Geriatric Medicine Fellowship

Ambulatory geriatric care training includes both primary care geriatrics and exposure to a wide variety of complementary ambulatory training experiences relevant to the clinical practice of geriatrics. Primary care geriatrics is based at the new clinical facilities of the CHAPS, within the Pavilion building, an intergenerational community and wellness center on the Piscataway/Highland Park campus of Parker Home. Geriatric fellows work with faculty in seeing patients here and at other faculty practices of the Department of Family Medicine. Specialty ambulatory exposures include detailed dementia assessment, based at the Comprehensive Services on Aging (COPSA) Institute for Alzheimer's disease and Related Disorders of University Behavioral HealthCare and additional outpatient ambulatory specialty clinics run by faculty from the fields of neurology, ophthalmology and retinal-vitreous surgery, wound care, and urogynecology.

Fellows are required to maintain a weekly continuity ambulatory clinic in their core discipline – family medicine or internal medicine – by seeing a broader age range of patients on a continuity basis.

Long-term care training is based within the nursing homes and new assisted living facility of Parker Homes. Fellows provide primary institutional care for a panel of patients at the Parker facilities under the direct supervision and guidance of faculty geriatricians. Administrative skills and medical directorship experience in long-term care setting are also obtained by experiences at other sub-acute and long-term care nursing homes in the region. Faculty roles as medical directors both at a single facility and at a corporate level provide the fellows valuable exposure and mentoring in long-term care administrative aspects. Geriatric fellows also gain additional experience in community-based long-term care aspects of care through experience in a variety of hospice and home care providers and work with the adult protective service from two central New Jersey counties in assessing and following older adult victims of elder mistreatment.

Inpatient geriatric medicine clinical rotations include acute primary care and consultative hospital care of the sick elderly at Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, NJ. This 584 bed tertiary care hospital with a medical staff of 1,300 physicians is the core teaching hospital for Robert Wood Johnson Medical School. This allows our geriatric medicine fellows peer interaction with the 300+ other residents and fellows from the other 33 fields of graduate medical education provided at this institution.

Working most closely with both the family medicine inpatient service and faculty from the Department of Family Medicine, geriatric fellows also interact with physician colleagues from the Department of Medicine, the Cancer Institute of New Jersey, and the multidisciplinary staff resources of the hospital in social work, discharge planning and outcomes, pharmacy, and complementary medicine. Geriatric fellows provide geriatric consultative care for hospitalized elderly within RWJUH on other inpatient services. Fellows also gain direct experience in palliative care consultation and management, decision-making capacity evaluations, and level-of-care determinations.

Inpatient Geropsychiatry training occurs at the Carrier Clinic, a private, not-for-profit behavioral healthcare system in Skillman, NJ, that since the early 1900's has specializes in psychiatric and addiction treatment. Carrier's system includes a 281-bed inpatient psychiatric hospital, including a dedicated 45 bed older adult unit where the geriatric medicine fellows receive focused instruction and experience in all aspects of Geropsychiatry.

Geriatric fellows experience a wide range of educational opportunities, both within the fellowship program itself and integrated with the RWJMS's training programs in Geropsychiatry, Family Medicine, and Medicine. A fellowship-specific core content geriatric didactic series is coordinated with the geriatric medicine fellowship program of Centrastate Medical Center, whose faculty and fellows collaborate with the New Brunswick program's faculty and fellows in research, scholarship, and peer evaluation. This core content series utilizes the teaching resources of the American Geriatric Society's Geriatric Review Syllabus Teaching Slides and the American Medical Directors Association.

In addition to the core content series, a weekly geriatric medical case presentation conference is complemented by a weekly “Geri Rounds” topic conference. A quarterly Geriatric Journal Club is led by the fellows and integrates Geropsychiatry faculty and staff as well.

The Parker Nursing Homes also serves as a site for monthly Geriatric conferences dealing with concerns for Nursing home patients. These “Parker Rounds” are conducted twice a month and are presented by residents, fellows, and faculty alike for a multidisciplinary audience. Geriatric fellows have participated in the Family Medicine departmental Faculty Development - Teaching Skills course and attend episodic gerontology and aging-related research presentations of interest by hosted by the Gerontological Institute of the medical school, Rutgers University's Institute for Health, Health Care Policy and Aging, and those relevant aging-related grand round series hosted by the various clinical departments within the medical school.

The fellowship curriculum for geriatric fellows provides the fellows with a dedicated month of both “selective” and then “elective” experiences, during which the fellow selects an area(s) of clinical interest and explores in depth the “state of the art” to develop clinically-derived questions central to these areas of their interest. These rotations are then followed by a “research” month focused on scholarship of reduced clinical responsibilities, during which the fellow can generate a scholarly product – e.g., a literature review, an abstract, poster, paper for publication, or formal presentation. The Research Division of the Department of Family Medicine Department is a resource for the fellows in such scholarly activities. Recent geriatric fellows have presented posters at the national meetings of both the American Medical Directors Association and the American Geriatric Society. Prior fellows have co-authored a book chapter with fellowship faculty on integrating mental health with medical care in the nursing home setting that was published in 2006. Others have made Grand Rounds presentations at their prior residency training hospital.

Fellows are evaluated both by fellowship faculty and also by non-physician staff and other professionals from disciplines outside of medicine with whom they work (“360 degree evaluation”). Fellows in turn provide direct feedback to faculty to continually improve and refine their learning experience. A required educational portfolio of clinical experiences, quality improvement activities, and scholarly products is maintained by the fellow to document their learning experience to aide in future career direction. Faculty from the Centrastate geriatric fellowship program also serve as a resource for New Brunswick geriatric fellows to provide specific feedback and help mold the program's clinical experiences and didactic series to meet best their needs.

David F. Howarth, MD, MPH
Program Director
Associate Professor, Department of Family Medicine and Community Health;
Coordinator, RWJUH Family Medicine Residency Program's Geriatric curriculum

Fred Kobylarz, MD, MPH
Associate Professor, Department of Family Medicine and Community Health;
Coordinator, Geriatric Undergraduate curricular development, RWJMS Curriculum Committee