Rheumatology Fellowship Training

The BAMC Rheumatology department emphasizes excellence in clinical education and recently earned the 2008-2009 “Best Teaching Department” award by the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Internal Medicine Residency Program.   Patient care within the department is optimal, and each of the faculty members participates in ambulatory and inpatient care/teaching.  The goals of the Rheumatology Fellowship Program are to provide trainees practical clinical experiences in the diagnosis and management of rheumatic disease in both the inpatient and outpatient settings.  This clinical experience is built upon a thorough education of the underlying basic sciences of pharmacotherapy and pathophysiology relevant to the rheumatic diseases.

Brooke Army Medical Center and Wilford Hall Medical Center are staffed by the Rheumatology consult service and provide significant exposure to the rheumatic diseases in the inpatient tertiary care setting.  The Rheumatology Clinic at Brooke Army Medical Center is the only major DOD Rheumatology referral center for the Military Health System in South Texas.  This Rheumatology Clinic is the primary site at which trainees receive extensive experience managing various manifestations of the rheumatic diseases in acute and continuity care clinics.

Additional clinical rotations are arranged for the Rheumatology fellows.  The first year fellows rotate through the Orthopaedics Clinic, BAMC Musculoskeletal Radiology Department and WHMC Physical Medicine and Rehabilitation Department.   Each month, the second year fellows gain experience managing cases of pediatric rheumatic disease while rotating through the Christus Santa Rosa Center for Children and Families Arthritis Clinic in downtown San Antonio. 

Additionally, the Rheumatology Department facilitates formal conferences to complement and solidify the clinical experience gained in the ambulatory and inpatient care settings.  The faculty participates in each of the formal conferences scheduled.

Rheumatology Review Series This is a semi-weekly core curriculum conference devoted to reviewing basic science and clinical Rheumatology.  The curriculum is based on recent literature and up to date, standard Rheumatology textbooks.  A two year cycle of the curriculum ensures a comprehensive review of all the topics necessary to attain a mastery of basic Rheumatology concepts.  Each week the assigned topics are reviewed in two 60 minutes conference sessions that convene in various forms (e.g. didactics, quizzes, discussions).

Rheumatology Grand Rounds This weekly conference is conducted every Friday morning from 0800-1200.  The collective Rheumatology department of faculty, fellows, rotating residents and medical students meet to review the inpatient and outpatient services.  Grand Rounds is subdivided as follows:

1. Radiology Rounds (60 minutes) – Coordinated by the consult fellow, this conference is devoted to reviewing numerous images relevant to the care of patients with rheumatic disease.  Basic concepts in musculoskeletal radiology are covered as plain radiographs, MSK ultrasound images, CT scans and MRI sequences are reviewed by the department.  A monthly combined conference with the Musculoskeletal Radiology department augments this educational conference.
2. Clinical Service Rounds (60-90 minutes) – This forum is devoted to reviewing interesting and educationally ripe cases seen by the inpatient consult services.  Case management review allows the rotating fellow(s) the opportunity to discuss diagnostic and therapeutic decisions with members of the department.  Particularly complicated or interesting outpatient cases are presented for discussion and review, as well.
3. Evidence Based Medicine Didactic Review (30-60 minutes) – This session is devoted to the literature based review of a clinical topic relevant to the care of a recently evaluated/treated patient.  This review is presented by the fellow rotating on the inpatient Rheumatology consult service.
4. Rheumatology Review Series (60 minutes) – See above.
5. Combined Conferences (Schedule/Time varies) – Throughout the academic year, various combined conferences with other departments (Pathology, Physical Therapy, Occupational Therapy, etc.) are convened to augment the education of the trainees.  These sessions are arranged periodically.

Journal Club

This monthly conference allows the Rheumatology fellows the opportunity to review the clinical and basic science literature relevant to the care of patients seen in the Rheumatology setting.  Emphasis is placed on the critical evaluation of the methods and statistical analyses employed in published research studies.

Combined UTHSCSA/BAMC Grand Rounds

Attended by the faculty, fellows, residents and medical students of the BAMC and the UTHSC-San Antonio Rheumatology Departments, this city-wide conference is held in the South Texas Medical Center.  The monthly forum is convened to discuss complicated and interesting rheumatic disease cases.  Every month, a fellow from each of the Rheumatology Departments presents a case for review and discussion.

Rheumatology Fellowship Opportunities

Education

The San Antonio Uniformed Services Health Education Consortium (SAUSHEC) offers a two year ACGME accredited fellowship in Adult Rheumatology.  The program is designed to provide an intensive clinical and research experience necessary to produce sub-specialist physicians with expertise in the care and management of patients with rheumatic disease.  One to two first year fellow positions (PGY4) are available each academic year.

Selection

Applicants for this program must be board eligible or certified in Internal Medicine at the time of matriculation in the fellowship program. Trainees are selected from a pool of applicants applying through the Joint Service Graduate Medical Education Selection Board.  This pool includes internists practicing on active duty and internal medicine residents training in active duty and HPSP deferred status.

For more information about the application process, you may contact the Rheumatology Program Director at 210-916-8137 or at 1-800-531-5800.