The clinical year of fellowship is divided amongst the following rotations:

RotationLocationDuration
Longitudinal Experiences
Geriatric Consultation ClinicCenter for Advanced Medicine (CAM)12 months
Geriatric Primary Care ClinicCovenant Place12 months
Nursing Home CareParc Provence & Delmar Gardens6 months at each location
Block Rotations
Inpatient Geriatric ConsultationBarnes Jewish HospitalSix, 1-month rotations
Inpatient RehabilitationThe Rehabilitation Institute of St. Louis2 weeks
Palliative CareBarnes Jewish Hospital &
Evelyn’s House
1 month
Home Based Primary Care
Geriatric Primary Care Clinic
VA St. Louis Healthcare System1 month
Sub-Specialty Clinics
Memory Diagnostic ClinicCenter for Advanced Medicine (CAM)Weekly x 1 month
Geropsychiatry ClinicWashU Department of PsychiatryWeekly x 6 weeks
Bone Health/Osteoporosis ClinicCenter for Advanced Medicine (CAM)Weekly x 1 month
Movement Disorders ClinicCenter for Advanced Medicine (CAM)Weekly x 1 month
Urogynecology ClinicCenter for Outpatient Health (COH)Weekly x 1 month
Wound Care ClinicCenter for Outpatient Health (COH)Weekly x 2 weeks

Fellowship Rotations

Longitudinal Experiences (12 months)

Outpatient Geriatric Consultation Clinic (Center for Advanced Medicine): Fellows participate in one half-day clinic per week developing their expertise providing outpatient geriatric consultation care with an inter-professional team. The clinic is also a training site for Internal Medicine residents and WUSM medical students. The fellows will work with two different faculty members, each for six months continuously.

Outpatient Geriatric Primary Care Clinic (Covenant Place): Fellows work with an assigned supervising faculty member one ½ -day per week to provide primary care to an assigned panel of older patients. This educational experience includes emphasis on management of common primary care geriatric medical problems, health prevention (such as outpatient screening), administrative aspects of practice, inter-professional team work, decision-making skills, appropriate diagnostic testing, and communication skills.

Long Term Care/Nursing Home Care: Fellows have two 6-month longitudinal clinical experiences, one at each of two nursing home sites (Parc Provence and Delmar Gardens), to provide primary care, under the supervision of a faculty attending, to an assigned panel of nursing home patients. Nursing home rounds are conducted one half-day per week. Fellows learn approaches to diagnosis and treatment of acute and chronic conditions and will manage or co-manage psychiatric symptoms related to dementia and depression. They provide and supervise end-of-life care in the LTC setting and gain related communication skills. They will also gain experience related to patient safety/quality improvement pertinent to the LTC setting, and learn Medical Directorship skills.

Block Rotations

Inpatient Geriatric Consultation Service (Six 1-month rotations)
The Inpatient Geriatric Consultation Service serves patients at Barnes-Jewish Hospital and The Rehabilitation Institute of St. Louis (TRISL). The geriatrics fellow is responsible for managing the consultation team in collaboration with an attending faculty member. The team usually includes medical residents and students. Each fellow completes six 1-month rotations on the consult service.

Inpatient Rehabilitation Service (2 weeks)
Fellows participate in a two-week rotation at The Rehabilitation Institute of St. Louis (TRISL), an acute inpatient rehabilitation facility (IRF). Under the supervision of the Rehabilitation attending, the fellow is assigned a panel of patients to provide inpatient primary care of the older adults with stroke, general deconditioning, or other neurological disease.

Palliative Care (Inpatient Consultation Service and Evelyn’s House) (1 month)
The Palliative Care Service at Barnes-Jewish Hospital is an interdisciplinary professional team that addresses many facets of care for patients with life-limiting diagnoses. The team consists of physicians, nurse practitioners, social workers who provide inpatient consultation. Trainees complete one 2-week block as a member of the inpatient Palliative Care Consult Service. They also complete one 2-week block and working as a team member at Evelyn’s House, which is a freestanding hospice facility, and participate in home hospice visits.

VA Geriatric Primary Care Clinic and Home-Based Primary Care Service (1 month)
The VA Home-Based Primary Care (HBPC) program provides interdisciplinary team-based primary care to homebound and/or otherwise frail and medically complex veterans in the St. Louis area who cannot easily travel to their clinic appointments.

Sub-specialty Clinics

Memory Diagnostic Clinic
Fellows spend four ½-day sessions early in the academic year in the Memory Diagnostic Clinic to develop clinical skills for the diagnosis and management of memory disorders, and receive training in the Clinical Dementia Rating Scale (CDR) and administration of a standardized psychometric test battery. They also receive training to advance their neurological examination skills. This experience provides foundational skills that will be used for other rotations, including the outpatient Geriatric Consultation Clinic and inpatient Geriatric Consultation.

Outpatient Geropsychiatry Clinic
This rotation includes four half-day clinic sessions with a faculty member in the WU Department of Psychiatry, didactic sessions and self-study modules. The goals are to prepare fellows to manage patients with common psychiatric disorders encountered in a typical Geropsychiatry outpatient practice, including depression, anxiety, and behavioral symptoms associated with dementia. Fellows will become familiar with how to manage older adults with psychiatric problems in the context of a Geriatrics primary care practice, and indications for emergent and non-emergent referral to a Geropsychiatrist.

Bone Health/Osteoporosis Clinic
This clinic focuses on the comprehensive evaluation and management of metabolic bone disease, primarily osteoporosis. Geriatrics fellows participate in new patient assessments and follow-up visits, under the supervision of a faculty attending. Fellows will attend four half-day clinics.

Movement Disorders Clinic
The fellow will understand how to diagnose and manage common movement disorders in the elderly, especially Parkinson’s disease, be able to detect subtle neurological impairment on physical examination and understand the side effects of drugs that are used in the treatment of movement disorders, which drugs to avoid which may exacerbate movement disorders, and alternative management strategies. Fellows participate in new patient and follow-up assessments, under the supervision of a WU Neurology faculty attending. Fellows attend four half-day clinics.

Urogynecology Clinic
Board certified and fellowship trained female pelvic medicine and reconstructive surgery providers treat women with pelvic floor disorders including: urinary incontinence (including urgency, stress, and mixed and refractory urgency urinary incontinence), pelvic organ prolapses (including uterine, vaginal prolapse and post-hysterectomy vaginal vault prolapse), fecal incontinence, bladder/pelvic pain. Fellows participate in new patient and follow-up assessments, under the supervision of a faculty attending. Fellows will also observe office procedures including urodynamic testing and cystoscopy. Fellows will attend four half-day clinics.

Call Schedule

Fellows take one week of phone call once every 7 weeks.

Didactics

Direct clinical teaching is supplemented by weekly conferences that include:

  • Core Curriculum lecture series
  • Journal Club
  • Case Conferences
  • Board Review
  • Patient Safety/Quality Assurance conferences
  • The Division of Geriatrics and Nutritional Sciences co-sponsors a seminar series with the Harvey A. Friedman Center for Aging.

We encourage our fellows to attend the annual scientific meeting of the American Geriatrics Society (AGS) and provide an educational stipend to support travel expenses to the meeting.

Quality Improvement Training and Research Opportunities

Fellows are encouraged to develop skills in multiple areas and are expected to complete a scholarly project in collaboration with faculty.  All fellows are required to complete a Patient Safety Quality Improvement (PSQI) Project in collaboration with a faculty mentor.  Fellows have the opportunity to familiarize themselves with ongoing research projects, choose a research mentor, and collaborate on ongoing projects or initiate a new project.