air force pediatrics · air force pediatrics. col karen ryan- philpott. afmoa/sghm. 22 may 2017....
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I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Headquarters U.S. Air Force
Air Force Pediatrics
Col Karen Ryan-PhilpottAFMOA/SGHM
22 May 2017
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AF Pediatric Teleconference Dial in information: 1800-1900 CST / 1900-2000 EST Call In: CONUS: 1-877-996-4423
OCONUS: 1-517-345-0062 Passcode 3627448
Please mute your phone by pressing *60; only unmute if you would like to ask a question to minimize background noise
Facilitators: Maj Dianne Frankel & Capt Megan McDonald Presenters:
Col Karen Ryan-Philpott, Maternal Child Consultant Wright-Patterson AFB: Lt Col Daniel Schulteis, APD National Capital Consortium: CAPT Greg Gorman, PD;
Lt Col Christopher Rouse, APD Naval Medical Center Portsmouth: CDR Rhett Barrett, PD;
Lt Col Justin DeVito, APD San Antonio Uniformed Services Health Education Consortium:
Col(s) Brian Faux, PD; Lt Col Candace Percival, APD2
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AF Pediatric Manning
Air Force Pediatrics is thriving! 152 staff general pediatricians; 53 sub-specialists; 34 serving in
non-clinical leadership roles Manning currently:
General Pediatrics: 99% Adolescent Medicine: 67% Pediatric Cardiology: 125% Developmental Pediatrics: 100% Pediatric Endocrinology: 133% Neonatology: 108% Pediatric Gastroenterology: 175% Pediatric Hematology-Oncology: 150% Pediatric Neurology: 40% Pediatric Infectious Diseases: 150% Pediatric Critical Care: 75%
Shortages: Neurology, Critical Care, Adolescent Medicine
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Residency OpportunitiesAcademic Year 2018
Naval Medical Center Portsmouth (NMCP)/Joint Base Langley-Eustis, VA – 6
Dayton Children’s Hospital/Wright-Patterson AFB, OH – 9
San Antonio Uniformed Services Health Education Consortium (SAUSHEC), TX – 8
National Capital Consortium (NCC), Washington, D.C. – 4
Civilian sponsored positions – 2
Deferred positions – 8
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Rotations & Interviews
Interest in Pediatrics/further questions, please contact: AF Surgeon General Maternal Child Consultant: Col Karen
Ryan-Philpott; [email protected] Residency Program Directors – see next slide
Consider rotating during 3rd and/or 4th year in medical school If serious about pediatrics, schedule 2 military rotations end
of 3rd & early 4th year before interviews conclude in November NCC & NMCP – interview at both with 1 rotation (3-4 hr drive)
All packages are scored by 3 independent staff members at GME programs or one of the consultants
AF medical student packages are scored by 3 AF program directors / associate program directors
Interview with multiple program directors if you really have an interest in pediatrics! The more people who know you, the better you fare at our selection boards.
