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SUNY Downstate Geriatric Fellowship Program
Geriatric Psychiatry Clinical Program and Curriculum
The program and curriculum will comply with HRSA and ACGME requirements. These include experiences in ambulatory, intermediate, and institutional settings. These are described in detail below.
Intermediate Inpatient Care in Geropsychiatry:
Kingsboro Psychiatric Center
Kingsboro Psychiatric Center Geropsychiatry Unit with a required 6 month rotation (KPC): 30 hours per week. The faculty consists of one full-time psychiatrist with prior fellowship in geropsychiatry; 1 board –certified with added qualifications in geriatric psychiatry provides 1-hour supervision biweekly; one psychiatrist with added qualifications in geropsychiatry and two other board-certified psychiatrists are available on-site for case discussions, consultation, or case supervision; one neuropsychologist (1 hour biweekly), 1 internist provides consultation to the unit; 1 social worker, 6 nurses, 10 mental health technicians, and 1 recreational therapist.
Fellows spend 1.5 hours biweekly in supervision/case conferences with SUNY Downstate faculty (Dr. Janardhanan), a board certified with added qualifications in geriatric psychiatry; 1-hour biweekly with neuropsychologist from SUNY, and 3 hours per week in team meetings. Daily morning rounds for the entire hospital (1 hour). Grand rounds presentations biweekly. Psychiatric supervision of all cases is also provided by one full-time geriatric psychiatrist with prior fellowship in geropsychiatry. An internist and neurologist are also available to provide supervision and consultation. Distribution of cases is monitored to ensure an adequate variety of clinical experiences. The resident also runs a weekly group therapy session with patients.
This is a 16-bed intermediate-stay inpatient unit. Patients are 40% male; 60% female; 20% White; 75% Afro-American; and 5% Latino. All patients are age 60 and over. There are approximately 50 new cases per year. Diagnoses are distributed as follows: 35% Affective Disorders, 50% Schizophrenia (early or late onset) or schizoaffective disorder, 8% neurocognitive disorders, 7% miscellaneous (personality disorder, alcohol, etc.). The unit serves geriatric patients living in Brooklyn, which is primarily a poor and minority area; most patients come from other area hospitals. Fellows are expected to gain proficiency in the following evaluation and treatment modalities: geriatric diagnosis and assessment techniques, neuropsychological techniques, care of treatment-resistant patients, psychopharmacology, individual therapy; group therapy, family psychoeducation, behavioral therapy, community resources and referrals, administrative skills, and learning to work with a multidisciplinary team, working with medically ill patients, and bioethical dilemmas working with the elderly. An average caseload consists of 8 patients of diagnoses of schizophrenia, bipolar illness, treatment of depression, or severe personality disorders. Other patients on the unit will be followed by an attending psychiatrist. Supervision is provided by on-site faculty members on daily basis (average of 30 minutes daily), and one board-certified geriatric psychiatrist from SUNY HSCB (1 hour biweekly), and one neuropsychologist from SUNY (1 hour biweekly). Additional supervision is provided on an individual basis. Level of responsibility: Indirect supervision with direct supervision available when necessary. Strong emphasis on working with persistent mentally ill as well as minority, indigent, and working class elders, public psychiatry; multiethnic faculty with a broad experience in geropsychiatry.
Geriatric Psychiatry Outpatient Clinic
Downstate Mental Hygiene Associates (Outpatient Division of the SUNY HSCB Department of Psychiatry) has a required rotation for 4 to 8 hours per week for 52 weeks. Faculty consists of 1 full-time psychiatrist with added qualifications in geriatrics, 1 part-time geropsychiatrist with added qualifications in geropsychiatry, 1 social worker. Geriatrician, psychologist, neuropsychologist, and neurologist are available for consultations. Fellows spend 3 hours per week in seminars and case conferences. Faculty members are always available for on-site consultation and they review each case with the resident. Caseloads are monitored to provide an adequate mix of patients.
The Clinic population is approximately 75% female; 25% male; 35% white; 50% Afro- American; and 10% Latino; 5% other. Patient must be age 55 or over. Diagnoses comprise the following: 57% Affective disorders, 14% schizophrenia (early or late-onset), 18% anxiety disorders, 22% personality disorders (primary or secondary), and 6% other disorders. There are approximately 40 new intakes per year, and about 100 active cases aged 55 and over. Residents are expected to learn the following: diagnosis and evaluation of the geriatric outpatient, individual psychotherapy, family intervention, pharmacotherapy, cognitive behavioral techniques, and consultation skills, working with medically ill patients, working with other disciplines, community resources, and bioethical concerns. Patients may also participate in clinical drug trials.
