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Geriatric Fellowship Curriculum

Curriculum

Geriatric Fellowship Curriculum

This is a fellowship training program in Geriatrics in Osteopathic Family Medicine and Manipulative Treatment, designed to provide osteopathic family physicians with advanced and concentrated training in the specialty of Geriatrics. It is sponsored by the Edward Via College of Osteopathic Medicine in Spartanburg, SC.

Upon the successful completion of this fellowship in Geriatrics, the physician will be prepared to provide comprehensive Geriatric care and will be prepared for Geriatric certification by the American Osteopathic Board of Family Physicians (AOBFP).

Educational Program Goals

The goal of the Geriatrics fellowship training is to prepare fellows for competency in the following core areas:

  1. Osteopathic Philosophy and Osteopathic Manipulative Medicine
    • The integration of osteopathic principles into the daily practice of Geriatrics.
    • The appropriate application of OMM to Geriatrics patient management.
  2. Medical Knowledge
    • Maintain current knowledge of clinical medicine that reflects the majority of patient care issues present in Geriatric settings.
    • Maintain current knowledge of behavioral medicine that reflects the majority of patient care issues present in Geriatric settings.
  3. Patient Care
    • Provide osteopathic Geriatrics patient care service in ambulatory continuity, hospital, and extended care sites.
    • Accurately gather essential information from all sources including patients, care givers, other professionals, electronic sources, and paper sources.
  4. Interpersonal & Communication Skills
    • Develop appropriate doctor-patient relationships in all Geriatrics settings.
    • Develop effective listening, written, verbal and electronic communication skills in professional interactions with patients, families and other health professionals.
  5. Professionalism
    • Demonstrate respect for patients and families and advocate for the primacy of patient’s welfare and autonomy.
    • Adhere to ethical principles in the practice of Geriatrics.
    • Demonstrate awareness and proper attention to issues of culture, religion, age, gender, sexual orientation, mental and physical disabilities.
  6. Practice-Based Learning and Improvement
    • Apply the principles of evidence-based medicine to Geriatrics.
    • Participate in practice-based objective performance improvement projects in Geriatrics settings.
  7. Systems-Based Practice
    • Effectively function within local and national health care delivery systems to provide high quality Geriatrics services.
    • Effectively function within a team to provide care to Geriatrics populations.

Facilities

  • VCOM has an organized department of Family Medicine, Osteopathic Manipulative Medicine, and Geriatrics.
  • The primary training facilities are located in geographic proximity so as to allow for efficient functioning at the educational program.
  • Training in ambulatory Geriatrics will take place in a Geriatric office, where medical care is delivered under supervision of the Geriatrics Program Director.
  • Training in nursing home care will take place in facilities that are licensed to provide skilled nursing care by state and federal authorities.
  • Training in inpatient Geriatrics care will take place in local hospitals.
  • Training is hospice care will take place in conjunction with local hospices.

Program

  • The duration of Geriatrics fellowship training will be twelve (12) months.
  • The program will have an organized schedule of didactic presentations on Geriatrics.  This is based on the AGS Geriatrics Review Syllabus.  At a minimum, it includes:
    • Disorders of the aging renal system.
    • The biology, psychology and physiology of aging.
    • Pharmacology in the elderly.
    • Comprehensive Geriatrics assessment including cognitive, functional, and psychosocial evaluation.
    • Preventive medicine, including proper nutrition, exercise prescription, counseling, immunizations and chemoprophylaxis.
    • Physical medicine and rehabilitation, including complications to rehabilitation caused by illness.
    • Health promotion and disease prevention, nutrition, exercise and health screening as it relates to the Geriatrics patient.
    • Mental health concerns including loss of a spouse, death and dying, depression, dependency, caregiver burden and sexuality in the elderly.
  • The program will provide clinical training in the following areas for Geriatric patients:
    • Special problems common in the hospitalized elderly including iatrogenesis, immobility, polypharmacy and pressure ulcers.
    • Cardiovascular disorders with emphasis on degenerative diseases, dysrhythmias, congestive heart failure and peripheral vascular disease.
    • Neurologic disorders, including cerebrovascular disease, neurodegenerative disease, dementias and delirium.
    • Endocrine disorders, including diabetes mellitus and thyroid disorders.
    • The arthritides and osteoporotic disease.
    • Fracture management including hip, spinal and extremity fractures.
    • Pre-surgical evaluation and medical clearance.
    • Post-surgical rehabilitation and recovery.
    • Nutritional needs to include hyperalimentation and parenteral nutrition.
    • Infectious diseases of the elderly.
    • Malignant diseases.
    • Psychiatric and psychological needs and evaluation of the Geriatrics patient.
    • The impact of health care cost or the elderly and public policy recommendations.
    • Geriatrics facility administration.
    • Ethics, advance directives and end-of-life decision-making skills.
  • Training will include the interdisciplinary approach to patient care:
    • Fellows will gain experience in collaboration with multiple professions such as physician assistants, nurse practitioners, nurses, social workers, physical, speech and occupational therapists, and others involved in the comprehensive care of elderly persons.
    • Training will include participation in interdisciplinary case management of nursing home patients.
  • The fellow will be assigned duties at the Edward Via College of Osteopathic Medicine in Spartanburg teaching and monitoring medical students.

