Rotations include:

Longitudinal Clinical Experiences:

Ambulatory Clinical Experience
In this year-long continuity clinical experience, fellows spend one half-day per week under the supervision of an UMass faculty member in the geriatric medicine ambulatory clinic. Fellows participate directly in initial and follow-up evaluations of older patients seeing 4-5 patients/week and following their care through the fellowship.

Long-Term Care and Skilled Nursing Rehabilitation
There are two types of nursing home experiences: Fellows have longitudinal year-long care of a 10-12 patient panel at one nursing home; and 2 blocks each of month long term care and skilled rehabilitation at multiple nursing home sites. The fellow conducts initial and annual histories and physicals, and develops treatment plans and care transition plans for both long-term and short-term rehab patients. Fellows are supervised by geriatricians and geriatric nurse practitioners. They work with nursing staff and the interdisciplinary care team; observe the work of certified medical directors.

Home Care
The fellow will acquire the skills and attitudes necessary to evaluate and treat a variety of home-bound patients with chronic conditions, acute exacerbation of chronic conditions and occasionally acute conditions. Fellows will participate in home visits with supervising attending physician, nurse practitioner, and also independent home visits.

Geriatric Psychiatry
In the longitudinal geriatric psychiatry experience, fellows spend one half-day per month under the supervision of a geriatric psychiatrist at the Moak Center on Aging (link). Fellows participate directly in initial and follow-up evaluations of older persons with psychiatric conditions, behavioral problems, dementia, and assessing capacity.

Education
The fellow will acquire knowledge, skills and attitudes necessary to provide UME, GME, and CPE medical education regarding geriatric medicine. Fellows have a one-month rotation dedicated to increasing skills as an educator. The fellow works on a defined geriatric medicine project. Throughout the year fellows participate in Teaching for Tomorrow, a four part course on how to improve teaching skills.

Hematology/Oncology
Fellows will acquire the symptom knowledge and tests necessary to evaluation and manage neoplastic diseases and hematological malignancies in the elderly patient. Fellow will be able to identify patients at risk for malignancy and counsel them regarding risk reduction and screening. Participate in the difficult decisions regarding all aspects of management including diagnostic evaluation and screening, treatment, and palliative care with the patient and family members, understand drug side effects and interactions.

Palliative Care
Fellows will acquire symptom management and communication skills required to provide quality palliative and end-of-life care in various settings. Fellows will see a variety of end-stage diseases including but not limited to: malignancies, end-stage dementia, end-stage neurological disease, cerebro-vascular accident, old age and frailty, intractable infections, and gangrene.

Neurology
Fellows will acquire the skills to recognize, treat or refer patients and perform high quality medical care to geriatric patients with a wide mix of neurological disorders including: cerebro-vascular diseases, movement disorders (e.g. Parkinson’s disease and syndromes, Huntington’s disease), and cognitive disorders.

Physical Rehabilitation
Fellows gain experience in acute in-patient rehabilitation management through this experience at Fairlawn Rehabilitation Hospital in Worcester, an affiliate of UMass Memorial Medical Center. The fellow assesses, treats and develops strategies for geriatric patients understanding the complexity and interaction of co-morbid conditions on rehab potential. The fellow works within an interdisciplinary team (including physiatrists, RNs, social work, and physical, occupational, and speech therapists), and participates in the interdisciplinary team meetings.

Program of All-Inclusive Care for the Elderly" (PACE)
During this block rotation at Summit ElderCare (link) a PACE site, the fellow will experience a geriatric-based interdisciplinary team that provides adult day care, home care, hospital, and sub-acute care of its program participants. The fellow will attend daily team meetings, will attend daily clinic at the daycare site under the supervision of a board certified geriatrician and be involved in formulating assessment, evaluation and treatment plans for frail older community dwelling adults. As appropriate the fellow will participate in home and sub-acute care visits. 

Geriatric Fellowship Program

The Geriatric Medicine Fellowship offered by the Division of Geriatric Medicine is a one-year experience for physicians trained in internal medicine or family medicine interested in the care of the older adult. The Geriatric Medicine Fellowship provides educational experiences in a supportive environment of scholarship, integrity and critical thinking. The aim of the fellowship is three fold:

• To impart to the Geriatric Medicine fellows clinical competencies in the assessment and management of the older adult with complex medical, psychiatric and social problems.
•To provide the basic knowledge and understanding to conduct research in Geriatric Medicine.
•To equip fellows with the skills to become clinician educators.

During the fellowship, fellows work with different subspecialties of particular importance in the care of the older adult: palliative care, neurology, hematology/oncology, geriatric psychiatry, and physical medicine and rehabilitation. Fellows are expected to complete a research/scholarly project and develop skills as an educator within the course of the fellowship.

