University of Hawaii Geriatric Medicine Fellowship Program

FIRST-YEAR FELLOWSHIP CLINICAL ROTATIONS

 

Each first year fellow will experience clinical rotations lasting 1 to 3 months each.  The program offers training in various settings, including in-patient, out-patient, nursing home, and home care, and provides comprehensive experiences in primary care and consultative geriatrics, rehabilitation and palliative care.

 

KUAKINI AND TEACHING NURSING HOME ROTATIONS (TNH) (3 rotations, 1 month each):  During these rotations, the fellows will provide primary care to patients at Kuakini Geriatric Care, as well as several community nursing homes.  The fellows will receive instruction and experience in medical directorship of nursing homes, rehabilitation, end-of-life and palliative care, and the hospice program.  The fellows will also perform nursing home consults.  A new palliative care consultation service will be starting at Kuakini Medical Center in September 2014, and the fellows will be involved in palliative care consults during some of these rotations.

 

KAISER HMO ROTATION (1 month):  The rotation is designed to thoroughly familiar­ize the fellow with health care delivery to the elderly in an HMO setting.  Fellows will be supervised by geriatricians, geriatric psychiatrists and palliative medicine faculty at Kaiser.  It includes a range of experiences, including outpatient consultations, geriatric psychiatry consultations and palliative care.

 

QUEEN'S MEDICAL CENTER ROTATION (2 months):  This is an in-patient rotation at Queen's Medical Center, where the fellow will primarily perform in-patient consultations.  Fellows will also care for patients in the SNF and will gain experience in rehabilitation.  This rotation includes experience in palliative care and working with the geriatric psychiatry team.

 

VA ROTATION (VA) (2 months):  The VA out-patient clinic is located next to Tripler Army Medical Center, and fellows will provide primary care and consultations to elderly veterans.  The VA in Hawaii has a strong clinic-based home care program as well as a relatively new Hospital at Home program.  Fellows make home visits and participate in inter-disciplinary team evaluations.  Inpatient care is current­ly delivered to veterans at Tripler, and is not part of this rotation.

 

VA COMMUNITY LIVING CENTER (VA-CLC) (3 months):   This is a long-term care and rehabilitation facility for veterans, located on the grounds of Tripler Army Medical Center.  This is an excellent opportunity to learn about sub-acute care, long-term care, rehabilitation and palliative care, working with an interdisciplinary team.

 


OTHER FIRST-YEAR FELLOWSHIP ACTIVITIES

PRIMARY CARE PANEL (PCP) CONTINUITY CLINIC:  This is a longitudinal experience that continues throughout the first year of the fellow­ship program.  Fellows acquire a panel of outpatients for whom they function as the primary care Geriatrician under the direct supervision of faculty.  For primary care panel, fellows are assigned for the duration of the fellowship to one or two of several sites.  All first-year fellows will have PCP clinic on Tuesday mornings. 

 

UNIVERSITY LONG-TERM CARE SERVICE (ULTCS):  This is a longitudinal nursing home experience in the first year of the fellowship.  Fellows are assigned a group of nursing home patients (3-5) to whom they provide primary care.  These nursing home patients are located at Kuakini Geriatric Care (Hale Pulama Mau Nursing Home).  Fellows should participate in the interdisciplinary team meetings held for their patients, if they don’t interfere with other clinical activities for whatever rotation they are on.  This experience is designed to completely familiarize the fellow with the physici­an's role in long-term care.

 

DIDACTIC SESSIONS:  Several different types of regularly scheduled seminars are included in the training program.  Fellows have protected time to attend these.  They include: Evidence-Based Medicine Seminar; Journal Club; Grand Rounds; Board Review; Problem-Based Learning sessions; "Core Curriculum" lectures; Epidemiology and Research Methods/Statistics course; Law and Ethics Seminar; Palliative Care Seminar; Morbidity and Mortality Case Conferences; Field Trips to community sites providing elder services; Medical Directorship of Nursing Homes Seminar; Teaching Skills Seminar; and Career Development Seminar.  On average, the fellows participate in 7-8 hours of didactic sessions each week.  These sessions are very valuable in preparing for the board examination in Geriatric Medicine.

TEACHING ACTIVITIES: Fellows participate in teaching activities and directly supervise medical students and residents assigned to the Geria­tric Medicine service.  Residents in Internal Medicine, Family Medicine and Ob-Gyn have required rotations in Geriatrics.  The fourth year medical students also have a required 4-week rotation in Geriatric Medicine and Palliative Medicine, during which they are supervised by the geriatrics fellows.  Fellows prepare and deliver several lectures on topics in Geriatrics, participate in rounds, case conferences and continuing educa­tion conferences.  There may be some opportunities for fellows to have their travel expenses paid to the neighbor islands for teaching and case con­ferences.

 

SUMMARY OF FIRST YEAR ACTIVITIES:

 

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

June

 

 

1-3 month block rotations

 

Primary care patient panel (PCP - Tuesday mornings)

 

University Long-Term Care Service (longitudinal nursing home patient panel)

 

Didactics (core lectures, board review, journal club, research methods course, etc.)

(Mondays 2-6 pm and Thursdays 8-11 am)

 

Planning 2nd year research or education project (for those planning to stay for a second year)

 

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