Geriatric Fellowship Program

Overview

The Cleveland Clinic Geriatric Medicine Fellowship Program seeks to train medical professionals to deliver high quality care to all older persons by enhancing their medical knowledge, developing skills as educators, and fostering inquisitive thought through participation in research and quality improvement.

The one year clinical Fellowship in Geriatric Medicine offered by the Cleveland Clinic is designed to train physicians to assume positions of leadership in the field of Geriatric Medicine. Experiences in outpatient consultative geriatric evaluation and management (GEM), inpatient geriatric consultation services, long-term and post-acute care, geropsychiatry, neurology, hospice/ palliative care/ home care, and elective services. Aside from clinical experiences, the fellows are immersed in teaching responsibilities for residents, medical students, and ultimately required to present at the department of general internal medicine grand rounds – these experiences increase the skill and confidence in the trainees to take on teaching responsibilities often associated with a position in geriatric medicine, and prepare them to assume a role as a clinician educator. The fellowship program takes advantage of educational programs available at the Cleveland Clinic (e.g. Essentials of Teaching) to further enhance the fellows’ skills. Participation in community activities (health care screenings, health talks), quality improvement projects, scholarly activities (abstract generation, poster presentations at local/regional/national conferences), and opportunities to for scholarly writing (review articles, etc.) are present throughout the year and further enhance the fellow’s education.

As the fellowship is only 1 year long and the types of work available to fellows are broad after graduation, the fellows are provided the opportunity to guide the direction of their own education and experiences to better prepare them for their anticipated career responsibilities while still achieving the competencies required of them for graduation. Consequently, fellows have elective months available to select clinical experiences and exposure to achieve this end. They are also able to modify the content of their conferences to bring in speakers, address topics they feel are necessary to either fill in knowledge gaps or further enhance the knowledge that they have. This flexibility and trainee-centered approach to the fellowship training is one of this program’s great strengths.

Program Aims

1. Provide high quality care for complex order persons in any venue
   • The program will provide opportunities to gain knowledge and skills to care for older persons in the ambulatory, acute care, post-acute, long term, and home care settings. The program will also provide guidance the practical aspects of clinical care, including knowledge of different models of care, requirements for billing and coding, and looking at the needs of older persons through the lens of social determinants of care. Skills will increase as the fellows are provided increasing responsibility during their training.
2. Gain skills necessary to teach learners of various backgrounds the principles of care for older persons
   • The program will provide the opportunity for the fellows to attend the Essentials of Teaching Program to enhance their teaching skills. The fellows will have the opportunity to apply their skills in didactics and teaching rounds with residents, medical students, and any other learners that may be present. All fellows in the program are required to give a presentation at Department of Internal Medicine Grand Rounds as a capstone project of their scholarly activity.
3. Develop a mindset to integrate new technologies and knowledge into processes of care and education
   • The program requires the fellows to present regularly in journal club updates in the medical literature that can enhance the care provided to patients. This may include assessment of knowledge and new technologies into care processes. Practical clinical application of the data they present is the key point they are meant to provide.
   • The program provides opportunities for the fellows to conduct patient care through virtual platforms to gain experience regarding the benefits and limitations of such interactions.
4. Prepare for leadership roles guiding care teams and fostering quality improvement and research initiatives that enhances patient care
   • The fellows are provided the opportunity to be involved in multidisciplinary care teams during their rotations, and given the opportunity to lead them as their skills advance. The fellows are also required to participate in quality improvement projects during the year to increase their experience and understanding of these processes – multiple opportunities exist.

The fellows are provided opportunities to attend national geriatric medicine meetings (including the American Geriatrics Society and the Society for Post-Acute and Long Term Care) to acquire knowledge of opportunities for career development and network with colleagues in this field to foster collaboration, career growth, and mentorship to help guide their development during and after fellowship.

Two 12-month geriatric fellowship positions are available each year. The Geriatric Medicine Program participates in the Electronic Residency Application Service (ERAS) developed by the Association of Medical Colleges (AAMC). Therefore, we only accept applications submitted electronically through ERAS:

• www.aamc.org/eras

The 12-month fellowship in Geriatric Medicine is offered by Cleveland Clinic Health System. At the completion of the fellowship, the fellow is eligible to sit for the Certificate of Added Qualification exam.