Fellows carry an average caseload of 30 patients, and see one new intake every 2 to 4 weeks. Many cases involve family members as part of the treatment; they may also participate in group therapy. They are expected to have 2 intensive psychotherapy cases. All fellows receive 1 hour biweekly group supervision (Dr. Casimir) along with additional supervision in individual psychotherapy of 2 hours per month (Dr. Skamai). Additional supervision is provided on-site for each patient by attending psychiatrist (Dr. Cohen). Level of responsibility: Indirect supervision with direct supervision available when necessary.
The program is situated in Central Brooklyn, in a largely indigent and minority populated area. The program focuses on public psychiatry and working with underserved groups. There is a multi-ethnic faculty with an eclectic experience in geropsychiatry.
Memory Disorders Unit
Alzheimer’s Disease and Memory Disorders Clinic is located in the Brooklyn Alzheimer's Disease Assistance Center, SUNY Health Science Center at Brooklyn. Required rotation: 4 to 8 hours per week for 52 weeks; 1 hour (case conference) for 52 weeks.
Faculty consists of 1 full-time psychiatrist with added qualifications in geriatrics, 1 full-time social worker, Geriatrician, psychologist, neuropsychologist, and neurologist are available for consultations. Residents spend 1 hour per week in a case conference, 1 hour of seminar program for 12 weeks devoted to dementia.
The clinic, located in Central Brooklyn, is comprised of 79% female, 21% male, 15% white, 76% Afro-American, 8% Latino, 1% other. The mean age is 75, although patients’ age have ranged from 48 to 100. All patients present with memory or other cognitive problems, and over 90% are found to have an neurocognitive disorder, usually dementia of the Alzheimer's type (65%) or Multi-Infarct Dementia (25%), although probably about one-fourth may have mixed dementias. An increasing number are thought to have mild cognitive disorder (10-15%). Many patients have co-occurring neuropsychiatric symptoms such as psychoses, depression, or agitation. Fellows are expected to learn the following: assessment of cognitive disorders, management of dementias including pharmacological and behavioral strategies, to work with caregivers and other family members, community resources available to patient and families, legal and ethical issues related to dementia, research drugs, consultative skills, and to work with other disciplines. Fellows will usually see 1 to 2 new intake per week and conduct follow-up care on approximately 50 patients and their caregivers. Supervision is provided in 1 hour case conference (and in sessions immediately following patient visits with outpatient supervisors (Drs. Cohen or Casimir). Attending (Dr. Cohen) also reviews each follow-up case with the resident. Faculty is also always accessible for consultation and sit-in on evaluations. Regular supervision is provided by Dr. Cohen, Dr. Casimir, and Ms. Walcott-Brown (Social Service). Level of responsibility: Indirect supervision with direct supervision available when necessary.
The program is unique in that it serves a large Afro-American population, about half of whom are of West Indian background. The staff has an eclectic background, is multi-cultural, and multi-lingual.
St Albans Extended Care Center:
Long Term care is done at St. Alban's Extended Care Center Veteran' Administration which is a required rotation of 24 hours per week for 2 months. The faculty consists of 1 full-time geriatric psychiatrist (board eligible with fellowship in geriatric psychiatry), 1 geriatric psychiatrist (boarded in family practice, geriatrics, with a fellowship in geriatric psychiatry), There are also 5 internists, 1 neurologist, 1 psychologist, 6 social workers, 6 activity therapists, 2 physical therapists, and 2 occupational therapists available for consultation. There is a 1.5 hour weekly case conference (Drs. Prehogan and David). The faculty meets daily with resident for 30 minutes daily and are always available for on-site consultation.
