This ACGME accredited, one-year fellowship in Geriatric Internal Medicine will provide the training necessary to be certified in the subspeciality of Geriatric Medicine. Applicants must have completed a three-year Internal Medicine residency. The Geriatric Fellowship is designed to provide the sub-specialty resident with detailed instruction, exposure and experience in the pathophysiology, diagnosis, treatment, management and understanding of Geriatric syndromes and related conditions. Fellows’ experiences will include the following:
- Inpatient and Geriatric Consult Team and Interdisciplinary Geriatric Program Unit: Fellows will become part of the interdisciplinary team (with geriatrician, advanced practice geriatric nurse, social worker, physical therapist, occupational therapist, pharmacist and chaplain) in the provision of consultative care to older adults. Fellows will be exposed to the full spectrum of geriatric syndromes. Such syndromes include dementia, delirium, falls, immobility, depression, polypharmacy, end-of-life issues and functional assessment, osteoporosis, and incontinence.
- Outpatient Geriatric Assessment: Fellows will be part of the interdisciplinary geriatric team, providing geriatric consultative services to a variety of referral services. This rotation will help fellows become experts in assessing geriatric syndromes that impact on function in older adults as well as interfacing with a variety of professional referral sources. Fellows will be exposed to the full spectrum of geriatric syndromes. Such syndromes include dementia, delirium, falls, immobility, depression, polypharmacy, end-of-life issues and functional assessment, osteoporosis, and incontinence.
- Geriatric Continuity Experience: Under the auspices of the Hospital of Saint Raphael’s ElderCare program, fellows will manage a cohort of older adults to provide ongoing primary care for a group of frail older adults. The goal of this experience is to enable fellows to learn to manage older adults with multiple chronic conditions. The (ElderCare Program is a series of primary care sites throughout the Greater New Haven area that provide to older adults living in a variety of senior housing sites comprehensive, ongoing primary care at the patient’s site of residence. Currently, the Hospital of Saint Raphael, in concert with the Greater New Haven Housing Authority, operates eight such sites). Fellows will have the opportunity to become experts in the provision of primary care to frail older adults that includes the management of multiple chronic conditions such as (in addition to the geriatric syndromes noted above) diabetes, hypertension, congestive heart failure, coronary artery disease and muscular skeletal disorders. Fellows will also complete home visits with Physician Assistants and the local Visiting Nurse agency as needed as part of their continuity experience.
- Geropsychiatry at the Hospital of Saint Raphael: Working with a board-certified geropsychiatrist, the fellow is exposed to the broad scope of common psychiatric syndromes, psychopharmacologic interventions, basic psychodynamics and psychotherapeutic interventions and family assessments in dealing with older adults. The intensity of the inpatient unit, as well as the hospital-wide consultative service, provides the required clinical experience in this rotation.
- Geriatric Rehabilitation: The fellow will learn to understand the principles of geriatric rehabilitation in both inpatient and outpatient environment. The fellow will participate in the interdisciplinary management of older adults with stroke, traumatic brain injury and musculoskeletal disorders. In addition, they will become adept at managing chronic medical conditions in the setting of acute rehabilitation at The Sister Anne Virginie Grimes Health Center (a 125-bed skilled nursing facility that is part of the Saint Raphael Healthcare System and is located proximal to the main hospital, providing both short-term and long-term care.
- Hospice (Inpatient and Outpatient): The Geriatric Fellow will become competent in the management of medical issues that relate to terminal care in older adults. Fellows will rotate in an inpatient setting through the Connecticut Hospice for a set period of time per our Affiliation Agreement. The Fellow will also receive exposure to the end of life care of older adults in the patient’s home environment. The fellow will also receive specific training in the areas of end of life issues, pain management, management of delirium and interdisciplinary team processes regarding the terminal care of older adults.
- Research: Fellows will become adept at the critical review of geriatric research publications. They will also become familiar with the basic methodology surrounding clinical outcomes, research and systems based research regarding issues in Geriatrics and Gerontology. Fellows will receive formal didactic sessions on the principles of geriatric research
- Conferences. In addition to weekly didactic conferences on a variety of geriatric topics and monthly geriatric journal club, fellows will be responsible for 4-6 conferences that they present per year to a variety of hospital professional audiences. Fellows will be expected to become comfortable with teaching and presenting information to large audiences. They also will be able to attend as time permits the full spectrum of internal medicine and subspecialty conferences throughout the various academic departments of the hospital.
- Teaching: The geriatric fellow has the usual teaching responsibilities to residents and medical students as fellows in other fellowship programs at the Hospital of Saint Raphael.In addition, the fellow will observe and is observed by teaching faculty in the full spectrum of didactic settings. They will also present on a scheduled basis in numerous didactic settings and share teaching roles with the faculty through the following:
- Involvement with the teaching of continuing education activities related to Geriatrics.
- Clinical teaching for students and house officers at each of the fellowship clinical sites outside of the acute hospital
- Community education of older adults themselves
If you are a qualified candidate interested in an application for the Geriatric Fellowship, please contact:
Barbara E. Dahl
Phone: 203.789.6080
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