Geriatrics fellows have 2 half-day continuity clinics every week of the year-long fellowship. Every Thursday afternoon, fellows evaluate new and continuity patients at the Geriatrics Assessment Clinic, housed at the Atrium Health Navicent Primary Care West Macon, a Facility of Atrium Health Navicent The Medical Center, under the supervision of one of our board-certified geriatricians. Further, one half-day a week fellows have either a continuity Family Medicine or Internal Medicine clinic, depending on their primary specialty. This clinic differs from Geriatrics Assessment Clinic in that patients younger that 65 years old may be scheduled. Family medicine physician may also be scheduled with children.
During the Geriatrics Assessment Clinic experience, fellows will have 60 minutes for new patients and 30 minutes for established patients. Fellows are expected to perform comprehensive geriatrics assessments on the majority of new patients. In many cases, these patients will have a received a preliminary assessment by nursing and case management inter-disciplinary team members; the fellow then reviews these assessments and completes the comprehensive evaluation.
An important component of geriatrics is the continuum of care opportunity presented by nursing home practice. The family medicine department has an academic relationship with Peake Healthcare Center, a private, 122-bed facility in west Macon that serves patients insured through Medicaid and Medicare Part A, as well as those with private resources. Nursing home patients generally have multiple medical problems, often including cognitive disorders, which provide a rich educational experience for geriatrics fellows.
Dr. Dipesh Patel and Dr. Richard Ackermann serve as attending physicians for a substantial number of the patients living at Peake. Our gerontologist physician
Fellows attend Geropsych Clinic every other Wednesday afternoon at the Atrium Health Navicent Primary Care West Macon, a Facility of Atrium Health Navicent The Medical Center under the guidance of Dr. Lee Hyer, who is Professor of Psychiatry and Behavioral Sciences at MUSM and a certified neuro-psychologist. His outpatient practice is dedicated to older adults with cognitive impairment, dementia, and the behavioral complications of dementia. There is no block experience in geropsychiatry.
These Wednesday afternoon sessions are set up especially for geriatrics fellows. In general, the fellow will see the patient first, do an initial assessment, and then present the patient to Dr. Hyer, who will then interview the patient. The fellow and Dr. Hyer jointly make management decisions. Follow-up appointments will be arranged to optimize continuity with the individual fellow, to allow trainees to review the affects of therapeutic interventions.
In addition, fellows receive 12 hours of didactics every year on geropsychiatry topics, as part of the regular Tuesday and Friday didactic conferences.
On the first day of each calendar month, fellows will receive a 30-question written practice examination, with questions in the format of the ABIM/ABFM CAQ Exam. Each test must be completed and the answer sheet turned in by the 1st of the following month. You will receive two sets of tests on July 1st (for July and August - the July test is not turned in). assistant, Kathy Kemle, PA-C, and Dr. Dipesh Patel each make nursing home visits several times per week.
In addition to the 12-week long-term care rotation, each geriatric fellow visits Peake one half-day every other week. Each geriatrics fellow is assigned 10 nursing home patients, whom they will follow in continuity for one year. Hospitalization of these patients is managed by the family medicine residency, in-service service. Fellows are usually scheduled to visit the nursing home when geriatrics faculty is on-site; in many cases, the fellows should arrive before the faculty, so that preliminary work and rounds can be accomplished. The fellowship program does not bill Medicare or other payers for fellow visits to the nursing home.
Each of the ten longitudinal nursing home patients should be seen by the fellow at least once per calendar month. This means that during the non-LTC rotations, at least 5 longitudinal patients should be seen at each visit. Once per year, the fellow should perform a comprehensive geriatrics assessment on each of their longitudinal patients.
On the Wednesday afternoon continuity visits, fellows see Peake Nursing Home patients, supervised by geriatrics faculty member. Generally, when the fellow enters the facility, he/she should first review the list of acute needs identified by the nursing staff; then tend to new admissions, then other administrative issues, and finally longitudinal patients.
These tests will be graded and returned at the monthly Board Review sessions. Faculty will focus that hour's discussion on questions missed by fellows. All answers are referenced and linked back to standard sources. Fellows are encouraged to read these sources to strengthen any identified areas of weakness.
In addition, test questions appropriate to the topic are attached to the required reading for each of our didactic sessions. In some cases, the faculty will review these questions during that conference. This gives you additional practice in evaluating potential CAQ questions.
Geriatrics fellows are scheduled for 26 - 30 half-days during the year of training on home visits. Home visits can be made on patients with physical or functional limitations, or for social situations where information gained from such a visit can improve understanding and care of the patient. Home visits are encouraged, because they provide knowledge about the home environment and promote continuity of care.
Fellows are required to participate in our home visit program on every rotation except for the inpatient geriatrics experience. Visits are organized by our home care manager, and are either to patient's homes or to selected assisted living facilities (personal care homes) in the Macon area. Depending on geography, medical complexity, and the number of patients in an individual assisted living facility, the fellow-faculty team may see 2-9 home care patients during a half-day.