The Center has 475 long-term and intermediate care beds. Fellows perform consults throughout the Center and also work on the Dementia Unit, which is a 20-bed unit designed for the comprehensive evaluation and management of persons with cognitive deficits. The Center also has an adult day care program to which residents participate in consults. The center's population is approximately 95% male, 5% female, 45% white, 54% Afro-American, 1% Latino. Patients' mean age is 72 years. Diagnoses in the center comprise the following: 25% dementia, with 20% Alzheimer’s disease, 20% vascular dementia, and 60% other (depression, schizophrenia, alcoholism, drug abuse). There are approximately 20 - 30 new admissions per month to the entire center, and 5 new admissions per month to the Dementia Unit. Fellows are expected to learn the following: diagnosis and assessment of patients in nursing homes, management techniques including behavioral strategies and pharmacotherapy; use of ECT, skills in consultation to other disciplines; family consultation and support, use of respite services such as day care; instruction in use of group and activity therapies, working with and teaching non-mental health professionals about mental health in the aged, and learning about bioethical demands of the very old. Fellows carry an average caseload of 20 patients on the Dementia Unit, and perform 10 - 15 consults per week of patients in the remainder of the Center. Supervision is provided in 1.5 hour per week case conference weekly rounds and at least 30 minutes of individual supervision with on-site faculty. Indirect supervision with direct supervision is available when necessary.
The program offers an opportunity to learn various aspects of long-term care -- special units, consultation, day care program, home care -- under the supervision of a multicultural faculty with an eclectic background and skills.
Kingsbrook Hospital–Rutland Nursing Home: As part of the fellows rotation at Kingsbrook Hospital they do extensive consultation work at Rutland Nursing Home, which is a large 522-bed facility in central Brooklyn, of whom four-fifths of the patients are African American or African Caribbean. Supervision is provided by a dual board-certified psychiatrist/internist (Dr. Pinkhasov).
Brooklyn Reginal Collaborative Geriatric Psychiatry Unit
Kingsbrook Jewish Medical Center
There is a required 3-month rotation for 30 hours per week at this facility. Faculty consists of 3 board-certified psychiatrists, one with added qualifications in geriatric psychiatry (Dr. Janardhanan), the other is dual-boarded in medicine and psychiatry (Dr. Pinkhasov), and a third who is board-certified in geriatric psychiatry (Dr.Valbrun); 2 gerontological social workers, 10 nurses, 12 nursing assistants, 2 recreational therapists, 2 pharmacists, one psychologist, and internists, neurologists, and surgeons available for consultation. Educational activities include morning rounds and case review. There is weekly case conference in which medical students present cases to faculty and fellows. Fellows also attend regular geriatric psychiatry didactic program and conferences during this rotation.
This is an acute care unit that is located on the campus of Kingsbrook Jewish Medical Center. This is a 30-bed unit dedicated to the treatment of a geriatric population. The average age of the patient population is 74. Patients fall into the following diagnostic categories: affective disorder (34%), schizophrenic/psychotic disorder (36%), complicated dementia (26%), adjustment disorder (4%). Fellows will spend 3 months on this rotation and will be expected to carry a caseload of patients and serve as primary physicians to their assigned patients. This involves psychiatric admission assessment, formulation of treatment plan, ongoing interaction with the multidisciplinary team as it pertains to treatment and discharge planning. Fellows participate in scheduled patient staff community meetings, morning rounds, interdisciplinary treatment planning meetings, staff meetings, etc. Daily review and supervision of cases is provided by Drs. Janardhanan, Pinkhasov. and Dr. Valbrun. There are opportunities to learn to use ECT with aging populations. They may participate in co-leading of groups for patients and/or families and research projects as they are developed. Fellows are also expected to provide geriatric consultations to medically-ill patients in the general hospital and to persons in a nursing home annex under the supervision of Drs. Pinkhasov and Janardhanan.
The average caseload is 5 patients, with one resident serving as the primary therapist. They conduct approximately 8 – 10 consults per week. Supervision includes daily clinical case review by Drs. Pinkhasov and Janardhanan, i.e., approximately 10 hours per week of individual supervision. Indirect supervision with direct supervision is available when necessary. Opportunity is provided to treat multi-ethnic elders with acute psychiatric disorders as well as to stabilize persons from severe behavioral problems of dementia.
Fellows will do four one-half day rotations in the following setting:
. Geriatric Medicine Clinic at Kings County Hospital:
This is a required 1-month rotation for 4 hours per week at Kings County Hospital. The faculty consists of a board-certified internist with added qualifications in geriatrics(Dr. Reid-Durant). Fellows’ educational activities include observation and participation in the care of elderly patients attending the geriatric clinic under the supervision of one of the faculty.