Curriculum

1. The Fellowship program focuses on the core competencies of patient care, medical knowledge, interpersonal and communication skills, professionalism, and systems based practice. Evaluation of the Fellow’s progress is based on the achievement of milestones as defined by the ACGME for the 12-month clinical fellowship in Geriatric Medicine. (https://www.acgme.org/globalassets/PDFs/Milestones/GeriatricMedicineMilestones.pdf)
2. The program enables Fellows to gain expertise in the physiology of aging, evaluation and management of geriatric syndromes, working within and leading interdisciplinary teams, and delivering high quality care for older persons in a number of clinical settings including outpatient clinic, inpatient acute care units, post-acute care, long-term care, and home care.
3. Fellows enhance clinic knowledge to deliver nuanced care for older persons who have common chronic medical illnesses such as diabetes and hypertension while gaining additional skills in managing commonly encountered neurological and psychiatric conditions in this population.
4. Upon completion of the Fellowship Program, candidates are prepared for clinical positions and educational leadership in the field of geriatric medicine, including medical directorship of long-term care facilities, consultation services, and outpatient assessment programs.

Required Rotations

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 the physicians for leadership in the interdisciplinary assessment and ongoing management of older persons 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

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

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.

Geriatric Rehabilitation/Skilled Nursing Facility

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

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.

Longitudinal (Fairfax Place Nursing Home) Experience

Goals:

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

Elective Rotations/Experiences

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

Adult Protective Services Experience

Goals:

Spend time with Cuyahoga County Adult Protective Services to learn how elder abuse reports are investigated, including the process of intake and evaluation, conducting home visits (including virtual capacity evaluations if possible), and attendance at a guardianship hearing if possible.

Audiology

Goals:

Work with audiologists to evaluate older persons referred with hearing problems and determine what types of assistive devices may be best suited for them.

Cardiology/Heart Failure

Goals:

The Geriatric Medicine Fellows to spend time in clinic with a precepting Cardiologist to gain familiarity with the management of heart failure. There will be opportunities to interact with other members of the heart failure team including Pharmacy Palliative Medicine, participate in interdisciplinary rounds with the Transplant Team, and round in the inpatient setting.

Ethics

Goals:

Participate in inpatient consultation of difficult cases involving ethical dilemmas (e.g. decision making, end of life care).

Home Care/PACE

Goals:

Conduct clinical care through Cleveland Clinic Home Care and/or the Program for All-Inclusive Care for Elders (PACE) program to learn how these health delivery systems operate.

Neuropsychology

Goals:

Observe the performance of neuropsychological testing and understand how the different cognitive domains are assessed and how performance is scored.

Occupational Therapy - Driving Evaluation

Goals:

Observe driving evaluations conducted by occupational therapy to understand the process and learn how safety can be improved for those who are capable of continuing driving.

Osteoporosis Clinic

Goals:

Work with endocrinologists in the outpatient setting to evaluate and manage osteoporosis and related metabolic bone disorders.

Sleep Medicine

Goals:

Clinically evaluate adults with sleep disorders and get familiarized with evaluation and management of commonly encountered problems such as sleep apnea, REM sleep disturbances, and insomnia.

Urology/Urogynecology

Goals:

Clinically evaluate older persons with urinary complaints and understand investigation and management options provided in a Urology clinic.

Requirements

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

Teaching is an essential skill for Geriatricians. Fellows are required to teach medical students and residents during their outpatient and inpatient rotations. They are also required to give one Cleveland Clinic Department of Internal Medicine Grand Rounds as a capstone educational experience. Opportunities to speak at community events are also offered to the fellows as they arise.

Scholarly Activity

Fellows have the opportunity to participate in many quality improvement and research projects that the Center for Geriatric Medicine is involved in. They are also encouraged to use these experiences as well as clinical activities to develop abstracts for submission for national conferences. As many of the staff are involved in writing projects, fellows may also have the opportunity to contribute and publish written work.

