Geriatric Fellowship Program

Fellows participate in 12 one-month rotations, based at either Cleveland Clinic (Cleveland) or in the following areas:

Outpatient Geriatric Evaluation and Management (GEM)

Goal:

To prepare physicians for leadership in the interdisciplinary assessment and ongoing management of frail elderly patients with common geriatric syndromes and medical problems.

Inpatient Consult Service

Goals:

• To enable Geriatric Medicine fellows to achieve expertise in hospital-based consultations on medical and surgical patients.
• To provide opportunities for fellows to develop skills as educators of medical residents and students and other medical personnel in the assessment, management, evaluation and treatment of elderly patients in the acute care setting.

Long-term Care/Nursing Home (Fairfax Nursing Home)

Goals:

• To prepare Geriatric Medicine fellows to assume leadership in the care of patients in long-term care institutional settings.
• To prepare physicians to meet the physical, medical and preventive care needs of elderly patients in long-term care settings.
• To achieve expertise in the management of patients in long-term care settings, including knowledge of the administration of long-term institutions and the continuum from short-term to long-term care.

Geropsychiatry (Lutheran Hospital)

Goals:

To prepare Geriatric Medicine fellows to gain expertise in the diagnosis, evaluation and management of common affective disorders and behavioral disturbances occurring in elderly patients.

Neurology

Goals:

• To prepare Geriatric Medicine fellows to gain expertise in the evaluation, diagnosis and treatment of elderly patients with common neurologic problems, including cognitive dysfunction, post-stroke disorders, seizure disorders, movement disorders and neuropathies.
• To gain expertise in the evaluation of dementia, treatments for dementia, and the interpretation of neuro-imaging studies.

Acute Care for Elderly (ACE) Unit (Summa Hospital)

Goals:

• To enable Geriatric Medicine fellows to become experts in the administrative, clinical and consultative roles of a medical director for an Acute Care for Elders (ACE) Unit for hospitalized older adults, as well as leaders of the inpatient interdisciplinary team of health professionals.
• To gain expertise as geriatricians in methods to improve the hospital care of older adults.

Geriatric Rehabilitation (Montefiore Nursing Home)

Goals:

• To enable Geriatric Medicine fellows to achieve expertise in the principles of geriatric rehabilitation.
• To prepare Geriatric Medicine fellows to assume leadership of a team of health professionals in the management of common medical diagnoses in the older adult, with an emphasis on chronic care issues and practices.

Palliative/Hospice/Home Care

Goals:

• To prepare Geriatric Medicine fellows to assess and manage chronically ill, elderly patients who suffer from progressive and incurable diseases and who are approaching the end of life.
• To provide fellows with the knowledge, skills and expertise in terminal illness, pain management and end-of-life issues needed to evaluate and treat patients with terminal illnesses.

In-Patient GEM Rotation (VA Medical Center)

Goals:

To gain expertise in the evaluation and management of frail veterans who require multidimensional assessment and restorative interventions in a hospital setting.

Outpatient Assessment and Management

(Euclid Hospital Geriatric Assessment Program) and Lakewood Hospital Geriatric Assessment Program.

Goals:

• To enable Geriatric Medicine fellows to achieve competence in the outpatient evaluation, diagnosis and management of common geriatric syndromes.
• To enable fellows to achieve expertise as a leader of the interdisciplinary team that provides a consultative service to physicians and assists in the education of families and caregivers.

Longitudinal (Fairfax Place Nursing Home) Experience

Goals:

• To provide fellows an opportunity to achieve and maintain skills in long-term care practice.

In addition to the one-month rotations, fellows may select elective rotations in:

Bioethics

Goal:

To gain expertise in the application of ethical principles germane to the practice of geriatric medicine, including patient autonomy, justice, confidentiality, competence and beneficence.

Home Care

Goal:

To prepare Geriatric Medicine fellows to attain expertise in the acute, chronic and rehabilitative needs of patients in the home setting.

Movement Disorders

Goal:

To prepare Geriatric Medicine fellows to gain expertise in the diagnostic evaluation, differential diagnosis and therapy of common movement disorders in elderly patients.

Stroke Clinic

Goal:

To enable Geriatric Medicine fellows to gain expertise needed in the diagnostic evaluation and rehabilitation of elderly patients who suffer major strokes.

Syncope/Autonomic Dysfunction

Goal:

To enable Geriatric Medicine fellows to gain the skills necessary to provide diagnostic evaluation of patients with syncope or autonomic dysfunction.

Urinary Incontinence/Voiding Dysfunction

Goal:

To attain expertise in the clinical presentation, pathophysiology, diagnostic evaluation and therapy of patients with urinary incontinence and/or voiding dysfunction.

Vascular Medicine

Goals:

• To gain expertise in the diagnosis, evaluation and therapy of patients with peripheral vascular disease and venous disease.
• To gain the skills needed in the non-invasive evaluation of vascular diseases.