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Residency Program Points of Contact
San Antonio Military Medical Consortium Program Director
Lt Col Brian FauxPhone: (210) 916-9928Email: [email protected]
Websites: www.bamc.amedd.army.mil/saushec/gme/residency/pediatrics ORwww.sampcpeds.org
Portsmouth Naval Medical Center Program Director
CDR Rhett BarrettPhone: (757) 953-2958Email: [email protected]
Website: http://www.med.navy.mil/sites/NMCP2/EduTrain/GMED/Residencies/PediatricResidency/Pages/Default.aspx
National Capital Consortium Associate Program Director
Lt Col Christopher RousePhone: (301) 319-5437Email: [email protected]
Website: http://nccpeds.com
Wright-Patterson AFB Associate Program Director
Lt Col Daniel SchulteisPhone: (937) 522-4776Email: [email protected]
Website: http://medicine.wright.edu/pediatrics/residency-program
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2016 JSGMESB ResultsMedical
StudentsAD
ResidentsDEF
ResidentsAD
InternsDEF
InternsField
Applicants
Applicants 320 70 23 32 30 127Non-
Selected 53 13 6 5 12 44
Match to 1st Choice
Training260
(Residency)54
(Fellowship)16
(Fellowship)25
(Residency) 17
(Residency)
79 (26/45 Residency)(53/82 Fellowship)
Match to 2nd Choice Training
7 ₫ 0 0 0 1 2
Match % 83% (100%) 82% 70% 78% 60% 62%No second
Choice 42
All Medical Students non-selected are selected for PGY1 only training₫ 11 Medical Students were not selected for their 1st and 2nd choice
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2014-2016 JSGMESB ResultsPrimary Residency Selections
Residency Applicants Selected Select % MD DONon-
Medical Students
MedicalStudents
ANESTHESIOLOGY 80 66 83% 47 33 40% 60%
DERMATOLOGY 43 16 37% 37 6 91% 9%
EMERGENCY MEDICINE 132 110 83 83 49 48% 52%
FAMILY MEDICINE 179 174 97% 95 84 17% 83%
GENERAL SURGERY 89 82 92% 61 28 29% 71%
VASCULAR SURGERY 10 8 80% 9 1 70% 30%
INTERNAL MEDICINE 144 137 95% 90 54 23% 77%
NEUROLOGY 17 16 94% 11 6 24% 76%
NEUROLOGICAL SURGERY 7 7 100% 4 3 100%
OB/GYN 64 58 91% 42 22 20% 80%
OPHTHALMOLOGY 20 13 65% 16 4 55% 45%
ORTHOPEDIC SURGERY 51 34 67% 36 15 39% 61%
OTOLARYNGOLOGY 15 14 93% 14 1 27% 73%
CLINICAL/ANATOMIC PATHOLOGY 26 23 88% 20 6 35% 65%
PEDIATRICS 124 120 97% 84 40 7% 93%
PSYCHIATRY 51 47 92% 36 15 20% 80%
DIAGNOSTIC RADIOLOGY 56 41 73% 45 11 46% 54%
UROLOGY 13 11 85% 11 2 38% 62%
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2014-2016 JSGMESB Results USMLE Scores
Residency Number Step 1Low
Step 1High
Step 1Mean
Step 2Low
Step 2High
Step 2Mean
AEROSPACE MEDICINE 15 183 285 209 171 260 212
ANESTHESIOLOGY 42 193 258 228 207 263 242
DERMATOLOGY 14 194 272 241 207 276 245
EMERGENCY MEDICINE 73 192 261 230 200 272 245
FAMILY MEDICINE 91 190 261 218 198 267 233
GENERAL SURGERY 59 195 269 235 199 278 244
GEN SURG PERIPHERAL VASCULAR 7 198 255 235 225 263 246
INTERNAL MEDICINE 87 183 263 230 189 273 240
NEUROLOGY 10 196 236 219 185 261 230
NEUROLOGICAL SURGERY 4 244 260 253 255 275 263
OB/GYN 41 192 263 224 202 281 241
OPHTHALMOLOGY 10 214 261 239 235 268 248
ORTHOPEDIC SURGERY 28 220 267 243 230 269 253
OTOLARYNGOLOGY 14 219 261 241 221 275 248
CLINICAL/ANATOMIC PATHOLOGY 18 197 255 230 210 277 239
PEDIATRICS 81 193 259 228 195 274 241
PSYCHIATRY 34 191 262 219 193 260 231
DIAGNOSTIC RADIOLOGY 36 194 260 237 201 276 244
UROLOGY 10 195 262 239 217 267 239
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2014-2016 JSGMESB Results COMLEX Scores
Residency Number Level 1Low
Level 1High
Level 1Mean
Level 2Low
Level 2High
Level 2Mean
AEROSPACE MEDICINE 15 414 576 489 405 627 487
ANESTHESIOLOGY 24 471 765 577 459 821 610
DERMATOLOGY 2 624 647 636 629 679 654
EMERGENCY MEDICINE 37 409 807 556 414 835 593
FAMILY MEDICINE 83 402 671 507 400 775 521
GENERAL SURGERY 23 405 666 543 405 605 565
GEN SURG PERIPHERAL VASCULAR 1
INTERNAL MEDICINE 50 403 734 526 402 782 558
NEUROLOGY 6 515 588 550 487 646 558
NEUROLOGICAL SURGERY 3 652 692 673 669 700 686
OB/GYN 17 410 709 550 412 765 563
OPHTHALMOLOGY 3 628 682
ORTHOPEDIC SURGERY 6 588 734 648 590 674 639
OTOLARYNGOLOGY 1
CLINICAL/ANATOMIC PATHOLOGY 5 450 581 518 433 620 520
PEDIATRICS 39 427 656 521 419 758 551
PSYCHIATRY 13 402 636 510 412 723 527
DIAGNOSTIC RADIOLOGY 5 535 671 593 508 643 597
UROLOGY 1
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Pediatric Match Fall 2016
