institutions. When not on service, fellows are on research blocks. During this time, they take call and attend didactic sessions but primarily work on research and other scholarly activity.

The fellowship maintains a scholarship oversight committee comprised of military and civilian members with varying neonatal research backgrounds. This committee provides oversees the progress of fellow research and helps fellows advance towards their career research goals.

SAUSHEC supports presentation of research at research conferences. It is common/expected that our fellows present research at premier neonatal research conferences nationally and even internationally. Our fellowship also annually hosts Conference on Military Perinatal Research (COMPRA), the sole neonatal research conference within the Department of Defense.

If interested in getting involved with research in neonatology, please contact our fellowship and active/forecasted projects can be discussed.

Recent/ongoing projects include:

• Simulation research surrounding neonatal air transport
• Neonatal outcomes after maternal transfer of care during pregnancy
• Utilization of donor breast milk in military NICUs and nurseries

Each fellow is required to design and conduct at least one quality improvement project during fellowship. Through SAUSHEC, formal quality improvement training is offered in the form of Lean Six Sigma courses and Root Cause Analysis courses. SAUSHEC maintains a Quality Improvement Patient Safety (QIPS) subcommittee designed to aid housestaff in conducting and completing quality improvement projects.

If interested in learning about active/forecasted NICU quality improvement projects, please contact our fellowship.

Recent/ongoing projects include:

• Post-partum depression screening in the NICU
• Implementation of a darbepoeitin protocol to reduce neonatal blood transfusions
• Development of a point-of-care ultrasound curriculum to evaluate umbilical line position

The SAUSHEC neonatology community is well established in the American Academy of Pediatrics. Through participation with the Section on Uniformed Services and Section on Neonatal Perinatal Medicine, fellows have many opportunities to serve as leaders and grow professionally. In addition, all committees within SAUSHEC can have fellow representatives and fellows are encouraged to serve in these roles for career development.

Additionally, SAUSHEC hosts faculty development courses given by local staff and traveling faculty from the Uniformed Services University of the Health Sciences (USUHS). Fellows in our program are highly encouraged to attend and can earn certificates in various disciplines. Fellows also have the opportunity to enroll in graduate level courses in health professions education through USUHS.

• Brooke Army Medical Center, Fort Sam Houston, Texas (Level III NICU)
• Christus Children’s Hospital, San Antonio, Texas (Level IV NICU with Extracorporeal Membrane Oxygenation (ECMO) in the NICU)
• University Hospital, San Antonio, Texas (Level IV NICU with ECMO in the PICU)
• North Central Baptist Hospital, San Antonio, Texas (Level IV NICU)
• Methodist Hospital, San Antonio, Texas (Level IV NICU with ECMO in the PICU)

Medical students will be assigned to the NICU for 4 weeks to satisfy requirements of a sub-internship rotation (PED4381) or for 2 weeks as part of a 4-week elective rotation. While on rotation, medical students will be assigned patients with resident/fellow oversight and participate in daily rounds. Rotation goals are to learn about neonatal pathophysiology, neonatal physical examination, and basic NICU management. Medical students are able to participate in unique learning opportunities such as simulation training, neonatal transports, and Extracorporeal Membrane Oxygenation (ECMO) training based on availability while the student is rotating. These skills can be important for future pediatric, family practice, and Ob-Gyn residents.

To schedule a rotation, e-mail: usarmy.jbsa.medcom-bamc.mbx.saushec-clerkship@health.mil.

For additional info, or if there is no response from the above e-mail, contact: dha.jbsa.brooke-amc.list.saushec-peds@health.mil.

Interviews are offered to all candidates who are interested in pursuing a military neonatology fellowship. Interviews are conducted virtually to promote equity among candidates (this standard is held consistently through all military neonatology fellowships). During interviews, candidates are invited to join a fellowship didactic session, spend approximately 30 minutes talking to the fellows, and have 30-minute interviews with four members of the core fellowship faculty.

To schedule an interview, e-mail: dha.jbsa.brooke-amc.list.saushec-neonate@health.mil.

Program graduates take the American Board of Pediatrics (ABP) Neonatal-Perinatal Medicine maintenance of certification exam. This computer-based examination is taken in March/April. This exam is offered biennially. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the American Board of Pediatrics by October 31 in the year preceding the test date. Following completion of this exam, members must complete 5-year maintenance of certification requirements in order to maintain board certification. The full requirements can be found at ABP Neonatal-Perinatal Medicine Board Exam Information.

Members may choose whether to continue to maintain board certification in Pediatrics.

Fellows are expected to develop and expand on their teaching of residents and medical student while on-service and on-call. As outlined above, they have many additional opportunities for teaching which include but are not limited to pediatric residency lectures, fellowship case presentations, academic presentations (journal club, clinical controversy, and morbidity/mortality).

Fellows have the opportunity to work toward obtaining a Master’s Degree in Health Professions Education through USUHS while in fellowship, if desired.

All fellowship faculty are board-certified in neonatal-perinatal medicine. The program director has a Master’s Degree in Ethics and multiple faculty are working towards a Master’s of Education in Health Professions Education.

Each fellow is assigned one fellowship advisor. Fellows meet with this advisor quarterly to discuss progress towards goals and fellowship requirements. Fellows then have an opportunity to select research mentors and career mentors. As part of the scholarship oversight committee, fellows may invite up to two members (can be remote experts in the field); which can provide additional mentorship as well as sponsorship toward research and career goals.

Additionally, SAUSHEC has an annual mentorship workshop that faculty and fellows are encouraged to attend. Among faculty, the program director meets with members twice annually to provide face to face mentorship sessions.

Our program has a designated wellness fellow who works with the program leadership to plan and schedule fellow-targeted wellness events. They also serve as a liaison between fellows and program leadership to address any issues related to fellow wellness. The program sets aside two half-days for fellow-only bonding activities.

Additionally, fellows are encouraged to attend wellness activities throughout the hospital and are given resources on wellness and mental health at the yearly orientation.