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Geriatric Fellowship Rotations

Our fellows will receive training in a variety of settings that span the typical spectrum of geriatric psychiatric care.

VA Inpatient Geriatric Psychiatry

Required 2-month rotation at the VA Medical Center and also available as an elective. Faculty consists of 2 full-time Geriatric Psychiatrists, 1 full-time psychologist, 2 full-time social workers and 2 full-time pharmacists. Fellows spend 1-4 hours weekly in seminars and case conferences; faculty are always available for consultations; case loads and supervision depends on the skills demonstrated by the fellow.

Treatment modalities include psychopharmacology; individual and group psychotherapy; behavioral modification strategies; psychoeducational classes; ECT and other non-pharmacological treatments; nutrition; case management; psychosocial rehabilitation; recreational and occupational therapy. Fellows are exposed to psychological and neuropsychological testing. Fellows also have the opportunity to testify at civil commitment hearings. Clinical teaching occurs daily during rounds. Also, fellows may take part in the group therapy component along with the psychologists. They work closely with pharmacists and pharmacy students. Resident/Medical Student/Physician assistant student teaching is a major emphasis of the resident experience on this service.

 

VA Inpatient Neurology

1 month required rotation at the VA medical center. Rotations are staffed by full-time faculty from the Department of Neurology. Fellows participate in the teaching rounds, the noon conferences and Grand Rounds of the Neurology services. The experience at the VAMC covers the full breadth of commonly encountered neurological disorders such as dementia, delirium, epilepsy, tumor, stroke, CNS infections, and demyelinating and degenerative illness.

While on consultation service, fellows frequently interface with the Psychiatry inpatient services, gaining experience in the interplay between the two disciplines. State-of-the-art treatment techniques are employed in both a clinical and research setting. Inpatient responsibilities may include a caseload of 3 to 5 patients, while consultation volume may vary greatly from day to day (on average 1 to 3 cases). The fellow has supervision weekly along with the daily teaching during clinical rounds.

 

Geriatric Psychiatry Outpatient at VAMC

Required rotation (1-month FTE) where fellows will have ½ day outpatient clinic throughout their fellowship. Clinic faculty consist of 2 Geriatric Psychiatrists, 1 Gero-Psychologist, 1 social worker, and 4 other full time psychiatrists. Fellows staff all patients with the onsite faculty; work on mastery of the biopsychosocial formulation; therapy cases are both staffed on-site, and discussed in more detail later during individual supervision.

The outpatient population is diverse in diagnoses, age, and socioeconomic status. A majority of patients receive some component of psychopharmacologic treatment, alone or in concert with psychotherapy; residents spend approximately 15-25% of their clinical time performing psychotherapy. Over the course of the year, average caseload consists of 10-20 patients in some form of psychotherapy and 40-50 patients in medication management.

 

Consult-Liaison Psychiatry at the VAMC

3 month required rotation. Faculty consists of two full time psychiatrists, one of who is the Director of Geriatric Psychiatry and is an expert on Delirium and the other is a board certified forensic psychiatrist. The fellow will learn about the legal aspects of geriatric psychiatry during this rotation. Departmental and hospital social work assistance is also present. Fellows spend 1-3 hours daily in rounds and they will have an opportunity to give presentations on various subjects pertinent to clinical cases. Fellows are responsible for thorough evaluations and providing opinions on civil commitment cases.

A number of treatment modalities are experienced including ECT, psychopharmacotherapy, crisis intervention, brief therapy, cognitive-behavioral therapy, and psychosocial rehabilitation. Part of the educational experience is also to effectively interface with other medical teams to provide care for a patient in a treatment team approach. The psychiatric faculty supervise all cases daily during rounds. There are also case discussions and formal lectures on C/L subjects scheduled throughout the week.

 

UF Health Inpatient Psychiatry

Fellows may request for an elective 1-month rotation at the UF Health Geriatric inpatient unit. Faculty consists of 1 full-time board-certified Geriatric Psychiatrist. 3 other full time psychiatrists are available for consultation. Fellows spend 1-3 hours daily in rounds with the faculty. They are in seminars 3-5 hours weekly. The patient population spans the breadth of socioeconomic classes.

A number of the patients have co-morbid personality disorders, neurocognitive disorders and substance use disorders. Treatment modalities include psychopharmacology, individual psychotherapy including brief, crisis intervention, and cognitive-behavioral, family and group therapy, case management, and psychosocial rehabilitation. Fellows are exposed to psychological and neuropsychological testing. Fellows also have the opportunity to testify at civil commitment hearings. The average caseload ranges from 5 to 8 patients. The fellow participates in the evaluation, treatment, discharge planning, and chart documentation.

 

VA Community Psychiatry Rotation: Mental Health Intensive Case Management (MHICM)

Required 1 month rotation and the faculty consists of 1 full-time psychiatrist. Fellows spend 3-5 hours weekly in didactics and 1-3 hours daily in clinical rounds with the faculty. The Community Psychiatry rotation at the VA has 2 components. Fellows primarily care for patients in the intensive case management service in which there are approximately 100 plus patients with severe mental illnesses, primarily schizophrenia as well as major mood disorders such as bipolar disorder.

Treatment modalities include psychopharmacology, crisis intervention, group therapy, case management, and psychosocial rehabilitation. At MHICM, fellows also have the opportunity to learn more about clozapine management and participate in the clozapine group. Fellows evaluate and treat veterans with psychiatric and dual diagnoses. Treatment modalities include psychopharmacology, crisis intervention, and supportive therapy. The severity of illness dictates the frequency of visits, including crisis interventions to avert exacerbations. Clinical teaching occurs daily in rounds and during clinic times as appropriate. The attending is always available for consultation.

 

Electroconvulsive Therapy (ECT) Rotation

1 month, elective and the faculty consists of 2 board-certified psychiatrists. Fellows spend approximately 3-4 hours every Monday, Wednesday, and Friday morning in the ECT suite performing ECT alongside the faculty member. The patient population is predominantly middle class but patients from all socioeconomic classes are encountered.

Most of the patients have co-morbid medical conditions. Treatment modalities include ECT and psychopharmacology. The fellow participates in the evaluation process, treatment planning, discharge process, and chart documentation.