The Kings County Hospital(KCH) Geriatric Clinic is a primary care clinic staffed by geriatric fellows and attendings, a gerontologic nurse practitioner, along with nursing and social work services. KCH is one of the largest public hospitals in the country, and primarily serves minority, indigent, and immigrant populations. All referral services needed in the care of this population including audiology, optometry, physical rehabilitation, podiatry, dentistry, nutrition, and pharmacy are available within the hospital campus. The patient population consists predominantly of elders with multiple medical conditions and relatively preserved functional status, but a range of functional problems is represented. They will work closely with the geriatric medicine resident. Residents receive on-site precepting by attending geriatricians, and interact with other members of the health care team in developing and achieving goals for the patient, such as maintaining function and independence, and obtaining health care screening, and receiving ongoing treatment of chronic and intercurrent medical problems. Emphasis is also placed on developing well coordinated care and continuity of care for patients who have not previously achieved this goal. This rotation is for 4 hours per week for one month. It is under the supervision of Dr. Reid Durant, a board-certified geriatrician.
Geriatric psychiatry fellows see 1-2 new and 4-5 follow up patients per half-day session. Supervision is provided by a board-certified geriatrician (Dr. Reid-Durant). Psychiatry residents will generally see patients with the attending geriatricians or geriatric medicine resident. The rotation provides an opportunity to learn more about the common medical problems affecting older adults, including their diagnosis and treatment; to examine the psychiatric issues that occur with older general medical patients. The program focuses on the care of older adults in a public setting.
Consultation-Liaison is provided at:
Kingbrook Jewish Medical Center: 10 hours per week for 3 months.
St. Alban’s Extended Care Center (Veteran's Administration): 8 hours per week for 2 months - 12-bed Geriatric Evaluation Unit & consultation to 475-bed long-term and intermediate care patients.
Faculty consists of 3 psychiatrists (2 with added qualifications in geriatric psychiatry and 1 board-certified in psychiatry and internal medicine), 1 part-time geropsychiatrist with added qualifications, and various neurologists, internists, and other medical specialists on-site at each institution. There are two psychiatrists at St. Albans (Drs. Prehogan and David) and 3 at Kingsbrook (Drs. Pinkhasov, Janardhanan, Valbrun).
There is a formal weekly 1.5 hour case conference at St Albans and a weekly 1-hour conference at Kingsbrook. The clinical populations (age 60 and over) vary between sites.
Kingsbrook Jewish Hospital
40% males, 60% females
40% White, 45% African American, 15% Latino
Elderly patients in general hospital with various medical conditions.
St. Alban's Extended Care Center
95% males, 5% females
45% White, 54% African American, 1% Latino.
This is a nursing home setting in which patients suffer from various chronic medical illnesses with some acute exacerbations.
Fellows will be expected to have the following caseload:
St. Alban’s Hospital: 15 new consults per week plus follow up (total 15 consults).
Kingsbrook Jewish Medical Center: 8-10 consults per week.
All fellows will have 30 minute daily review at St Albans and up to 2 hours daily of rounds/supervision at Kingsbrook. At both sites: Indirect supervision with direct supervision available when necessary. These rotations provide opportunities for geriatric feloows to learn consultation- liaison skills with several diverse populations: acute medically all inpatients, chronically ill long-term care patients, and medically ill elderly psychiatric patients. Faculty is multi-cultural and come from diverse clinical backgrounds.
Trainees from dentistry and psychiatry provide on-site evaluation and treatment at Bowery Residents' Committee-Homeless Senior Services Center. They go biweekly for 4-hour sessions for 3 months in their second year.
Physical Medicine and Rehabilitation — Dr. Susan Smith McKinney Nursing and Rehabilitation Center & St. Albans Extended Care Center
In this experience, fellows learn to understand the categories of impairment, disability, and handicap, and to apply the principles of physical medicine and rehabilitation to the geriatric patient. They will enhance their understanding of the roles of the physiatrist, the physical therapist, the prosthetist, the orthotist and other members of the PM&R team. Fellows will spend 4 hours per day for one month at Susan Smith McKinney Nursing and Rehabilitation Center. Note that they also spend time in these services at St Albans Extended Care Center.