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Applicant Pool
HPSP students USUHS students General Medical Officers (GMOs)
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Pediatric Match Fall 2016
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First choice military Second choicemilitary
Fourth choicemilitary
Deferred Not matched
Match Selections
USUHS students HPSP medical students GMOs
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Pediatric Match Fall 2016Scoring Criteria
Pre-clinical med school yrs (incl USMLE Step 1/COMLEX) – 2 pts 0 Unsatisfactory; 1 Good; 2 Outstanding (top 25%)
Clinical med school yrs (incl USMLE Step 2/COMLEX) – 3 pts 0 Unsatisfactory; 1 Acceptable; 2 Good (50-75th percentile); 3
Outstanding (top 25%) Potential for successful practice & career officer – 5 pts
0 Unsatisfactory; 1 Marginal; 2 Acceptable; 3 Good; 4 Excellent; 5 Outstanding (truly exceptional potential)
Largely based on rotations & interviews Bonus points awarded by Panel Chair:
Research – AF applicants max of 2 pts; single publication or poster presentation = 1; multiple publications/presentations = 2
Prior military service: AD ≥ 2 yrs; NOT working as physician; 1 pt for non-medical job; 2 pts for medical position
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Pediatric Match Fall 2016Scoring Criteria
GMOs/residents applying for residency/fellowship: Internship (incl USMLE Step 3/COMLEX) – max 5 pts for GMOs,
max 3 pts for current interns Post-internship operational tour – 5 pts, unless duty tour has
lasted less than 9 months, then max 3 pts Post-residency operational tour – 10 pts for residency; 15 for
fellowship applicant
Common misconceptions: USUHS students can earn more pts than HPSP: FALSE
USUHS time does not count as AD time Doing research in med school can earn a lot of pts: max of 2 GMOs can earn more pts: TRUE, but selection list is based on
percentage of possible pts not original score USMLE better than COMLEX: irrelevant; only the score matters
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Pediatric Match Fall 2016Scoring Criteria
Caveats to military match: Try to keep joint military (same branch of service) spouses
together; does not apply to civilian or other service spouses USUHS students must match to a military program (may be a
program of their choice or transitional program) GMOs (completed internship year only) applying for residency
will only have 1 AF scorer; the others will be Army & Navy Applicants below AF cut line will not be recommended for
pediatric residency training, but may match to another program
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Pediatric Fellowships Fellowship opportunities after residency (AY2018 / pre-select
AY2019 slots requested): Adolescent Medicine (2) Allergy & Immunology (?) Pediatric Cardiology (1) Developmental Pediatrics (4) Pediatric Endocrinology (1) Pediatric Gastroenterology (1) Pediatric Hematology-Oncology (0) Pediatric Infectious Disease (0) Neonatology (3) Pediatric Neurology (2) Pediatric Critical Care (1) Child Abuse (1)
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Pediatric Fellowship Match 2016
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0 0 0 0
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0
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0 0 0
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00
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1 1 1 1
0 00
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Adol Med Cardiology Critical Care Dev Peds Endo GI Heme-Onc Neonatology Neurology
Match Selections
Resident - matched Resident - not matchedStaff - matched Staff - not matched
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USAF Graduate Medical Education Programs (71)
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Staff Pediatrician Opportunities AF pediatricians at 69 Military Treatment Facilities worldwide
56 are outpatient clinics only 13 inpatient sites/12 w/active nurseries – decrease to 12 Jun
17, then 11 May 18 12 bases are overseas
Leadership positions: Medical Director, Element Leader, Commander (Flt, Sq, Gp) SGH or Chief Medical Officer Program Director or Associate Program Director MAJCOM / Headquarters positions
Opportunities: Academic medicine – faculty for Pediatric, Family Medicine, or
