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Collaboration with military strengthens surgical education (10-7-99)

The general surgery residency program at The University of Texas Health Science Center at San Antonio continues to benefit from a unique blend of civilian and military medical expertise. Surgeons who spend five requisite years in the program receive a much broader educational experience in surgery than is available almost anywhere else, say the program's leaders.

The Health Science Center's Medical School offers general surgery residencies to nine doctors a year. It is one of the largest surgical residency programs in the state. In 1998 the Medical School integrated its program with the U.S. Air Force surgical residency program at Wilford Hall Medical Center in San Antonio.

"We looked at the experience of the residents at the Health Science Center, and Wilford Hall did the same with its residents," said William E. Strodel, M.D., professor and chairman of the Health Science Center's Department of Surgery. "When we looked at the two programs, we saw opportunities for complementary support to improve the education of residents, especially pertaining to the types of diseases they treat and the range of operations they perform."

"Residency" is one of the terms applied to a physician's postgraduate education. Residents have already attained the Doctor of Medicine degree (M.D.) and are in the midst of multiple years of work alongside established peers in surgery or other branches of medicine. Surgical residencies are among the longest such educational experiences.

Residents in the San Antonio program gain proficiency in all areas of surgery, including pediatric surgery, penetrating and blunt trauma surgery, liver and pancreatic cancer surgery, and disaster response. Some of these offerings can be traced to the university-military relationship, Dr. Strodel said. "Many academic surgical residency programs have tried to integrate with military partners, but few have had as durable or stable a relationship as we do with Wilford Hall."

"The integration makes this a unique setting for physicians interested in trauma surgery," said Kenneth R. Sirinek, M.D., Ph.D., professor of surgery and director of the Health Science Center's general surgery residency program since 1985. "For example, while Wilford Hall records more cases of penetrating trauma, such as stabbing and gunshot wounds, our primary teaching hospital, University Hospital, records more cases of blunt trauma, such as injuries from auto accidents. Young surgeons in training must see both types."

Integration also provides faculty and residents with opportunities to observe and participate in military-related projects abroad. Ronald M. Stewart, M.D., director of the Department of Surgery's trauma program, recently spent time in Chile doing a project in conjunction with the U.S. Air Force. "The Air Force surgeons at Wilford Hall participate fully in events around the world, providing triage and other services soon after disasters occur," Dr. Strodel said. "No civilian residency programs offer that aspect of trauma management education."

A general surgeon practicing in a rural community would benefit immensely from such preparation, he said. Were an accident to happen at the local factory, for example, the surgeon would be well prepared to triage patients, determining who could be treated on site and who would need to be airlifted for treatment.

The closure of Kelly Air Force Base in San Antonio and the oft-rumored closure of Brooks Air Force Base served to solidify the historically strong university-military surgical collaboration. "The base closing issue has brought the university and the military even closer together to preserve medical education, which is one of the strengths of San Antonio," Dr. Sirinek said.

Contact: Will Sansom