The goal of the fellowship is to produce expert clinicians in the field of geriatric medicine who are able to practice successfully in the various settings, in which the elderly seek care. The program curriculum consists of seminars, conferences and clinical teaching of defined geriatric syndromes. The curriculum emphasizes:
- The benefits of, and need for, an interdisciplinary team approach to care delivery
- Palliative and family-focused care
- Community care for the elderly
Fellows are also taught the ACGME "core" competencies including professionalism, practice-based learning and systems-based practice. We have developed several highly specialized training modalities as part of the core curriculum. These include hospice and palliative home-based sub-acute care, pain management, wound care, gero-psychiatry and neurology.
An expanding home visit program for functionally compromised older patients is a part of the training experience. This service delivers care to many chronically ill older people unable to visit medical clinics or offices. The fellow in training is expected to develop a panel of patients to follow under faculty supervision
The ACE Unit is a specialized inpatient service delivering comprehensive, compassionate care to the elderly using the skills of an interdisciplinary team. The goal of this unit is to minimize the hazards of hospitalization for the elderly and to design safe and effective transitional care. The medical team consists of an attending physician trained in geriatric medicine, fellows-in-training (all of whom rotate through the ACE Unit), residents and medical students. The geriatric fellow functions as a junior attending on the ACE Unit, involved in teaching through bedside rounds and seminars. Administrative duties of the fellow include coordination of the unit-based interdisciplinary, discharge planning, management, and teaching rounds on the unit, and journal club. Residents and students learn about the specialized care necessary for effective treatment and discharge of older patients, and become familiar with the relevant baseline assessments necessary to formulate a good care plan. There is a specific ACE curriculum with goals and objectives outlined for fellows.
Each fellow follows a longitudinal cohort of nursing home residents for monthly visits. In addition, each fellow will rotate through two nursing home sites — one oriented toward "specialty" experiences, such as physical therapy, occupational therapy, speech therapy, podiatry, hospice and audiology, and the second to gain experience as a nursing home physician on a sub-acute nursing home floor.
Fellows follow a panel of outpatients throughout their fellowship in one of our ambulatory care sites with a geriatric preceptor.
In addition to the ACE unit, fellows rotate on an inpatient consult service and evaluate patients on medical, surgical, and psychiatric services for concurrent geriatric issues. They also spend time learning wound care with a wound care specialist.
As part of the didactic curriculum, fellows are expected to participate in question sessions to equip them for the certificate of Added Qualifications in Geriatric Medicine, using standard textbooks of geriatric medicine, the AGS Geriatric Syllabus and relevant journal articles.
Fellows are encouraged to participate actively in the Metropolitan Area Geriatrics Society, a New York State affiliate of the American Geriatrics Society. We encourage submission of original work in the field of aging to national and local organizations, and fellows are expected to develop a research project leading to such submissions.