Transitional residents, medical & nursing students, PAs, NPs Humanitarian assistance missions / rare deployments Paid fellowships / additional training (MBA/MHA, PhD) Flight Medicine & other unique military opportunities
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Retention data
Percent of Physicians that reach 20 Calendar Years of Service (CYOS) MC – 19% 44E – 7% 44F – 20% 44K – 27% 44M – 9% 44P – 12% 44R – 12% 45A – 19% 45B – 10% 45G – 5% 45S – 18%
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44K (Pediatrician) Retention
Median retention from FY 2005-2015
Cumulative Continuation Rate: What % of accessions will complete Calendar Years of Service (CYOS) X?
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CYOS % Retained4 85%8 53%
12 38%16 28%19* 27%20 21%
* CYOS 19 shows % that will make it to CYOS 20
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Retention Data
Average # of separations & retirements per year MC - 358 44E – 19 44F – 61.1 (trending down) 44K – 27 44M – 42.5 44P – 13.4 44R – 17.1 45A – 15.8 (trending up) 45B – 13.4 45G – 17.1 (trending down) 45S – 25.4
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Why Pediatricians Stay?
Salaries commensurate or better than civilian practice
Ability to work to your skill set – outpatient only, inpatient and/or nursery coverage, GME / academic medicine
Opportunities to participate in humanitarian missions Short term (2-4 weeks) in developing countries 4-6 month deployments on Navy medical ships Previous deployments to Iraq/Afghanistan – none currently
Pediatricians thrive in leadership positions More pediatricians in SGH positions than other specialties
Academic opportunities Paid master’s/PhD programs, fellowships, military education
We take care of the most amazing kids who didn’t have a choice, but still serve their country every day!
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Wright-Patterson AFB / Wright State University
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Lt Col Daniel Schulteis, USAF, MC
Associate Program Director
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Wright-Patterson AFB / Wright State University
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Fully Integrated Pediatric Residency Residents train in a free-standing
children’s hospital-155 beds-15 bed PICU-36 bed NICU-80K visits/yr to ER->35 pediatric subspecialties
WPAFB for ambulatory, nursery,adolescent, continuity clinic
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Wright-Patterson AFB / Wright State University
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Fully integrated program provides unparalleled volume, access to subspecialists, and opportunity to experience “textbook” and “real-life” medicine together 48 residents total 25 military
Multiple unique military experiences Military Medical Humanitarian Assistance Course Military Medical Officer Training and Orientation Course 711th Human Performance Wing School of Aerospace Medicine Naval Medical Research Unit-Dayton “Ready the Warfighter” deployment program Pediatric Fundamental Critical Care Skills Course
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Wright-Patterson AFB / Wright State University
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Program Strength: Medium sized program Patient volume Resident autonomy No fellowships Focused on strong, general pediatrics foundation
Continuity Clinic: National Capital Curriculum
Resident Mental Health: “Healer’s Art” Size allows for flexibility Hospital Grieving Team
https://www.childrensdayton.org/health-care-professionals/education-and-resources/pediatric-residency-program
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Interviewing Strategies
Interviewing Strongly recommend scheduling interviews at all
programs, preferably in person—it can only help you Doing an ADT is your best opportunity to see the
programContact sites early in 3rd year for scheduling
timelineBe yourself, show intellectual curiosity, remember
customs/courtesies, talk to the residentsRemember “Officer Potential” up to 5 pts
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Fellowships
Fellowships It’s what the Air Force needs, not necessarily what
you want to do You may not be able to become a pediatric
____________. To be a good subspecialist, you need to be a good
generalist It’s all about timing