Lectures, Journal Clubs, and Conferences

From July to September, fellows are required to attend multicampus tutorial lectures on basic topics in geriatric medicine. In addition, fellows are expected to participate in and present at weekly interdisciplinary team conferences and geriatric fellows' conferences. Geriatric fellows' conferences include an evidence-based monthly journal club, monthly topic reviews conducted by fellows, quarterly geriatric faculty conferences, and citywide journal clubs in conjunction with the other Cleveland programs.

Fellows are encouraged to attend either the American Geriatrics Society (AGS), American Medical Director's Association (AMDA), or Gerontological Society of America (GSA) annual meeting. Opportunities exist to attend other national meetings.

Teaching

Fellows are required to participate in resident and medical student teaching/training in both outpatient and inpatient settings; and to give lectures at General Internal Medicine Grand Rounds. In addition, fellows are asked to give presentations to community groups (including the lay public).

Call

Fellows are expected to take call from home - weeknight and weekend coverage - 12 weeks during the year at Fairfax Place, a long-term care facility affiliated with Cleveland Clinic's Geriatric Fellowship Program.

Scholarly Activity

Fellows have ample opportunity to purse scholarly activities and to publish manuscripts.

More than 2,400 clinical research trials currently are under way at Cleveland Clinic. Many are focused on diseases associated with aging, including cerebrovascular disease and movement disorders.

Fellow Responsibilities

Fellows are responsible for completing their master schedule of rotations in consultation with Geriatric Fellowship Program Director Dr. Barbara Messinger-Rapport.

Fellows share responsibility for scheduling teaching conferences and giving presentations at the conferences. (A monthly schedule of teaching conferences is posted on the program bulletin board and distributed by e-mail.)

Fellows share office space on A-91 and have access to a computer that allows them to access the Cleveland Clinic network and necessary software applications.

Required:

• Continuity clinics in A-91, two half-days per week
• Longitudinal nursing home practice at Fairfax Place, including weekly rounds on patients and examination of re-admitted patients
• Selection of cases and guest "discussants" at Thursday noon interdisciplinary team conferences
• Topic review each month at Monday Research and Lecture Conference
• Presentations at Journal Club each month, at Monday Lecture Conference and/or at citywide Journal Club
• Weeknight and weekend coverage from home of Fairfax Place
• Presentation of one brief lecture each month to medical residents and students during their geriatrics rotation (later in the academic year)
• One-hour Geriatric Review Syllabus presentation monthly (Thursday or Monday), arranged with Dr. Messinger-Rapport
• One General Internal Medicine Grand Rounds presentation per year
• Attendance at Multicampus Geriatric Conferences, July-September (MetroHealth Medical Center)
• Attendance at Topics in Geriatric Medicine (citywide Grand Rounds) each Friday morning September-May
• Attendance at Cleveland Clinic/GME required lectures (e.g., ethics)
• Attendance at either American Geriatrics Society (AGS), American Medical Director's Association (AMDA), or Gerontological Society of America meeting each year
• Presentation at geriatric faculty conferences (M&M) (off campus)
• Presentation at citywide Journal Club (rotating sites)
• Participation on Fairfax Place committee
• Community lectures to non-health professionals

Optional

• Completion of scholarly project, including submission of abstract to national meeting, presentation at Monday research conference and preparation of manuscript
• Presentation at CME programs sponsored by the Section of Geriatric Medicine
• Submission of review article or case reports for publication

Applicant Characteristics

Fellow applicants must be board-eligible or board-certified in Internal Medicine or Family Medicine and demonstrate enthusiasm for the medical care of older adults. Prior experience in research or clinical practice is desirable.

Ronan Mangcucang Factora, MD, is Assistant Staff in the Department of General Internal Medicine, Section of Geriatrics; Program Director for the Geriatric Medicine Fellowship program; Co-Director of the Aging Brain Clinic, Cleveland Clinic; and Associate Professor, Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Dr. Factora is a diplomate of American Board of Internal Medicine, with added qualifications in geriatric medicine. His clinical interests include Alzheimer’s disease, dementias, functional capacity and pain management.

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Department:
Family Medicine
Associate Staff
Location:
Willoughby Hills Family Health Center
Mail Code WH10
2570 SOM Center Road
Willoughby Hills, OH 44094
Appointment:
(440) 943-2500

Department:
Family Medicine
Medical Director, Geriatric Assessment ClinicLocation:
Euclid Medical Office
99 Northline Circle
Euclid, OH 44119Work
Appointment:
(216) 692-8876

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Department:
Center for Geriatric Medicine
Associate Staff
Location:
Cleveland Clinic Main Campus
9500 Euclid Avenue
Cleveland, OH 44195
Appointment:
216.444.0319

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Barbara Messinger-Rapport, MD, PhD, is a Geriatrician with a special interest in cardiovascular risk reduction in older adults, polypharmacy and older drivers, osteoporosis and women’s health, the role of evidence-based medicine in frail elders and quality of life in dementia. She is on the Professional Advisory Board of the Alzheimer’s Association in Cleveland.

