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SUNY Downstate Geriatric Fellowship ProgramGeriatric Psychiatry Clinical Program and CurriculumThe 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. Clinical TrainingIntermediate Inpatient Care in Geropsychiatry:
Fellows will have a required rotation of 4 months duration at the Kingsboro Psychiatric Center. An average caseload consists of 10 patients of various diagnoses. Fellows will spend 1.5 hours per week in case conferences/seminars with outside faculty, 2 hours per week in case conferences with intramural faculty, and 3 hours per week in team meetings. Psychiatric supervision of cases is provided by one full-time on-site faculty member and by three faculty members from SUNY Health Science Center at Brooklyn who are board-certified geriatric psychiatrists. 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. Fellows are expected to gain proficiency in the following evaluation and treatment modalities: geriatric diagnosis and assessment techniques, care of the treatment-resistant patient, psychopharmacology, individual therapy; family psycho-education, behavioral therapy, community resources and referrals, administrative skills, learning to work with a multidisciplinary team, working with medically ill patients, and bioethical dilemmas in working with the elderly. Faculty consists of one full-time psychiatrist with a prior fellowship in geriatric psychiatry; two geriatric psychiatrists (Drs. Cohen, Casimir) are available 3 hours per week for case conferences, consultation, or case supervision; 1 internist and 1 neurologist provide consultation to the Unit; 2 social workers, 6 nurses, 15 mental health technicians, and 1 recreational therapist. A neuropsychologist (Dr. Kelly) provides biweekly consultation. There is also a half-time attending psychiatrist who is responsible for 10 of the unit's patients. Outpatient Geropsychiatry:Fellows have a required rotation of 4 hours per week for 52 weeks at the geropsychiatry clinic of the Department of Psychiatry at SUNY Downstate Medical Center. Fellows will be expected to learn the following: diagnosis and evaluation of the geriatric outpatient, individual psychotherapy, group therapy, family intervention, pharmacotherapy, cognitive behavioral techniques, and consultation skills, working with medically ill patients, working with other disciplines, community resources, and bioethical concerns. Fellows will carry an average caseload of 10 to 20 patients, who they will follow over the course of their training, and they will see one new intake every 2-4 weeks (they will see more new intakes in July through September). Fellows will average 1-2 hours per week in seminars. Faculty are always available for on-site consultation. Caseloads are monitored to provide an adequate mix of patients. All fellows will receive at least 1-3/4 hours per week of group supervision. Additional supervision may be provided as required. Faculty consists of a full-time psychiatrist with added qualifications in geriatrics (Dr. Cohen), a part-time geropsychiatrist (Dr. Casimir) with added qualifications in geropsychiatry, a part-time psychologist, a part-time neuropsychologist, two social workers, and one part-time neurologist. Memory Disorders and Dementia Assessment:Fellows have a required rotation of 4 hours per week for 52 weeks with a 1-hour per week at the Brooklyn Alzheimer's Disease Assistance Center. 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 one new intake per week and follow-up on approximately 50 patients at any given time. In this rotation, fellows will do one home visit per month. Fellows will spend one hour per week in a case conference and a one-hour seminar for 12 weeks devoted to dementia. Supervision is provided in one-hour case conference and in 1-3/4 hour sessions with outpatient supervisors. Faculty is also always accessible for consultation and will often sit-in on evaluations. Faculty consists of a full-time psychiatrist with added qualifications in geriatrics (Dr. Cohen), a part-time neuropsychologist, part-time neurologist, a recreation therapist, and two social workers. Long-Term Care:St Albans Extended Care Center: Fellows will have a required rotation of 24 hours per week for 2 months at the St. Alban's Extended Care Center Fellows will perform consults throughout the center and also work on the Dementia Unit. The center also has an adult day care program and a home care program to which fellows will participate in consult. Fellows will be expected to learn the following on this rotation: 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. There are two weekly case conferences. Faculty is always available for on-site consultation. Supervision is provided in the case conferences and in 1-hour individual supervision with on-site faculty. Faculty consists of 1 full-time geriatric psychiatrist (with fellowship in geropsychiatry and former HRSA fellow), 1 half-time geriatric psychiatrist (boarded in internal medicine). 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. 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). Acute Inpatient Geriatric Psychiatry:Fellows have a required 3-month rotation for 32 hours per week at Kingsbrook Jewish Medical Center. Fellows 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, and 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. 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. They also do consultations in the general hospital. Faculty includes two board-certified psychiatrists, one with added qualifications in geriatric psychiatry, two gerontological social workers, two nurses, and one psychologist. Consultation – Liaison Experiences:Fellows will provide extensive consultation at the St. Alban's Extended Care Center, Kingsboro Psychiatric Center, and Kingsbrook Jewish Medical Center. The facilities are described above: The clinical populations (age 60 and over) for consultations vary between sites. Homeless Program: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 CenterIn 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. Geroneurology Clinic: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. Palliative Care and End-Of-Life Treatment:Required 1-month rotation for 5 hours per week at Kings County Medical Center. The faculty consists of board-certified internists (Dr. Sarah Egan, Dr. Cho). 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. Sarah Egan at Kings County. Psychiatry and geriatric medicine fellows will see patients on the in-patient palliative care service and also participate in in-patient consultations on other wards. In addition, residents 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. 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. « Back to Top Research ExperiencesThe 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:
« Back to Top Geriatric Psychiatry Conferences and Didactic ProgramsCore Lecture Series – 1st year (Fellows in Medicine, Psychiatry, Dentistry):Core Lecture Series for All Medicine, Psychiatry, and Dental Fellows
« Back to Top 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
« Back to Top Geriatric Psychiatry Two-Year Program
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* Shared with medicine and/or dentistry« Back to Top
* Shared with medicine and/or dentistry
* Shared with medicine and/or dentistry« Back to Top |