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Air Force vs Civilian Residency
If you are a good medical student, you will probably be a good resident, regardless of what you wear to work
However, Air Force residents & staff train with “global” mindset
Many civilian institutions “groom their own”
Civilian programs provide full spectrum of SES influences
At the end of the day, medicine is still a competitive business
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National Capital Consortium
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CAPT Greg Gorman, MC, USNProgram Director
Lt Col Christopher Rouse, USAF, MCAssociate Program Director
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National Capital Consortium
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Reasons to train at the National Capital Consortium: Integration with USUHS & pediatric grand rounds Resident wellness & a diverse metro area Pediatrics Boards passage rate over 90% Unparalleled opportunities for research More faculty and more subspecialties Train in the only tri-service program Daily protected learning
www.nccpeds.com
facebook.com/nccpeds
twitter.com/nccpeds
Mrs. Theresa Kiefer (301) 319-5437
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Naval Medical Center Portsmouth
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CDR Rhett Barrett
Program Director
Lt Col Justin DeVito
Air Force Associate Program Director
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Naval Medical Center Portsmouth
Robust Pediatric Population: 158,000 military children in area 34,500 gen peds visits per year & 30,500 specialty clinic visits
per year 9,000 Pediatric ED visits per year 26 bed NICU
400 admissions/year/ 250-300 deliveries per month Highest volume of micropremies in the DoD!
18 bed unit ward, 6 bed PICU 1,300 ward admissions per year
~ 10 daily encounters 300 PICU admissions per year 1,090 PICU sedation per year
All interns perform PICU rotation
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Naval Medical Center Portsmouth
Continuity Clinic Weekly 1/2 day clinic, Interns enroll 50 patients, 4 appts per session Assigned to you as the PCM by name Weekly pre-clinic academic discussion
Research / Scholarly Activity Multiple faculty committed to mentoring in research – not required Research oversight committee
Clinical Experience Augmented by Civilian Hospital Rotations Children’s Hospital of Richmond at VCU--3rd year PICU rotation Children’s Hospital of the King’s Daughters, Norfolk, VA
Intern Ward and ED rotations 2nd year ED rotation 2nd and 3rd year elective opportunities
Commitment to resident wellness Residents lead fitness/wellness activities: Intramural sports, summer
picnic, fall retreat, intern dining out, off site meetings, annual party Duke Life Curriculum integrated into academic conferences/sleep
education AAP Resilience Curriculum—Resilience in the face of grief & loss
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Naval Medical Center Portsmouth
Intern Curriculum: 13 Four week rotations:
Pediatric Ward (x3): 2 at NMCP, 1 at civilian children’s hospital NICU (x2) Pediatric Orthopedics General (Adult) ED Pediatric ED: at civilian children’s hospital Newborn Nursery PICU Adolescent Medicine General Pediatrics Clinic OB/GYN for Navy (elective for Air Force)
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Naval Medical Center Portsmouth
What makes a candidate competitive? Candidates selected on combination of: Academic record Board performance Clinical rotations performance
Clinical ability Professionalism /demonstration of potential for leadership Communication Ability to perform on a team
Strengthen application by showing commitment to pediatrics in extracurricular activities
To set up rotation at NMCP Pediatrics (for BOTH USAF & Navy): Open for requests in January for following academic year Lt Josh Eubanks (Navy Chief Resident): [email protected] Ms. Denise Martin (Residency Program Coordinator):
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Naval Medical Center Portsmouth
Are there rotations that medical students should try to complete during their 4th year of school to prepare for residency?
How is Osteopathic Manipulative Therapy (OMT) used within an Air Force pediatrics program?