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Department:
Center for Geriatric Medicine
Location:
Cleveland Clinic Main Campus
9500 Euclid Avenue
Cleveland, OH 44195
Appointment:
216.444.5665

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Department:
Center for Geriatric Medicine
Clinical Nurse Specialist
Location:
Cleveland Clinic Main Campus
9500 Euclid Avenue
Cleveland, OH 44195
Appointment:
216.444.5665
Desk:
216.444.6819
Fax:
216.445.8762

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Cleveland Clinic Lorain Family Health & Surgery Center, Lorain, Ohio

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Department:
Center for Geriatric Medicine
Location:
Lorain Family Health Center
Mail Code LN12
5700 Cooper Foster Park Road
Lorain, OH 44053
Appointment:
(440) 989-4874Itri Eren, M.D.

Department:
Internal Medicine
Location:
Lorain Family Health Center
Mail Code LN12
5700 Cooper Foster Park Road
Lorain, OH 44053
Appointment:
440-989-4874

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Cleveland Clinic Lorain Family Health & Surgery Center, Lorain, Ohio

Mark H Frankel , MD
Specialty: Psychiatry
Facilities: Fairview Hospital, Lutheran Hospital
Primary Address: 1730 W 25th St Ste 2A
Cleveland, OH 44113
Phone: 216.363.2340
Certification: Board Certified in Psychiatry and Internal Medicine
Medical School: Ohio State University College of Medicine

Department:
Solid Tumor Oncology
Associate Staff
Location:
Cleveland Clinic Main Campus
Mail Code M76
9500 Euclid Avenue
Cleveland, OH 44195

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Department:
Center for Geriatric Medicine
Location:
Lorain Family Health Center
Mail Code LN12
5700 Cooper Foster Park Road
Lorain, OH 44053Work
Appointment:
(440) 989-4874Kashif Khan, M.D.

Department:
Internal Medicine
Location:
Lorain Family Health Center
Mail Code LN12
5700 Cooper Foster Park Road
Lorain, OH 44053
Appointment:

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Cleveland Clinic Lorain Family Health & Surgery Center, Lorain, Ohio

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Cleveland Clinic Lorain Family Health & Surgery Center, Lorain, Ohio

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Department:
Center for Home Care and Community Rehabilitation
Location:
Cleveland Clinic Main Campus
Mail Code RK30
9500 Euclid Avenue
Cleveland, OH 44195
Appointment:
(216) 636-8742

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Babak Tousi, MD
Specialty: Geriatric Medicine
Facilities: Lakewood Hospital, Lutheran Hospital
Primary Address: 1730 west 25th Street Suite 2A
Cleveland, OH 44113
Phone: 216.363.2319
Certification: Board Certified in Internal Medicine
Medical School: Tehran University of Medical Sciences
Residency: Morristown Memorial Hospital, University of Medicine and Dentistry of New Jersey
Fellowship: Cleveland Clinic Foundation

Department:
Family Medicine
Location:
Fairview Hospital
Mail Code Fairview
18101 Lorain Avenue
Fairview, OH 44111
Appointment:
(216) 476-7088

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Department:
Center for Home Care and Community Rehabilitation
Location:
Cleveland Clinic Main Campus
Mail Code RK30
9500 Euclid Avenue
Cleveland, OH 44195
Appointment:
(216) 636-8742

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• Director, Center for Senior Health, Summa Health System
• Director, Fall Prevention and Balance Program, Summa Health System
• Assistant Professor of Medicine, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio
• Assistant Professor of Medicine, Ohio University College of Osteopathic Medicine, Athens, Ohio

Phone:

330.375.4100

Appointed:

1992

Education:

• M.D.: Michigan State University, College of Human Medicine, East Lansing, Mich., 1987
• B.A.: Biology, Alma College, Alma, Mich., 1983

Specialty Training:

• Fellowship: Geriatric Medicine, Case Western Reserve University, Cleveland, Ohio, 1990-1992
• Residency: Internal Medicine, Akron City Hospital, Akron, Ohio, 1987-1990

Biographical Sketch:

Dr. Cleveland completed her internal medicine residency at Summa Health System in 1990 and her geriatric medicine fellowship at University Hospitals of Cleveland in 1992. She has been practicing consultative geriatric medicine at Summa Health System since 1992.

Currently, Dr. Cleveland is Medical Director of Summa Health System's Center for Senior Health and its Falls and Balance Program. She is Associate Professor for Clinical Medicine at NEOUCOM, where she coordinates the Geriatric Curriculum for M2 Students. She also is a regular contributor to Consultant.

