Clinical Training
Intermediate Inpatient Care in Geropsychiatry:
Kingsboro Psychiatric Center
Kingsboro Psychiatric Center is a a required 6 month rotation (KPC). This is a 16-bed intermediate-stay inpatient unit. The unit serves patients living in Brooklyn; most patients are transferred for intermediate-care 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. Strong emphasis is placed 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.
The faculty consists of one full-time psychiatrist with prior fellowship in geropsychiatry who provides daily supervision of clinical care and an additional 1-hour supervision weekly; one psychiatrist with added qualifications in geropsychiatry and two other board-certified psychiatrists are available on-site for case discussions, consultation, or case supervision; 1 internist provides consultation to the unit; 1 social worker, 6 nurses, 10 mental health technicians, and 1 recreational therapist.
Outpatient Geropsychiatry:
Geriatric Psychiatry Outpatient Clinic
The Geriatric Psychiatry Outpatient Clinic has a required rotation for 4 to 8 hours per week for 52 weeks. Faculty consists of 2 full-time psychiatrist with added qualifications in geriatrics, 2 part-time geropsychiatrists, a nurse practitioner, 3 social workers, 2 patient care assistants / research support. A geriatrician, psychologist, 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.
Fellows are exposed to approximately 40 new intakes per year and carry an average caseload of 30 patients, and see one new intake every 1 to 2 weeks. Fellows 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.
In addition, Fellows are expected to have 2 intensive psychotherapy cases. All fellows receive 1 hour of biweekly to monthly supervision in psychotherapy of 2 hours per month (Dr. Rahim). Additional supervision is provided on-site for each patient by an attending psychiatrist (Drs. Reinhardt, Cohen, and Talavera).
Center of Excellence for Alzheimer's Disease - Memory Disorders Clinic
Fellows are exposed to the Center of Excellence for Alzheimer's Disease at SUNY Downstate - one of 10 NY State Department of Health-funded Centers of Excellence. This is a required rotation, 4 to 8 hours per week for 52 weeks including weekly 1 hour case conferences for 52 weeks. Center faculty consists of 2 full-time geriatric psychiatrists, 1 part-time geriatric psychiatrist, 3 full-time social workers, consulting Geriatrician, consulting psychologist, and consulting neurologist.
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 intakes 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, Reinhardt, and Talavera). Attendings also reviews each follow-up case with fellows and are also always accessible for consultation and direct observation of evaluations. 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.
Long-Term Care:
St Albans Extended Care Center:
Long Term care exposure is obtained 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 psychiatrist. There is a 1.5 hour weekly case conference (Dr. Prehogan). 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. 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.
Kingsbrook Jewish Medical Center – Rutland Nursing Home: As part of the fellows rotation at Kingsbrook Jewish Medical Center, they conduct 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 board-certified psychiatrist (Dr. Janardhanan).
Consultation-Liaison Exposure:
Kingbrook Jewish Medical Center: 10 hours per week for 3 months, 8-10 consults per week.
St. Alban’s Hospital: 15 new consults per week plus follow up (total 15 consults). 8 hours per week for 2 months - 12-bed Geriatric Evaluation Unit & consultation to 475-bed long-term and intermediate care patients.
Kingsboro Psychiatric Center: 1 to 2 consultations per week of older adults admitted throughout the intermediate care facility.
Acute In-Patient
Kingsbrook Jewish Medical Center
There is a required 3-month rotation for 24 hours per week at this facility. Faculty consists of 2 board-certified psychiatrists, one of whom is board-certified in geriatric psychiatry (Dr. Janardhanan), 2 gerontological social workers, 10 nurses, 12 nursing assistants, 2 recreational therapists, 1 pharmacist, one psychologist, with 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. 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 Dr. Janardhanan. 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 Dr. Janardhanan. The average caseload is 5 patients and approximately 8 – 10 consults per week.
Fellows are also provided experiences in Electroconvulsive Therapy (ECT) while at Kingsbrook. During a typical week, Dr. Janardhanan will provide supervision and training to fellows while treating 1 to 3 patients with ECT.
Specialty rotations:
Fellows will complete four one-half day rotations in the following settings:
Geriatric Medicine Clinic at SUNY Downstate:
This is a required 1-month rotation for 4 hours per week at SUNY Downstate. The faculty consists of a board-certified geriatrician (Dr. Everton Prospere). 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.
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. Prospere). 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.
Geroneurology Clinic:
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. It is under the supervision of Dr. Alice Beal. Geriatric psychiatry fellows will see 15 to 20 patients during the rotation.
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.
Research Experiences
The fellow will have about 10% time for conducting research and educational scholarship.
The geropsychiatry fellows have been actively engaged in research that have included papers on 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. Fellows have written multiple textbook chapters in prominent geriatric psychiatry texts.