This is a required 1-month rotation for 4 hours per week The faculty consists of a board-certified neurologist (Dr. Howard Crystal)
Educational activities include observation and participation in the care of elderly patients in an outpatient neurology clinic that focuses on older persons with cognitive disorders and neurological disorders with comorbid cognitive and behavioral problems. Patients are seen under the supervision of Dr. Crystal. This clinic is situated at University Hospital of Brooklyn (SUNY Downstate Medical Center) is under the supervision of a behavioral neurologist (Dr. Howard Crystal). The clinic affords the resident the opportunity to see older persons with dementia and neurological disorders, especially persons with movement disorders. Many patients have mixed disorders that include elements of vascular dementia, Lewy-Body dementia, Parkinson’s disease or Alzheimer’s disease. Residents also see patients with mild cognitive disorders. They spend 4 hours per session for one month. Geriatric psychiatry fellows will see 4 patients per half-day session. Supervision is provided by a board-certified neurologist (Dr. Crystal).
The rotation provides an opportunity to learn more about the care and treatment of older adults suffering from dementia and cognitive disorders secondary to other neurological conditions.
Palliative Care and End of Life Treatment (Brooklyn VA)
This is a required 1-month rotation for 4 hours per week or two sessions for 8 hours. The faculty consists of a board-certified internist with added qualifications in palliative care (Dr. Alice Beal). Educational activities include observation and participation in the care of elderly patients in the in-patient palliative care service and also participate in in-patient consultations on other wards under the supervision of Dr. Beal. This rotation is situated at the main campus of the Veterans Administration Hospital in Brooklyn, NY. Patients are 95% male and about 50% minority. Geriatric Psychiatry fellows will see patients on the in-patient palliative care service and also participate in in-patient consultations on other wards. In addition, fellows will attend an ambulatory palliative care clinic and participate in diagnosis and management of a variety of life-threatening diseases, including advanced cancer, emphysema, and other end stage illnesses, under the supervision of palliative care attendings. Interdisciplinary skills and ethical and legal issues are an additional focus. This rotation is for 5 hours per week for 1 month. It is under the supervision of Dr. Alice Beal. Geriatric psychiatry fellows will see 15 to 20 patients during rotation. Supervision is provided by a board-certified internist (Dr. Beal). Psychiatry residents will generally see patients with Dr. Beal.
The rotation provides an opportunity to learn more about the care and treatment of older adults suffering from terminal illness and/or severe pain; to examine the psychiatric issues that occur with terminally ill patients and patients with severe pain.
Geriatric Medicine Clinic
Required 1-month rotation for 4 hours per week. The faculty consists of five board-certified internists (Drs. Prospere, Reid-Durant, Lawrence, Price, Kaner), four with added qualifications in geriatrics. Educational activities include observation and participation in the care of elderly patients attending the geriatric clinic under the supervision of one of the faculty. Fellows receive on-site precepting by attending geriatricians, and interact with other members of the health care team in developing and achieving goals for the patient, such as maintaining function and independence, and obtaining health care screening, and receiving ongoing treatment of chronic and inter-current medical problems. They will work closely with the geriatric medicine resident. Emphasis is also placed on developing well coordinated care and continuity of care for patients who have not previously achieved this goal.
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The fellow will have about 20% time in the first year and 30% time in the 2nd year for conducting research.
The geropsychiatry fellows have been actively engaged in research that have included papers on paratonia in Alzheimer's disease, factors associated with anxiety and depression in older patients, prospective study of depressive symptoms a multiracial older population, PTSD among Holocaust survivors; neuropsychiatric symptoms in dementia patients, and cognitive symptoms in older schizophrenia patients, oral health in schizophrenia and dementia.
Our staff is working on research in several areas that can include fellows:
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Geriatric Psychiatry Conferences and Didactic Programs
Core Lecture Series – 1st year (Fellows in Medicine, Psychiatry, Dentistry):
Core Lecture Series for All Medicine, Psychiatry, and Dental Fellows
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Journal Club (Fellows in Medicine, Psychiatry, and Dentistry)
In this joint fellow conference, fellows are assigned a specific topic or review article to present to other trainees and attendings. Following the presentation, the fellow is expected to give a short discussion outlining his/her level of understanding of the topic and raises areas of controversy or uncertainty. This interactive part of the presentation includes input by other trainees and attending faculty.
Additional conferences for psychiatry fellows
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Geriatric Psychiatry Two-Year Program
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* Shared with medicine and/or dentistry
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* Shared with medicine and/or dentistry
* Shared with medicine and/or dentistry
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