The Division of Geriatric Medicine is within the Department of Medicine and is closely connected to the Department of Family Medicine and Community Health, with fellowship faculty from both departments. Fellows are able to work with physicians and researchers dedicated to keeping the older adult healthy and at home as long as possible.

Catherine DuBeau, MD, Fellowship Program Director

Application Process:

Beginning with the 2014 academic year, Geriatric Medicine will be participating in the match program. For more information on the fellowship and the application process, please contact Margherita Altobelli, Fellowship Program Coordinator at 508-856-3085 or margherita.altobelli@umassmemorial.org. Information about our current fellows can be found here.


Rotations include:

• Longitudinal Clinical Experiences:

~Ambulatory Clinical Experience
In this year-long continuity clinical experience, fellows spend one half-day per week under the supervision of a UMass faculty member in the geriatric medicine ambulatory clinic. Fellows participate directly in initial and follow-up evaluations of older patients; seeing 4-5 patients/week and following their care through the fellowship.

~Long-Term Care and Skilled Nursing Rehabilitation
There are two types of nursing home experiences: Fellows have longitudinal panel of 10-12 patients at one nursing home and 2 blocks each of month long-term care and skilled rehabilitation at multiple nursing home sites. The fellow conducts initial and annual histories and physicals, and develops treatment plans and care transition plans for both long-term and short-term rehab patients. Fellows are supervised by geriatricians and geriatric nurse practitioners. They work with nursing staff and the interdisciplinary care team and observe the work of certified medical directors.

~Home Care
The fellow will acquire the skills and attitudes necessary to evaluate and treat a variety of home-bound patients with chronic conditions, acute exacerbation of chronic conditions and acute conditions. Fellows will participate in home visits with supervising attending physician, nurse practitioner, and also independent home visits.

~Geriatric Psychiatry
In the longitudinal geriatric psychiatry experience, fellows spend one half-day per month under the supervision of a geriatric psychiatrist at the Moak Center on Aging. Fellows participate directly in initial and follow-up evaluations of older persons with psychiatric conditions, behavioral problems, dementia, and assessing capacity.

• Education
The fellow will acquire knowledge, skills and attitudes necessary to provide Undergraduate Medical Education, Graduate Medical Education, and Continuing Physician Education regarding geriatric medicine. Fellows have a one-month rotation dedicated to increasing skills as an educator. The fellow works on a defined geriatric medicine project.

• Hematology/Oncology
Fellows will learn about the evaluation and management of neoplastic diseases and hematological malignancies in the older adult patient. Fellows will be able to identify patients at risk for malignancy and counsel them regarding risk reduction and screening. The fellow will participate in the difficult decisions regarding all aspects of management including palliative care and discussions with the patient and family members about the disease. The fellows will also learn about medication side effects and interactions.

• Palliative Care
Fellows will learn about symptom management and communication skills required to provide quality palliative and end-of-life care in various settings. Fellows will see a variety of end-stage diseases including but not limited to: malignancies, end-stage dementia, end-stage neurological disease, cerebro-vascular accident, old age and frailty, gangrene, and intractable infections.

• Neurology
Fellows will acquire the skills to recognize, treat or refer patients and perform high quality medical care to geriatric patients with a wide mix of neurological disorders including: cerebro-vascular diseases, movement disorders (e.g. Parkinson’s disease and syndromes, Huntington’s disease), and cognitive disorders.

• Acute Rehabilitation
Fellows gain experience in acute in-patient rehabilitation management through this experience at Fairlawn Rehabilitation Hospital in Worcester, an affiliate of UMass Memorial Medical Center. The fellow assesses, treats and develops strategies for geriatric patients understanding the complexity and interaction of co-morbid conditions on rehab potential. The fellow works within an interdisciplinary team (including physiatrists, RNs, social work, and physical, occupational, and speech therapists), and participates in the interdisciplinary team meetings.

• Program of All-Inclusive Care for the Elderly
During this block rotation at Summit ElderCare a PACE site, the fellow will experience a geriatric-based interdisciplinary team that provides adult day care, home care, hospital, and sub-acute care of its program participants. The fellow will attend daily team meetings, clinic at the daycare site under the supervision of a board certified geriatrician and be involved in formulating assessment, evaluation and treatment plans for frail older community dwelling adults. As appropriate the fellow will participate in home and sub-acute care visits.

• Wound Care
To provide the geriatric fellow with knowledge and skills to identify patients at risk for development of wounds and wound complications; prescribe preventive measures to promote skin integrity; and to treat wound problems once they develop.

• In-Patient Care
The geriatric fellow will become an efficient provider of high quality in-patient care of geriatric patients. Daily mentoring/feedback sessions between attending physician and trainee covering the following areas: case presentation, chart review, interaction with consultant specialist and allied health care providers, discharge planning, family conferences in person or by phone.

• Electives
Geriatric fellows will also have two elective months for them to focus in on areas that specifically interest them. Electives may include Research, Palliative Care, Urology, and Education.