Outpatient Geriatric Continuity Practice

Each fellow will be assigned a panel of patients to follow during the fellowship year.  Visits include new patients, acute visits, physicals, home visits, and follow-up of chronic conditions.  Time spent in the office will vary between 2 and 4 half days per week.  Faculty preceptors are on site to answer questions and discuss patient management.

Comprehensive Geriatric Assessments and Outpatient Consultations

Patients are referred to the outpatient office for formal assessments and consultations for geriatric syndromes, dementia-related issues, and other complex medical issues.  Initially fellows observe faculty, then perform the visits under the supervision of faculty, and finally are assigned to complete the visits independently.  The assessments are done with the assistance of geriatric nurses and social workers.

Inpatient Medicine

The fellows will spend several weeks working on an inpatient medicine service supervised by a geriatric certified internist.  The fellow will follow a panel of geriatric patients which will include primary care, consultation, and ICU patients.

The fellows will also spend several weeks participating as a geriatric consultant on the inpatient geriatric trauma and heart failure services.  They will work under the supervision of the faculty geriatricians and will follow a panel of geriatric patients admitted to the trauma service.  They will also participate in trauma and heart failure multidisciplinary conferences.

Nursing Home Care

Each fellow is assigned a panel of nursing home patients which include acute rehabilitation patients and long term care patients.  The fellow rounds at the nursing home 2 half days per week for the entire year.  Each fellow is under the supervision of one of the faculty who meets weekly with the fellow to review cases and provide teaching.

Hospice and End of Life Care

The fellows will spend 1 month working with the area’s largest hospice organization, Hospice of Lancaster County.  Under the supervision of the hospice physicians the fellow will assess and manage patients in the hospice inpatient center, nursing home, and hospital.  They will also accompany the hospice physicians and nurses on home visits.

Geriatric Psychiatry

Approximately 6 weeks will be spent working with geriatric psychiatrists in various settings.  Some time will be spent doing consults on geriatric patients in an acute care hospital and in a nursing home.  The fellow will also spend time working on a dedicated inpatient geriatric psychiatry unit under the supervision of a certified geriatric psychiatrist.

Neurology

The fellows will spend 4 to 6 weeks working with a private neurology group seeing geriatric patients in the office, consultations in the hospital, and primary management in the hospital.  The fellow will have opportunity to independently assess and manage geriatric patients under the supervision of a neurologist.

Physical Medicine and Rehabilitation

The fellows will spend 2 weeks caring for a panel of patients on the inpatient rehabilitation unit under the supervision of a physiatrist.

In addition, the fellows will spend several days working with inpatient speech therapists, and physical and occupational therapists in the extended care facility.

The fellows will spend several days in a physical therapy-based incontinence center, and a physical therapy-based gait and balance center learning assessment and management techniques.

Home Care

The fellows will spend several half days participating in home visits through a local home health agency, and will be assigned to complete structured home visits on some of their continuity patients.

In 2008 a new home care program called Life Care will begin in Lancaster.  The fellows will have opportunity to spend time with this program during their home care rotation.

Office of Aging Experience

The fellows will spend time with the Adult Protective Services Team during investigations regarding elder abuse and neglect.  They will also have exposure to formal decision making capacity evaluations performed by a geriatrician.

Wound Care

Each fellow will spend several days working in Lancaster General’s Wound Management Clinic under the supervision of plastic and vascular surgeons.  They will also work with the inpatient wound care team at Lancaster General Hospital learning about wound assessment and management.

Elective

Each fellow has 1 month of elective time when they can choose to “build their own” rotation.  Popular rotations include cardiology, rheumatology, nephrology, endocrinology, medical direction of nursing homes, and wound care.

Scholarly Activity

• Present 4 lectures on geriatric topics to fellows, faculty, and residents each year
• Assist family medicine residents in geriatric morning report presentations
• Participate in weekly geriatric fellowship educational conferences
• Work on a project (writing, curriculum design, quality improvement, clinical research, etc.) throughout the year with opportunity to present at national geriatric conferences and the family medicine residencies yearly poster presentation.
• Participate in teaching family medicine residents on their geriatric rotation
• CME money and time given to attend a national geriatric conference or review course
• The American Geriatric Society’s Geriatric Review Syllabus is provided to each fellow at the beginning of the year for their personal use.
• CME money is available to join national geriatric organizations and to subscribe to publications.

7/08 MJB

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