Curriculum

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 actively involved on site to teach and oversee 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, with increasing independence given as their skills progress. The assessments are done with the assistance of geriatric nurses and social workers.

Inpatient Medicine

The fellows will have longitudinal and block experience participating as a geriatric consultant on the inpatient Geriatric Consultation Service (GCS). Areas of particular emphasis include geriatric trauma, geriatric heart failure, and delirium. They will work under the supervision of the faculty geriatricians and will follow a panel of geriatric patients admitted to the GCS. They will also participate in trauma 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. In addition to clinical care of nursing home patients, fellows will learn about the role of the Medical Director in long term care.

Hospice and Palliative Medicine

The fellows will spend 6 weeks working with the area’s largest hospice and palliative care organization, Hospice of Lancaster County (HLC). Under the supervision HLC physicians the fellow will assess and manage patients in the hospice inpatient center, nursing home, and on the inpatient Palliative Medicine Consultation Service. 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 6 weeks working with a local 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 the neurologist.

Physical Medicine and Rehabilitation

The fellows will spend 6 weeks focusing on rehabilitation in various settings including acute hospital, outpatient, home, rehab hospital, and nursing home. Time will be spent in the Lancaster General Gait and Balance Center, and with physical, occupational, and speech therapists in the various settings.

Introduction to Geriatric Services

The fellow will spend several weeks at the beginning of the year visiting and learning about various geriatric services available in the region. Some of these include:

• Home health agency including general medical, cardiac, and wound care
• Office of Aging, including Adult Protective Services and Capacity Assessments
• Adult day programs and senior centers
• Incontinence Center
• Gait and Balance Center
• Memory Disorders Center
• Lifecare PACE (program of all-inclusive care of the elderly) Program
• Physician home visits

Wound Care

Each fellow will spend several weeks 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 several 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 (e.g. writing, curriculum design, quality improvement, clinical research, etc.) throughout the year with opportunity to present at national geriatric conferences and the Lancaster General Health Research Day
• 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.