University Hospitals/Veteran’s Administration Fellowship Program in Geriatric Medicine
The University Hospitals (UH)/Veteran's Administration (VA) fellowship program in geriatric medicine is directed by the Center for Geriatric Medicine at University Hospitals Case Medical Center and is a collaborative program sponsored by the Case/UH departments of Family Medicine and Internal Medicine. We involve health professionals from a variety of other disciplines including nursing, social sciences, dentistry, public health, environmental sciences, and education. The Institute of Medicine (IOM) in April, 2008 noted that “the nation faces an impending health care crisis as the number of older patients with more complex health needs increasingly outpaces the number of health care providers with the knowledge and skills to adequately care for them. Right now the United States is not prepared to meet the social and health care needs of elderly people.” This UH/VA fellowship program is designed to train family physicians and internists in the practices and principles of caring for frail elders. We strive to train tomorrow’s senior care leaders whether it is for academia, clinical care, and/or research. We offer unique training opportunities in each of these areas. Our fellows are expected to participate in a scholarly project during their fellowship. We have a broad inter-professional staff of physicians, nurses, social scientists, and educators working with our program to help our fellows meet these objectives.
Our program offers four fellowship positions each year. One year clinical fellowship slots are available as are multi-year fellowships for individuals interested in pursuing research. Opportunities for additional fellowship training in Quality Improvement (VA Scholars program) or advanced degrees such as a Master in Public Health through CWRU are available.
The UH/VA Geriatric Medicine Fellowship Program takes advantage of the growing senior care network within these two systems. Fellows will spend time at each institution as well as interacting with community agencies. The program strengths include training in Comprehensive Geriatric Assessment, Transitional Care, Inpatient geriatrics, Hospice/Palliative Care and House Calls Medicine. A new addition to our training program is a Palliative Care consult service at University Hospitals.
University Hospitals Case Medical Center
- Inpatient consults—geriatrics and palliative care
- Research opportunities
VA Medical Center at Wade Park in Cleveland (four blocks from UH)
- Geriatric Evaluation Management Unit
- Primary care clinic
- Rehabilitation medicine
- Research opportunities
University Foley Elder Health Center
- Comprehensive Geriatric Assessment
- Comprehensive care of frail elders
- Memory and Aging Center – behavioral neurology
Selected Extended Care Facilities near the main campus
House Calls Medicine (physician home visiting)
Hospice and Palliative Medicine
- Hospice of the Western Reserve
- Montefiore Hospice
- UH Palliative Care consult service
Educational Program Goals
The goals of the educational program for our fellows are:
- Knowledge Base
- To provide current scientific knowledge of aging and longevity including theories of aging, physiologic versus pathologic changes of aging, epidemiology of aging and natural history of aging, and diseases of the aged;
- To review aspects of preventive medicine including nutrition, exercise, screening, immunizations, and awareness of community resources;
- To present syndromes of special interest to geriatric medicine including but not limited to cognitive impairment, falls, incontinence, osteoporosis, pressure ulcers, sensory impairment, polypharmacy, oral health and nutrition;
- To present pharmacological alterations associated with aging including pharmacokinetics, pharmacodynamics, drug interactions, over medication, and issues regarding compliance in treating patients;
- To review psychosocial aspects of aging including housing, depression, bereavement, and anxiety;
- To review economic aspects of supportive services including Title II of the Older Americans Act, Medicare, Medicaid, and cost containment in working with patient and family;
- To review ethical and legal issues especially pertinent to geriatric medicine including competency, guardianship, right to refuse treatment, and advance directives;
- To review research methodologies related to geriatric medicine including biostatistics, clinical epidemiology, medical information, information sciences, decision analysis, critical literature review, and research design for cross-sectional and longitudinal methods;
- To review economic aspects of a geriatric practice, including practical experience with billing issues.
- Psychomotor skills
- To be able to use appropriate audiovisual aids to develop and present didactic instruction on general medical, clinical care of the elderly and common medical syndromes to groups of colleagues, students, or other health professionals;
- To be able to design and present patient education programs on general medical care in clinical settings such as the nursing home, outpatient clinic or in-patient setting.
- Practical Experience
- To present a lecture on theories of physiology and biology of aging and tissue and organ systems at the VAMC or UHCMC to faculty and/or residents/students;
- To present lectures or lead discussions at University Hospitals Case Medical Center, an outside hospital, or in the community on geriatric issues;
- To present current knowledge of aging including theories of aging, physiologic versus pathologic changes of aging, epidemiology of aging and natural history of aging, and diseases of the aged at conferences, lectures, and rounds;
- To lead case-based conferences on geriatric syndromes.
For more information or an application to the Geriatric Medicine Fellowship program, contact Deborah Armstrong-Davis at 216.844.6338 or Deborah.Armstrong-Davis@uhhospitals.org.