Dr. Cleveland's primary interests within Geriatric Medicine are evaluation and management of dementia and working with family members as they navigate the unfamiliar waters of becoming a caregiver.

Peer-Reviewed Publications:

Falls: A preventable geriatric syndrome, Murphy, DP, Cleveland, ML, Consultant, 2006, 46(4)500-502

Myalgia in the elderly: Arthritis...or something else? Murphy DP, Cleveland ML, Consultant, 2005, 45(10):1141-1143

Strategies to promote successful aging: Part 1: What patients can do, Murphy DP, Cleveland ML, Consultant, 2005, 45(4):469-472

Urinary tract infections in elderly patients: How best to diagnose and treat, Murphy DP, Cleveland ML, Consultant, 2004. 44(12):1502-1506

Alzheimer Disease: A commonsense approach to evaluation and management, Murphy DP, Cleveland ML, Consultant, 2004. 44(3):388-392

A systematic - and realistic - approach to functional assessment of elderly persons, Murphy DP, Cleveland ML, Consultant, 2004. 44(1):47-49

• Associate Director, Center for Senior Health, Summa Health System
• Medical Director, Laurel Lake Retirement Community
• Assistant Professor of Internal Medicine, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio
• Clinical Assistant Professor of Family Medicine, Ohio University College of Osteopathic Medicine, Athens, Ohio

Appointed:

2002

Education:

• D.O.: Philadelphia College of Osteopathic Medicine, Philadelphia, 1998
• B.A.: Biology, Washington & Jefferson College, Washington, Pa. 1994

Specialty Training:

• Fellowship: Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio, 2001-2002
• Residency: Internal Medicine, St. Francis Medical Center, Pittsburgh, 19989-2001
• Osteopathic Internship: St. Francis Central Hospital, Pittsburgh, 1998-1999

Biographical Sketch:

Dr. Istenes completed her osteopathic internship (1998-1999) and internal medicine residency (1998-2001) at St. Francis Medical Center in Pittsburgh. In 2002, she completed her Geriatric Medicine Fellowship at Cleveland Clinic.

She is a member of the American Geriatrics Society, the American Medical Directors Association and the American College of Physicians-American Society of Internal Medicine.

Publications:

How common is depression in older adults? Attitude, Spring, 2006

Geriatrician, Summa Health System, Division of Geriatrics

Appointed:

2002

Education:

• M.D.: University of Illinois College of Medicine, Chicago, 1995
• B.A.: Cellular and Molecular Biology, Northwestern University, Evanston, Ill., 1991

Specialty Training:

• Fellowship: Geriatric Medicine, Cleveland Clinic, 2001-2002
• Internship/Residency: Internal Medicine, Vanderbilt University Medical Center, Nashville, Tenn., 1995-1998

Biographical Sketch:

After Dr. Kayani completed her internship and residency in internal medicine at Vanderbilt University Medical Center in Nashville, she worked at the Veterans Administration Medical Center there, and as a primary care physician in rural North Carolina. She completed her fellowship in Geriatric Medicine at Cleveland Clinic in 2002 and joined Summit County Geriatricians where she currently provides inpatient and outpatient consultations.

She is a member of the American Geriatrics Society.

Publications:

Book Chapter

Back and Neck Pain in The Internal Medicine Peripheral Brain, Kayani N, Talreja D, Talreja Reena, Talrega Roshan, 2004

Peer-Reviewed Publication:

The non-Alzheimer dementias: An approach to evaluation and management, Murphy D, Kayani N, Consultant, May, 2004: 869-873

• Associate Director, Center for Senior Health, Summa Health System
• Associate Professor of Clinical Internal Medicine, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio
• Clinical Associate Professor of Gerontology, Ohio University College of Osteopathic Medicine, Athens, Ohio

Appointed:

1999

Education:

• MD: St. Louis University School of Medicine, 1978
• B.S.: Zoology, Duke University, 1974

Specialty Training:

Internship/Residency: Internal Medicine, Akron General Medical Center, Akron, Ohio, 1978-1981

Biographical Sketch:

Dr. Maxwell completed her internal medicine residency at Akron General Medical Center in 1981. She received her Added Qualification in Geriatric Medicine in 1988 (renewed in 1998), and has been at the forefront of instruction in gerontology and geriatrics in Northeast Ohio since the early 1990s. Currently, she serves on several committees, including the Geriatric Medicine Regional Coordinating Committee for the Northeastern Ohio Universities College of Medicine.

She is a member of the American Geriatrics Society and the Ohio Geriatrics Society, and she has been a fellow of the American College of Physicians since 2001. In 2003, she received the Summit County Elder Abuse Prevention Coalition's Seniors' Advocate Award.