Curriculum

Inpatient Geriatric Consultation Team

Over the course of the year, each fellow will spend 3 months on the inpatient interdisciplinary geriatric consultation team. The team consists of a social worker, geriatric clinical nurse specialist, geriatrics fellow, attending geriatrician, and rotating residents and students. Fellows gain skills in clinical geriatrics, consultation, and leadership of an interdisciplinary team. The team averages 2 to 4 new consultations per day, with over 50 percent of its referrals derived from general internists or internal medicine sub-specialists.

Outpatient Geriatric Consultation

Fellows participate in a weekly outpatient multidisciplinary Geriatric Assessment Clinic where patients are referred for evaluation of cognitive impairment, falls, depression, incontinence, failure to thrive, and other geriatric syndromes. The 3-part evaluation process is comprehensive, including memory testing, medication review and a complete physical exam. Fellows learn to work effectively in an outpatient team format, and communicate recommendations to patients, families, and referring physicians, all while under the supervision of faculty.

Geriatric Primary Care Clinic

Fellows spend one day per week managing the primary care of elderly patients, under the supervision of attending staff. Patients range from those needing preventive health maintenance and counseling to those with frailty and multi-system chronic disease. Fellows enhance the skills learned during their residency program, applying their expanding geriatrics knowledge base. Home care visits are included on the Geriatric Primary Care Clinic patients who are homebound.

Longitudinal Nursing Home Experience

Fellows participate in monthly follow-up of a small cadre of long-term nursing home patients at Beaumont's Woodward Hills Nursing Center over the course of the entire year. Fellows participate in ongoing quality improvement activities at the facility.

Nursing Home Block Rotations

Fellows spend three one month block rotations at Beaumont-affiliated nursing facilities throughout the year. Experiences include participation in Beaumont's novel subacute congestive heart failure rehabilitation program (designed to improve functional status in frail elderly patients admitted to hospital with congestive heart failure), subacute orthopedic rehabilitation, caring for a broad variety of skilled nursing facility patients, and chronic long term care. During the orthopedic subacute component, fellows interact with therapists and participate in team meetings with the consultant physiatrist. While caring for residents of the skilled nursing facility or long-term nursing facility, fellows become familiar with function-oriented assessment and management of a wide variety of geriatric syndromes.

Nursing Home Locations

• Evergreen Nursing Center
• Shelby Nursing Center
• West Bloomfield Nursing Center
• Woodward Hills Nursing Center

Psychiatry Rotation

Fellows spend one month on the Geropsychiatry service, managing elderly patients admitted to the psychiatry ward, participating in Geropsychiatry consultations, and spending time in the outpatient Geropsychiatry setting.

Hospice and Palliative Care Rotations

Fellows spend time each on the Hospice and Palliative Care Service where they participate in hospice/palliative care team meetings, make house calls under the supervision of the attending geriatrician, and have an opportunity to make house calls with other members of the hospice team in order to better understand their role as a hospice team member.  They participate in teaching rounds with Palliative Care and gain experience in end-of-life care providing compassionate care for the patient and family members.

Physical Medicine and Rehabilitation

The fellow spends one month on the Physical Medicine and Rehabilitation service, outpatient and inpatient with the PMR Chief and attending staff honing their skills on neuromusculoskeletal examination and becoming familiar with appropriate Physical, Occupational and Speech Therapy interventions.  They attend the PMR weekly didactics.

Outpatient Block Rotations

During this eight week block, the fellow spends two weeks with Urology in the Urodynamics lab, allowing him or her to correlate physiological abnormalities with the history and physical findings in patients with complex causes of incontinence. The fellow also spends two weeks in the Beaumont Wound Treatment Center, where he or she can develop expertise in superficial debridement of wounds, and become familiar with state-of-the-art management of chronic wounds. The fellow spends two weeks with the cardio rehab service where he or she will participate in the Heart Failure Rehab Program, EECP clinics and participate in the Optimal Aging Programs becoming familiar with cardiac rehabilitation in the geriatric setting.  Finally, the fellows spend two one-half days per week in the outpatient Geriatric Primary Care clinic with a psychologist for their Neuro Psych rotation assessing cognitive skills, mental status and spending time with the patient and family members discussing outcomes and diagnoses.

Notes

All sites are under the same governance of the Sponsoring Institution, the Beaumont Health Board of Directors and/or physicians are members of its  Beaumont Medical Group.

Site 1: Beaumont Hospital, Royal Oak
Site 2: Beaumont Hospital, Dearborn
Site 3: Henry Ford Village (also used for clinic 1 day per week)
Site 4: Evergreen Nursing Home
Site 5: Beaumont Commons
Site 6: Woodward Hills Nursing Center
Site 7: Michigan Institute for Neurological Disorders (MIND), 28595 Orchard Lake Rd., #200, Farmington Hills, MI  48334
Site 8: Beaumont Berkley Clinic
Site 9: Beaumont Hubbard Clinic 

SAR: Sub Acute Rehabilitation
AServices: Ancillary services at nursing home such as wound care, psychology, physical therapy, infection control
AMDA:Training toward certification by the American Medical Directors Association

Vacation: Fellows are provided four weeks of vacation, which may be taken throughout the year, except on the following rotations: Inpatient and SAR 

Driving distance between sites»

Didactics

Regularly scheduled conferences include:

• Weekly: Internal Medicine Grand Rounds and Seminars in Geriatrics
• Monthly: Journal Club, Morbidity and Mortality Conference
• Annually: CITI Research Training, Wound Care Curriculum, Kaizen Experience

Fellows receive didactic instruction on Medical Direction in long-term care, leadership, quality management, risk management, employee health, staff governance, infection control, and rules and regulations pertaining to long-term care. Additionally, teaching rounds are held regularly on the inpatient consultation service and during nursing home rotations.