Curriculum

Participating Institutions

Fellowship Rotations

Longitudinal Experiences (year-long):

Outpatient Clinics: Fellows participate in each of the clinics two half-days a week developing their expertise as outpatient geriatric medicine providers. They work with various faculty members at an on-site location (with a case worker) at the Outpatient Geriatric Consultation Clinic. The clinic is also a training site for Internal Medicine residents and WUSM medical students. The goal is for fellows to be able to perform the physician assessment independently (with supervision), and also provide guidance to Internal Medicine residents and students as they learn components of geriatric assessment. The fellows will work with two different faculty members, each for six months continuously.

At the off-site Outpatient Geriatric Primary Care Clinic (Covenant Place) the fellows will work with an assigned faculty member devoting one half-day continuously for the year. This educational experience includes emphasis on management of common primary care geriatric medical problems, health prevention (such as outpatient screening), administrative aspects of practice, and inter-professional team work. There is emphasis on clinical assessment skills, including history taking, physical exam, primary and secondary data collection, prioritization, problem solving and decision-making skills, appropriate diagnostic testing, communication skills, and self-directed learning.

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), with an assigned panel of nursing home patients (25-30 at Parc Provence and a smaller number at Delmar Gardens) for whom they provide primary care, under the supervision of a faculty attending. Nursing home rounds are conducted one half-day per week. At the Parc Provence nursing home site, fellows will typically supervise the Internal Medicine residents (usually one or two) and medical students on the Geriatrics rotation. The fellow is expected to manage incoming and outgoing telephone and fax request on behalf of their assigned Long-Term Care/Nursing Home attending.

Fellows will learn approaches to diagnosis and treatment of acutely and chronically ill/frail elderly in a less technologically sophisticated environment than the acute-care hospital, work within the limits of a decreased staff-patient ratio compared with acute-care hospitals, manage or co-manage psychiatric symptoms related to dementia and depression, manage communication related to end-of-life issues, and supervise end-of-life care in the LTC setting.

Block Rotations:

VA Clinic and Home-Based Primary Care Service (1 month)
The VA Home-Based Primary Care (HBPC) program provides interdisciplinary team-based care to homebound and/or otherwise frail and medically complex veterans in the St. Louis area who cannot easily travel to their clinic appointments. The fellow will rotate for 2 weeks VA Home-Based Primary Care Program as well at at the Jefferson Barracks facility for 2 weeks.

Inpatient Consultation Service (6, 1 month)
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 the attending faculty member. The team usually includes medical residents and students. Consultations are typically provided on the day of the request, although sometimes within 24-36 hours, depending upon the reason for the request and the schedule of the consult attending and/or fellow on a particular day. Each fellow will complete six one-month rotations on the consult service over the course of the 12-month fellowship period, with the goal of completing at least 25 consultations over the course of the fellowship.

Inpatient Rehabilitation Service (2 weeks)
Fellows will participate in a four-week rotation at The Rehabilitation Institute of St. Louis (TRISL), an acute inpatient rehabilitation facility (IRF). The rotation is comprised of two 2-week blocks; one intensive and one less intensive. During the intensive 2-week block, the fellow spends with the rehab team focused on inpatient primary care of the older adults with stroke, general deconditioning, or other neurological disease.

Inpatient Palliative Care 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, and chaplains; they work together to support patients and their families by providing symptoms relief, including pain, and psycho-social or spiritual distress. Trainees participate on this rotation for one intensive 2-week block as a member of the inpatient Palliative Care Consult Service and one less intensive 2-week block participating in home hospice visits (2 sessions) and working as a team member at Evelyn’s House (2 sessions).

Outpatient Geropsychiatry Clinic (1 month)
This rotation includes four half-day clinical sessions that include 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 general medical practice, and which patients require emergent and non-emergent referral to a geropsychiatrist.

WU Memory Diagnostic Clinic (1 month)
The Memory Diagnostic Center (MDC) provides clinical evaluations for patients with concerns about their memory and cognitive function. This rotation includes four half-day sessions for four weeks.

Hospice and Home Health Care

Sub-specialty Clinics:

Bone Health (4 sessions)
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 (4 sessions)
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 faculty attending. Fellows attend four half-day clinics.

Urogynecology (4 sessions)
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.

Wound Care (4 sessions – optional)
The fellow will become competent at diagnosis of etiologies of wounds; including pressure, PVD, venous stasis, diabetes; assessment tools used to determine those at-risk; how to properly describe and stage wounds, particularly pressure ulcers; techniques for wound prevention and management in the outpatient setting. They will also become familiar with management of common problems encountered by podiatrists, including bunions and other foot deformities. Fellows participate in 4 clinic sessions at the Wound Care clinic.

Curriculum

View the Geriatric Fellowship Curriculum Manual AY20-21

Conferences

Direct clinical teaching is supplemented by weekly conferences that include a Core Curriculum lecture series, Journal Club, Case Conferences, Board Review, and 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. The Seminar Series upcoming events can be found on Washington University’s Institute for Public Health’s website.

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.

Research and Quality Improvement Training

Fellows are encouraged to develop skills in multiple areas and are expected to produce 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 are also given the opportunity to familiarize themselves with ongoing research projects, choose a research mentor, and collaborate on ongoing projects or initiate a new project.

Fellows can elect to pursue an additional year or two of research training, which is supported by a T32 grant.