Fellow Responsibilities

Fellows are responsible for completing their master schedule of rotations in consultation with Geriatric Fellowship Program Director Dr. Ronan Factora.

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 at the Center for Geriatric Medicine at the X-building and have internet and computer access to conduct patient care clinical as well as scholarly and administrative responsibilities.

Required:

• Continuity clinic 1-2 half days per week
• 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
• Presentation of one brief lecture each month to medical residents and students during their geriatrics rotation (later in the academic year)
• One General Internal Medicine Grand Rounds presentation per year
• Attendance at either American Geriatrics Society (AGS), American Medical Director's Association (AMDA), or Gerontological Society of America meeting each year
• Community lectures to non-health professionals when offered
• Participation in community health screening when available
• Involvement in quality improvement projects

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.

Faculty

Cleveland Clinic Faculty

Ronan Factora, MD

Program Director

Luke Dogyun Kim, MD, MEd

Associate Program Director

Oliver Glen Ancheta, DO

Associate Staff

Roopa Anmolsingh, MD

Associate Staff

Ardeshir Hashmi, MD

Section Chief Center for Geriatric Medicine

Hiba Khan, MD

Associate Staff

Kenneth Koncilja, MD

Staff

Kasia Rothenberg, MD, PhD

Staff

Saket Saxena, MD

Staff

Ciera Sears, MD

Associate Staff

Steven Schwartz, MD

Staff

Willy Marcos Valencia Rodrigo, MD

Staff

Anne Vanderbilt, CNS

Clinical Nurse Specialist

Gina Ayers, Pharm.D., BCGP, BCPS Pharmacy Clinical Specialist

Kenyette Smith Program Coordinator

Application Process

Applications are accepted starting July 1 of the year preceding the fellowship. Interviews are conducted from July through November, or until all positions have been filled. The Section of Geriatric Medicine does participate in the match process.

• Apply to Cleveland Clinic Health System Fellowship in Geriatric Medicine (ERAS Website)

If you have questions about the Cleveland Clinic Fellowship in Geriatric Medicine, contact:

Kenyette Smith, Program Coordinator
The Cleveland Clinic Foundation
Geriatrics Medicine
10685 Carnegie Avenue, X10
Cleveland, OH  44106
Phone: 216.445.1381
Email: smithk23@ccf.org

About

Cleveland, an ethnically diverse mid-sized city located on Lake Erie, features a host of cultural and recreational attractions. Cleveland Clinic is located near the University Circle area, which is the major cultural center in Cleveland. This area also features the Cleveland Orchestra, the Cleveland Museum of Art, several other museums, and Case Western Reserve University. Downtown Cleveland is approximately 2 miles from the Cleveland Clinic campus.

Downtown Cleveland has seen dramatic changes over the past decade. Foremost are the additions of Progressive Field - home of the Cleveland Indians baseball team, Quicken Loans Arena - home of the Cleveland Cavaliers basketball team, and Cleveland Browns Stadium - the home of the Browns football team. Other notable downtown attractions include the Rock and Roll Hall of Fame and Museum and the Great Lakes Science Center, which houses the Cleveland Clinic OMNIMAX Theater. Cultural attractions in the downtown area include Playhouse Square, the second largest theater district in the United States. In addition, the downtown area and surrounding suburbs are home to a diverse and excellent array of restaurants.

Many activities are also available for outdoor enthusiasts. The natural woodland Cleveland Metroparks form an “Emerald Necklace” which surrounds the city and contains picnic areas as well as miles of bicycle, hiking, jogging, and horseback riding trails. Cleveland also offers sailing enthusiasts, boaters, swimmers, and fishermen abundant lakeshore to enjoy. Cedar Point Amusement Park and Cleveland Metroparks Zoo are among the attractions that offer a day of fun for the whole family.

Cleveland has nearly 90 residential communities with many convenient suburbs located just outside the city center. Housing is very affordable throughout the greater Cleveland area.

• Learn more about what Cleveland has to offer.