LancasterGeneralHealth Family Medicine Residency Program

Curriculum

Lancaster General Hospital Geriatric Fellowship
Curriculum Overview


Outpatient Geriatric Primary Care

Each fellow cares for their own panel of patients during the fellowship year. The fellows will see patients in the main office of the Lancaster General Health Physicians Geriatrics practice.  This practice has offices at three sites and is staffed by 14 geriatricians and 13 nurse practitioners. Visits include new patients, acute visits, physicals and preventative care, management of chronic conditions and common outpatient procedures. The fellows will see older patients ranging from healthy, active older adults to frail elderly near the end of life.  Time spent in the office will vary between two and three half days per week. Faculty preceptors are actively involved on site to teach and oversee patient management.

Medical House Call Program

In the summer of 2013 Geriatrics started a Medical House Call Program where geriatricians provide primary and transitional care for frail elderly patients who are home-bound.  The fellows will have one session designated per month to provide home care as part of this program, supervised by the Home Care Geriatrician.  Visits will include caring for patients with significant functional impairment or frailty rendering them home-bound and those near the end of life who are receiving palliative and hospice care within their homes.

Nursing Home and Long-Term Care

Each fellow is assigned their own panel of nursing home patients which includes both acute rehabilitation and long-term-care patients. The fellow rounds at the nursing home two half days per week throughout the year under the supervision of a faculty preceptor.  The supervisor provides direct and indirect supervision and meets weekly with the fellow to review cases and provide teaching. In addition to clinical care of nursing home patients, fellows will learn about the role of the Medical Director in long term care through lectures, discussions and direct participation in Medical Director-related activities at their assigned facility.  Fellows gain in-depth experience in a wide range of aspects of long-term care including chronic disease management, dementia and related behavioral disturbances, rehabilitation, and palliative and end of life care.

The long-term care facilities where fellows are currently assigned are:  Moravian Manor, Conestoga View, and Mennonite Home

Alzheimer’s and Memory Care Program (AMC)

In 2012 Lancaster General Health combined multiple pre-existing programs to formulate the comprehensive Alzheimer’s and Memory Care Program (AMC).  The AMC is a place where patients and families can receive comprehensive assessment, management recommendations, education and ongoing support for memory disorders.  The AMC is staffed by an interdisciplinary team that includes: neuropsychology, geriatrics, neurology, social work, an RN case manager and other support staff.  The Geriatricians take part in the medical assessment of patients with suspected memory disorders, participate in interdisciplinary case discussions and assist in leading family meetings where diagnoses and management strategies are discussed.  The geriatricians also provide ongoing dementia care to some of the AMC patients.  The geriatric fellows take an active role in all aspects of this program throughout the fellowship year.

Inpatient Geriatric Assessments and Consultations

The fellows spend several weeks throughout the fellowship year serving as a geriatric consultant on the inpatient Geriatric Consultation Service (GCS). They perform comprehensive geriatric assessments on new consults and provide daily co-management of key geriatric issues for patients on the service.  Patient types frequently included on the service include geriatric trauma, heart failure in frail and/or cognitively impaired geriatric patients and patients with delirium. The fellows work under the supervision of the faculty geriatricians and follow a panel of geriatric patients assigned to the GCS. They also have opportunity to participate in interdisciplinary trauma rounds.

Hospice and Palliative Medicine

The fellows spend approximately six weeks working with the area’s largest hospice and palliative care organization, Hospice and Community Care (HCC). Under the supervision of HCC physicians, the fellows assess and manage patients in the hospice inpatient center, nursing homes and on the inpatient Palliative Medicine Consultation Service at Lancaster General Hospital. They also accompany the hospice physicians and nurses on home visits as part of their experience.

Geriatric Psychiatry

The fellows spend several weeks learning geriatric psychiatry in a variety of settings.  At Lancaster General Hospital they are assigned to the inpatient Consultation Liaison Psychiatry Service where they perform new psychiatric consults and perform follow-up assessments under the supervision of the attending psychiatrist.  The focus is on elderly patients in the general medical units or ICU who are experiencing significant behavioral, psychological or psychiatric symptoms.  The fellows also spend time rounding with psychiatrists at two local long-term care facilities learning about assessment and treatment of common psychiatric conditions in the elderly in that setting.

Neurology

The fellows spend approximately one month working with a local neurology group seeing geriatric patients in the office and rounding on inpatients on the neurology service at Lancaster General Hospital. Fellows have the opportunity to independently access and manage geriatric patients under the supervision of the neurologist.

Physical Medicine and Rehabilitation

The fellows spend approximately six weeks focusing on rehabilitation in various settings including acute hospital, outpatient, and nursing home. Time is spent in the gait and balance program, the incontinence program, and with physical, occupational and speech therapists in the various settings.

Introduction to Geriatric Services

At the beginning of the fellowship year, the fellows spend several weeks visiting and learning about various geriatric services available in the region. Some of these include:

  • Home Health Nursing Agency ( general medical, cardiac, and wound care)
  • Lancaster County Office of Aging (overview, Adult Protective Services, Capacity Assessments)
  • Adult day programs and senior centers
  • Incontinence Center
  • Gait and Balance Center
  • Alzheimer’s and Memory Care Program

Wound Care

Each fellow spends several weeks working in the Lancaster General Health Wound Care & Hyperbaric Services under the supervision of wound specialists including podiatry, internists, and plastic and vascular surgeons. They also work with the inpatient wound care team at Lancaster General Hospital and with the wound team at a local nursing home learning about wound assessment and management.

Scholarly Activity

There are many areas of the fellowship where fellows participate in scholarly activity.  Dedicated time for education about and working on scholarly activity is given throughout the fellowship year.  Lancaster General’s Research Institute is available to provide additional support as needed. Activities for fellows include:

  • Presenting two evidence-based review lectures on geriatric topics to fellows, faculty and residents
  • Assisting family medicine residents in geriatric morning report presentations
  • Participating in weekly geriatric fellowship educational conferences and quarterly journal clubs
  • Taking part in a scholarly project (e.g. case reports, poster presentations, curriculum development, quality improvement, clinical research, etc.) throughout the year with opportunity to present at national geriatric conferences and the Lancaster General Health Spring Research Day
  • Participating in teaching family medicine residents who are on their geriatric rotation
  • Using CME money and time to attend a national geriatric conference or review course
  • Reviewing the American Geriatric Society’s Geriatric Review Syllabus - provided to each fellow at the beginning of the year for their personal use.
  • Using CME money to join national geriatric organizations and to subscribe to publications.

Quality Improvement

Fellows spend dedicated time each month working on a geriatric quality improvement (QI) project and learning about principles of quality improvement.  Fellows may either develop a new QI project or participate in QI projects already underway within the Division of Geriatrics.

Didactic Conferences

As mentioned elsewhere on our webpage, the fellows attend weekly geriatric conferences which cover a wide range of topics.  For each of the main rotations or topics listed above, there are several related didactic conferences throughout the year that complement the information learned while directly caring for patients.