GERIATRIC MEDICINE FELLOWSHIP CURRICULUM

Curriculum Overview

Geriatrics is a One-Year Fellowship

• Continuity nursing home care, 2 half-days a week
• Outpatient geriatric office, 2 half-days a week

Core Fellowship Rotations

• Rehabilitation Medicine
• Home Care Experience
• Geriatric Consultation Service
• Palliative Care and Hospice
• Wound Care
• Alzheimer's and Memory Care Program
• Neurology
• Cardiology
• Psychiatry
• Elective

Outpatient Geriatric Primary Care

Each fellow cares for their own panel of patients during the fellowship year as part of their outpatient continuity experience. Fellows see older patients ranging from healthy, active older adults to frail, elderly near the end of life.

Fellows see patients in the main office of the Lancaster General Health Physicians Geriatrics practice two half-days per week. Faculty preceptors are actively involved on-site to teach and oversee patient management. Fellows have the opportunity to collaborate with our on-site Geriatrics Social worker and Geriatric Clinical Pharmacist.

Visits include:

• New patients
• Acute visits
• Physicals and preventative care
• Management of chronic conditions
• Common outpatient procedures
• Outpatient geriatric consultations, often for memory concerns or other geriatric syndromes

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. Fellows round 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 regularly with the fellow to review cases and provide instruction.

In addition to clinical care of nursing home patients, fellows 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 long-term care treatment, including:

• Chronic disease management
• Dementia and related behavioral disturbances
• Rehabilitation
• Palliative and end-of-life care

Inpatient Geriatric Consultation Service

On the inpatient Geriatric Consultation Service (GCS) fellows perform comprehensive geriatric assessments on new consults and provide daily co-management of key geriatric issues for patients on the service. Fellows work under the supervision of faculty geriatricians, follow a panel of geriatric patients assigned to the GCS, and have the opportunity to participate in interdisciplinary trauma rounds.

Common scenarios include:

• Geriatric trauma
• Patients with delirium
• Capacity evaluations
• Polypharmacy
• Goals of care discussions

Geriatrics at Home Program

In 2013 Geriatrics started a medical house call program in which geriatricians provide primary and transitional care for frail elderly patients who are homebound. As part of this program, fellows have one session per month designated to providing home care.

Visits are supervised by the home care geriatrician and include caring for patients who have significant functional impairment or frailty rendering them homebound and those near the end of life who are receiving palliative and hospice care within their homes.

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
• RN case manager
• Support staff

Fellows 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.

Cardiology

Fellows round with cardiologists in both the inpatient and outpatient setting with a focus on care of elderly. Fellows learn to manage and provide guidance to patients with worsening or end-stage cardiac disease.

Geriatric Psychiatry

At Lancaster General Hospital fellows 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.

Hospice and Palliative Medicine 

Fellows rotate with both LG Health palliative medicine physicians and physicians through the area’s largest hospice and palliative care organization, Hospice and Community Care (HCC).

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.

Neurology

Fellows work with LG Health Physicians Neurology physicians seeing geriatric patients in both the office and inpatient settings 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

Fellows focus on rehabilitation in various settings, including acute hospital, outpatient, and nursing home. Fellows spend time in the gait and balance program, the incontinence program, and with physical, occupational and speech therapists in the various settings.

Wound Care

Each fellow spends several weeks working in the LG Health Physicians Wound Care and Hyperbaric Medicine practice under the supervision of wound specialists including podiatry, internists, and plastic and vascular surgeons. Fellows also work with the wound team at a local nursing home learning about wound assessment and management.

Scholarly Activity

Fellows have the opportunity to participate in scholarly activities throughout the year including quality improvement projects, case reports, poster presentations, curriculum development, and clinical research. Lancaster General Health's Research Institute is available to provide additional support, as needed. 

Fellows present two evidence-based review lectures on geriatric topics through the weekly Geriatric Fellowship Conference.