Geriatric Evaluation and Management:
3-4 months per year. The GEM months focus on the care of geriatrics patients in sub-acute rehabilitation, after discharge from the hospital. This occurs within 1-2 skilled nursing facilities, currently located at the Colorado State Veterans Home, with an additional location planned to open in the fall of 2017. Fellows provide supervision and education of Internal Medicine residents, who are on their 4-week Geriatric Medicine rotation, as well as providing direct care of patients when needed. Core didactic curriculum is provided during these rotations with approximately 10 lectures each month by faculty and fellows, totaling 16 different core geriatric topics.
Home Based Primary Care: 1 month per year. Early in the year, fellows will experience the collaborative, interdisciplinary approach of the VA HBPC team and acquire 2- 3 continuity patients to follow throughout the fellowship. Time is spent with attending physicians doing admissions, as well as experiencing visits with other team members such as OT, social work, and nutrition. Fellows then continue to follow continuity patients every 4-6 weeks throughout the year and attend HBPC meetings periodically throughout the year. See below for more information on HBPC continuity experience.
Palliative Care: 1 month per year. Based at the VA Medical Center, fellows experience daily pre-rounding preparations, inpatient rounds, inpatient consults, as well as outpatient consult clinic. Fellows become members of the collaborative palliative care team, working alongside social workers, psychologists, nurse practitioners, and a therapy dog, amongst others, to contribute to the care of patients.
Neuropsychiatric Medicine: 1 month per year. Fellows will spend time in a variety of settings with neurology, psychiatry, and psychology providers. Requirements will include weekly attendance at neuro palliative care clinic, which focuses on palliative care management of late stage movement disorders. Fellows will also spend time with a VA geropsychologist performing neuropsychiatric evaluations and providing counseling to patients and caregivers, as well as with a VA geropsychiatrist performing dementia and psychiatric evaluations of older adults.
Community Nursing Home/Medical Directorship: 1 month per year. Fellows will spend time with community based providers in a variety of community nursing home settings, including the State Veteran’s Home, LifeCare, and various other nursing homes throughout the Denver metro area. Fellows will participate in direct patient care and will also observe and participate in administrative meetings led by medical directors, including psychopharmacology reviews and care plan meetings.
PACE: 2 weeks per year. The Program for All Inclusive Care of the Elderly program in Denver is run by InnovAge, with multiple locations across the Denver area. Many prior fellows have joined their team after graduation. This comprehensive care model for dual eligible (Medicare and Medicaid) patients provides a unique opportunity for fellows to experience a community based multi-disciplinary approach to geriatric care.
Acute Care of the Elderly (ACE): 2 weeks per year. This full time inpatient service is a primary teaching service for residents and students at University Hospital. Fellows will rotate for 2 weeks while one of the geriatrics faculty is attending. Fellows will participate in interdisciplinary team meetings and rounds each day. Fellows will also provide geriatric teaching to residents and students during this rotation, serving as an expert geriatric consultant.
Electives: Approximately 2-3 months per year. Each month becomes a “build your own” experience with a few required experiences to complete over the course of the year, as well as a wide variety of options to consider. Elective suggestions are detailed below. Any combination of clinical or research activities can be selected.