The Wake Forest Geriatric Medicine Fellowship program hosts three training pathways:
- 12-month clinical fellowship
- Two-year clinician-scholar training in clinical geriatrics and research
- Two-year sequential training in Geriatrics and Palliative Medicine
Multiple aspects of geriatric care are represented, including:
- Acute care and consultative care
- Inpatient and outpatient rehabilitation
- Geriatric psychiatry
- Ambulatory care (primary and consultative)
- Home visits
Our affiliated continuing care retirement communities host every level of long-term care, including assisted living and Medicare-certified, nursing-home based rehabilitation.
Each pathway includes:
- Clinical training
- Didactics and teaching
- Research opportunities – both for clinical fellows and for fellows who choose further dedicated clinician-scholar training
- Palliative Medicine opportunities
The one-year clinical geriatrics fellowship aims to develop internal medicine and family medicine physicians into geriatricians. The EPAs, Curricular Milestones, and ACGME Competencies and Milestones unite to describe, respectively, the professional definition of a geriatrician, the competencies geriatricians must master, and the skill set a geriatrics fellow will demonstrate in order to successfully complete fellowship.
A major part of becoming a geriatrician is learning how older adults differ in their physiology, response to pharmacology, and in the approach to care. Much evidence has demonstrated that older adults value independence and prioritize function; research investigating therapies for older adults has focused on key areas of function: physical function and cognitive function, and increasingly, social function as well. This concept of a “Function First,” rather than disease-first, philosophy allows geriatricians to consider how disease states and organ systems promote older adults’ function and independence, and to partner with patients and their families to determine goals of care and shared decision making.
Thus, the quarterly rotations of the geriatrics fellowship reflect the concept of Function First:
In this rotation fellows will learn the assessment and improvement of physical function, working with inpatient neuro-rehabilitation, outpatient rehabilitation, and specialists who focus on neurological, muscular and bone health. Fellows also will spend this quarter in the inpatient geriatric trauma consultative service.
Fellows will focus on cognition, dementia and geriatric psychiatry, mastering cognitive assessment and exploring management of dementia from initial diagnosis through end-of-life care (often occurs in long-term care). This rotation includes dementia training, geriatric psychiatry, Memory Counseling Program and the Kulynych Geriatric Consult Clinic. In addition, the fellows will gain exposure to the cutting-edge research done at the Sticht Center’s Alzheimer Disease Research Center.
Models of Care
As the structure of medical care changes with health policy reform, new models of care will be required to assist older adults in navigating the structure of medical care. Fellows will embed within the transitional and supportive care team, learn more about community-based organizations and resources that many older adults rely upon, and spend time within both traditional and novel primary care models such as a PACE program. Fellows will also join the Continuing Care Retirement Community setting at Bermuda Village and spend time in the long-term care setting, in managing a skilled nursing panel of patients and learning about the role of a medical director in such a facility.
This rotation encourages the application of the Function First concept in considering two sets of goals: a) goals of care for patients and families, and b) goals for your career as a geriatrician. Fellows will rotate with the Kate B. Reynolds Hospice Home, Hospice & Palliative Care, and work on a scholarly project of your choosing. Fellows explore geriatric electives with geriatricians and other specialists who focus on aging patients. Electives that have been chosen in the past include dermatology, ophthalmology, sports medicine, podiatry and audiology. Electives will be scheduled after consultation with the fellow.
Weekly didactics are scheduled for the fellows with the MD and PhD faculty of the Geriatric Section and invited subspecialists. These conferences cover the span of geriatric medicine and prepare our fellows to pass the ABIM Geriatric Board Exam. Approximately half of the didactics are shared with the Hospice and Palliative Care fellows. The fellows will participate in presenting at case conferences, Morbidity and Mortality conferences, and section journal clubs.
The extensive research resources available through our Claude D. Pepper Older Americans Independence Center and Kulynych Center for Memory and Cognition Research, among others, provide the opportunity to interact with interdisciplinary faculty members of diverse backgrounds and research interests. Fellows develop skills to critically appraise the literature; throughout their training, they are given the opportunity to participate in research and quality improvement projects.
Research areas include:
- The biology of aging
- Clinical trials
- Health services research
- Policy research
On-call responsibilities are assigned for the whole academic year before July 1.This is a night and weekend on-call by phone or page rotation that is shared between clinical faculty, APPs and fellows.