Geriatrics Fellowship
Goal
To provide training for ABFM or ABIM Certified/Eligible Physicians to become effective, efficient and compassionate geriatricians who will pass their CAQ examination in Geriatric Medicine and pursue careers in academic or clinical Geriatrics.
Status
The Geriatrics Fellowship Program has been fully accredited by the Accreditation Council of Graduate Medical Education since 1987. The program has graduated 54 geriatricians through 2004. In 2006 the geriatric fellowship program was realigned through the generous support of the Francis E Parker Memorial Homes ( www.FrancisEParker.com ) to be integrated into the newly established Center for Health Aging at Parker Stonegate (CHAPS) of the Robert Wood Johnson Medical School Department of Family Medicine.
The program is administratively linked with the Family Medicine Residency Program at Robert Wood Johnson University Hospital and welcomes applicants from either family medicine or internal medicine backgrounds into its 12 month training program.
Clinical Training
The fellowship's clinical training is based in ambulatory care, long-term care (both institutional and community settings), and acute care inpatient hospital settings. Defined rotational experiences in such complementary disciplines as Geropsychiatry, Physical Medicine and Rehabilitation, Palliative and Hospice Care are incorporated into the core geriatric medicine experience of fellows in each setting.
Inpatient clinical rotations include acute and consultative hospital care of the sick elderly at Robert Wood Johnson University Hospital in New Brunswick , NJ . This 584 bed tertiary care hospital with a medical staff of 1,300 physicians is the core teaching hospital for Robert Wood Johnson Medical School and allows our geriatric medicine fellows peer interaction with the 300+ other residents and fellows from the other 33 fields of graduate medical education provided at this institution. Working with both the family medicine inpatient service and with patients of physician collogues from the Department of Medicine, the Cancer Institute of New Jersey, and the multidisciplinary staff resources of the hospital in social work, discharge planning and outcomes, pharmacy, and complementary medicine, geriatric fellows provide direct and formal consultative care for hospitalized elderly dealing with issues like palliative care management, decision-making capacity evaluations, and level-of-care determinations. Inpatient Geropsychiatry training occurs at the Carrier Clinic, a private, not-for-profit behavioral healthcare system in Skillman , NJ , that since the early 1910 has specializes in psychiatric and addiction treatment. Carrier's system includes a 281-bed inpatient psychiatric hospital, including a dedicated 45 bed older adult unit where the geriatric medicine fellows receive focused instruction and experience in all aspects of Geropsychiatry.
Long-term care training is based within the skilled nursing homes and new assisted living facilities of Parker Homes. Fellows provide primary institutional care for a panel of patients at the Parker facilities under the direct supervision and guidance of faculty geriatricians. Administrative skills and medical directorship experience in long-term care setting are also obtained by experiences at other sub-acute and long-term care nursing homes in the region. Geriatric fellows also gain additional experience in community-based long-term care aspects of care through experience in a variety of hospice and home care providers and work with the adult protective service from two central New Jersey counties in assessing and following older adult victims of elder mistreatment.
Ambulatory care training includes both primary care geriatrics and exposure to a wide variety of complementary ambulatory training experiences relevant to the clinical practice of geriatrics. Primary care geriatrics is based at the new clinical facilities of the CHAPS, within the Pavilion building, an intergenerational community and wellness center on the Piscataway/Highland Park campus of Parker Home. Geriatric fellows work with faculty in seeing patients here and at other faculty practices of the Department of Family Medicine. Specialty ambulatory exposures include detailed dementia assessment, based at the Comprehensive Services on Aging (COPSA) Institute for Alzheimer's disease and Related Disorders of UMDNJ University Behavioral HealthCare. Fellows are required to also maintain a weekly continuity clinic in their core discipline, seeing a broader age range of patients.
Didactics
Geriatric fellows experience a wide range of educational opportunities, both within the fellowship program itself and integrated with the RWJMS's training programs in Geropsychiatry, Family Medicine, and Medicine. A weekly geriatric medical case presentation conference is complemented by a weekly “Geri Rounds” topic conference and a monthly Geriatric Journal Club, led by the fellows themselves. Interaction with the Geropsychiatry Fellowship Program's didactic experiences also enhances collaborative learning at the fellowship level. The Parker Nursing Homes also serves as a site for monthly Geriatric conferences dealing with concerns for Nursing home patients. These rounds are conducted twice a month and are presented by residents, fellows, and faculty alike for a multidisciplinary audience. Geriatric fellows have participated in the Family Medicine departmental Faculty Development - Teaching Skills course and attend episodic gerontology and aging-related research presentations of interest by hosted by the Gerontological Institute of RWJMS and by Rutgers University .
Scholarship
The fellowship curriculum for geriatric fellows provides the fellows with a dedicated month of “selective” experience, during which the fellow selects an area of clinical interest and explore in depth the “state of the art” and develop clinically derived questions central to this area of their interest. This selective rotation is followed by a month focused on scholarship of limited clinical responsibilities when the fellow can generate a scholarly product – e.g., a literature review, an abstract, poster, or paper for publication, a formal presentation.) Recent geriatric fellows have co-authored a book chapter published in 2006 on integrating mental health with medical care in the nursing home setting, presented a 2004 research poster at the American Geriatric Society annual meeting on Clock-Drawing, and made a Grand Rounds presentation at a local hospital. The Research Division of the Department of Family Medicine Department is a resource for the fellows in such scholarly activities.
Evaluation
Fellows are evaluated both by physician faculty and by non-physician disciplines with whom they work (“360 degree evaluation”) and also provide direct feedback to faculty to continually improve and refine their learning experience. A required educational portfolio of clinical experiences, quality improvement activities, and scholarly products is maintained by the fellow to document their learning experience to aide in future career direction.
Faculty
John M. Heath, MD, AGSF Co- Director of Geriatric Fellowship
David F. Howarth, MD, MPH Co-Director of Geriatric Fellowship
Marian Stuart PhD
John Clabby PhD
Joshua Raymond MD, MPH, CMD
Robert Chen, MD, MBA
Umesh Mehta MD (Carrier)
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