Does a letter of recommendation from a USAF pediatrician carry more weight than a similar letter from a civilian pediatrician or a military physician in another non-pediatric specialty?
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San Antonio Uniformed Services Health Education Consortium
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Col (s) Brian Faux, USAF, MC
Program Director
Lt Col Candace Percival, USAF, MC
Associate Program Director
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Vision Statement
SAUSHEC Pediatric Residency Program will train exceptional
officers and compassionate physicians in the art and science of pediatric medicine in support
of our nation and for the betterment of all children.
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SAUSHEC Residency
Apprentices 14-15 Residents Yearly8 Air Force & 6 Army (varies per year)
Rotations at four local centers serving 7th largest US city with over 600,000 children
1. San Antonio Military Medical Center (SAMMC)2. Wilford Hall Ambulatory Surgical Center (WHASC)3. CR Darnall Army Medical Center, Ft. Hood, TX4. Children’s Hospital of San Antonio, San Antonio, TX 5. University of Texas Hospital, San Antonio, TX
San Antonio Military Medical Center (SAMMC Campus) State of the art hospital opened
in 1996 with addition completed in 2011
DoD’s only Level 1 Trauma Center, Burn Center
Wilford Hall Ambulatory Service Center (WHASC) Largest outpatient center in
the DoD Patient Centered Medical
Home (PCMH) New facility opens June 2017
Darnall Army Medical Center Largest Military Base in the world! Two Blocks during training: PGY2 (ER) and PGY3 (Nursery) Experience true community military hospital setting Run Inpatient Nursery/NICU as Third Year
Learn when to refer to tertiary care center Experience greater independence and autonomy Very large pediatric patient population
40,000 DoD dependents < 18 yrs 2,510 annual deliveries (CY 13-16)
Residents routinely rate rotations in top 10 of all rotations!
Children’s Hospital of San Antonio (CHofSA) Affiliation: Texas Children’s Hospital/Baylor College of Medicine
Primary teaching site in San Antonio
First Year Pediatric Emergency Medicine Rotation
82,000 pediatric patient visits yearly Second Year
Pediatric Intensive Care Rotation 29 Bed PICU, 1100 annual admissions, ADC: 15.1 Pediatric Transplant center
Third Year Pediatric Emergency Medicine Rotation Pediatric Anesthesia Rotation—Focus on procedures Pediatric Intensive Care Rotation
University of Texas Hospital First Year – NICU rotation,
Ward rotations 58 Bed NICU, 600 annual
admissions 48 Bed Ward, 3210 annual
admissions
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Trainee Clinical Experience
Diversified, hybrid education Military: educational, complex patients, economy of scale Civilian: volume, diverse patient characteristics, specific
subspecialties (e.g., cardiothoracic surgery)
SAUSHEC Residents will experience annually: CRDAMC 2510 + SAMHS 1501 ≈ 4000 births SAMHS 335 + UH NICU 600 ≈ 935 NICU births SAMHS 1278 + UH Ward 3210 ≈ 4500 ward admits SAMHS 181.5 + CHofSA PICU 1100 ≈ 1300 PICU admits
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Unique Program Designs Resident as Teacher (RAT) Curriculum Individually Designed Resident Rotations (echocardiogram, bedside
ultrasound, research) Quality Improvement/Patient Safety and Research Curriculum Separate Advisor and Mentorship Programs Extensive Simulation Exercises
Pediatric Fundamentals of Critical Care Support (PFCCS) course Critical Patient Transport Course
June Transition to Practice Curriculum Wellness/Health and Fitness Program Resident Resiliency Program Residency Family Support Group (RFSG) Safe HARBOR
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International Research
Opportunities for international research missions
Previous research locations: Mongolia Thailand Nepal Select countries in Africa
CAMP Doctor1 week camping with children with special needs
Didactics on managing complex childrenLots of FUN!!!
The River Walk & The Pearl
Parks
Password: sampcpeds
MSIV Rotation POC Shelly Martin M.D.
Lt Col, USAF, M
Office: 210-916-9145
Pager: 210-513-1391