Continuity of Care Training

  • The fellow will receive continuity patient training at an ambulatory continuity site, an inpatient facility, a nursing home facility, and in the patient’s home.
  • Ambulatory Continuity: 
    • Each fellow will be assigned a panel of patients at the Geriatrics ambulatory continuity site.
    • The fellow will be responsible for the management of these patients, for the majority of the year of fellowship.
  • Inpatient Medicine:  Each fellow will receive training in the inpatient care of Geriatrics patients. At a minimum, this includes:
    • Participation in an integrated Geriatrics service that includes medical and surgical services with cooperative involvement of all other related departments of the institution.
    • Management of Geriatrics acute and chronic illness.
    • Management of Geriatrics patients with other health care professionals.
    • Coordination of care.
    • Management of transfer of care to and from the patient’s residence.
    • Production of comprehensive medical records.
    • Utilization management and discharge planning.
  • Nursing Home:  Each fellow will receive training in the care of Geriatrics patients in nursing home settings.  At a minimum, this includes:
    • Evaluation of new patients and completion of requirements for admission.
    • Adherence to regulatory requirements governing nursing home care.
    • Participation in interdisciplinary team meetings and discharge planning when appropriate.
    • Completion of discharge duties and arrangement for appropriate follow-up.
    • Call several times a month with backup.
  • Home Care:  Training for home care services will be offered. At a minimum, this includes:
    • Referrals to appropriate home nursing or hospice care services.
    • Completion of appropriate admission and follow-up paperwork.
    • Home care visits.
    • Identification and utilization of community resources for care of elderly patients at home.
  • Hospice Care:  Training for hospice care services will be offered. At a minimum, this includes:
    • Evaluating patients for appropriate hospice referral.
    • Face to face evaluations regarding hospice recertification.
    • Managing the pain and symptoms of hospice patients and their families.
    • Interdisciplinary group meetings.
    • Home care visits for hospice patients.

Osteopathic Manipulative Medicine

  • The program must train fellows in the clinical application of osteopathic manipulative medicine to Geriatrics patients. At a minimum, this must include:
    • Training in outpatient and inpatient settings.
    • Documentation of OMM in the medical record.
    • Coding and reimbursement.

Other Educational Endeavors

Monthly Journal Club
Biweekly educational conferences
American Medical Directors Association: The Society for Post-Acute and Long-Term Care Medicine
Mentoring 3rd year VCOM students in their Geriatric rotations
Mentoring 2nd year VCOM students in their Early Clinical Experience rotations
Other teaching and mentoring at VCOM
The VCOM Library
Maintenance of a procedure log
A study with research and a paper suitable for publication in a medical journal
Assistance with medical writing and manuscript preparation

Extracurricular Offerings

  • Therapy dogs
  • Aspects of Medical Marriages
  • DiSC and difficult family/patient/colleague relationships
  • Importance of hobbies: music, cooking, language, outdoor activities, etc.