Curriculum

The goal of the Geriatric Fellowship is to conduct an intensive one year program of learning in Geriatric Medicine. The graduate will be prepared to pass the geriatric board exam and to practice geriatrics in any arena including but not limited to patient care, teaching, and administration. The following is a description of the rotations included as part of the fellowship program:

1. Continuity clinic:
This experience consists of the evaluation and following over the residency of ambulatory older persons as they receive primary medical care. It will consist of one 4 hour session per week for the entire residency in a primary care geriatric office. The experience will include new patient evaluations, yearly assessments and interval care. Patients will be selected in a way to insure a broad mix of outpatient geriatric problems. The Fellow will see patients independently and will organize treatment plans under the supervision of the attending.

2. Assisted Living (Piper Shores):
The Fellow will admit and follow over the course of the residency selected older persons living in the assisted living unit of a local retirement community called Piper Shores. The supervising physician is the Medical Director of the facility. The Fellow will also provide some acute illness care, when needed, for the patients of the Medical Director.

3. Nursing Home and Skilled Care (Seaside Nursing Home, Portland):
Throughout the residency experience the Fellow will spend one four-hour session weekly at Seaside Nursing Home (Portland) under the supervision of the Medical Director, Dr. Richard Marino. The Fellow will admit and care for a panel of patients over time and will be an integral part of the teaching of other Internal Medicine and Family Medicine residents at that site.

4. Outpatient geriatric assessment (The Geriatric Center):
The clinic meets weekly and is designed to provide comprehensive geriatric assessment in a multidisciplinary form to elderly patients who are community living and perceived to not be functioning well. The Fellow will work with geriatricians, geriatric psychiatrists and other clinical staff in the evaluation of new patients, provision of early dementia patient and family services and other clinic functions. The Fellow will perform and participate in the physician portion of the assessment and will play a major part in the synthesis of information in order to create a list of diagnoses and a treatment plan. The Fellow will also conduct the family/caregiver meetings. The assessment is supervised by faculty who have experience with Geriatric Assessment in outpatients.

5. Acute Care for the Elderly unit (ACE Unit):
The ACE Unit is a geographically and structurally distinct unit of the Maine Medical Center designed to provide the team concept of care for complicated acutely ill elderly patients. While assigned to the Acute Care Rotation (four months per year) the Fellow will be an integral member of the ACE unit team. The unit and the Fellow are supervised by a member of the geriatric faculty (Dr. Weirman). All patients assigned to the unit are seen daily by the ACE team and the principles of geriatric medicine are utilized to shorten the length of stay, prevent hospital related complications, and to maintain maximal function and independence. 

6. Geriatric Consult Service:
The Geriatric Consult Service is a team of geriatricians organized to provide consults to acutely ill hospitalized patients. When assigned to the Acute Care Rotation (four months per year) The Fellow will be a member of the consult team. He/she will perform consults under the supervision of the geriatrician assigned to the consult service at that time. Each patient consult will be reviewed with the faculty member and the care plan will be reviewed on the day the patient is seen.

7. Hospital Elder Life Program (HELP):
HELP is a program designed to prevent delirium in acutely ill, at risk, hospitalized patients through the use of volunteer administrated, validated protocols. The program is administrated by a physician director who is assisted by a masters level recreational therapist and a masters degree nurse. The program also uses principles of geriatrics to maintain maximal levels of patient independence and, therefore prevent nursing home placement. While assigned to the Acute Hospital Rotation, the Fellow will assist the team in the evaluation of patients and will help administer protocols to patients.

8. Geriatric inpatient service:
During this rotation, the Fellow will follow inpatients from the Consult Service, the ACE Unit, and the Hospital Elder Life Program (HELP).  Supervision will be provided by the faculty member performing the consults and by the physician who oversees teh ACE Unit and the HELP Program.

9. Outpatient geriatric neurology:
During the Geropsychiatry and Neurology rotation, the Fellow will spend one four to five-hour session per month over the course of the year in the office of a local neurologist. In this time the Fellow will perform neurology consults and revisits under the supervision of the neurologist. 

10. Geriatric rehabilitation (New England Rehabilitation Hospital):
This three month experience exposes the Fellow to an intense experience dealing with patients who are recovering from conditions such as hip fractures and replacements, knee replacements, strokes, amputations, spinal cord injury, multiple trauma, brain injury and debility due to various medical conditions, including cancer. The Fellow will admit and manage patients as a member of the rehabilitation team. The supervising physicians are physiatrists or internists and the hospital Medical Director. The Fellow will also take part in a number of outpatient clinics such as the Stroke Clinic and the Amputee clinic.


11. Home visit program:
It is expected that the Fellow will conduct a minimum number of home visits to the homes of patients whose care he/she has had a part in arranging. A member of the faculty will precept the resident in this function. The Fellow will assure that the care rendered through the home visits is coordinated with the other providers of care (especially the appropriate home nursing service).

12. Geropsychiatry:
The geriatric psychiatry rotation will include patient care in both the inpatient and outpatient arenas. Some supervised time will be spent consulting on patients in nursing homes. Some time will be spent on the inpatient geriatric psychiatry service both evaluating and treating elderly patients hospitalized with acute psychiatric illnesses under the supervision of a geriatric psychiatrist. An outpatient geriatric psychiatry clinic is available for additional training. Geriatric psychiatrists will supervise the Fellow in all sites.