All 5 Ms (Mind, Mobility, Medications, Multicomplexity, and Matters Most)
Continuity Clinic (Longitudinal)
This rotation focuses on mastering knowledge and skills needed to care for the geriatric patient in the ambulatory setting alongside an interprofessional team. Additionally, it gives fellows the opportunity to complete comprehensive geriatric assessments. Fellows will have one half-day session per week throughout the fellowship.
Long-Term Care Continuity Experience (Longitudinal)
The Kerrville Community Living Center (CLC) is home to Veterans in long-term care and in a locked memory unit. Fellows will have the opportunity to manage a panel of long-term care patients in this setting over the course of the year.
Geriatric Trauma Co-Management Service (5 blocks)
The Geriatric Trauma Service co-manages older adults admitted to the UHS trauma service who are 65 years and older with dementia, delirium, fall as mechanism of injury, or involved as driver of a motor vehicle collision, as well as any adult 75 years or older. The focus is on management of common inpatient geriatric syndromes, prevention of hazards of hospitalizations, and safe transition planning. This service is currently expanding to include consultative care from hospitalist teams.
Rural Geriatric Medicine (1 block)
The Kerrville VA is a branch of the South Texas Veterans Health Care System located in Kerr County that serves a rural population. Fellows will have experience in its long-term care unit, locked memory unit, geriatric clinic, and multiple other associated health specialties.
Home Based Primary Care (2 blocks)
The Home Based Primary Care service is an interprofessional team who provide primary care for homebound older Veterans. The Home Based Primary Care rotation is the fellow’s primary experience in home care, an integral aspect of Geriatric Medicine. Services center around Sequin, TX and give fellows an experience in rural medicine as well as home care.
Geriatric Psychiatry (2 blocks)
The Geriatric Psychiatry rotation focuses on the diagnosis and management of cognitive disorders and exposes learners to psychosocial aspects of aging including interpersonal and family relationships, adjustment disorders, depression, bereavement, and anxiety. Fellows will rotate in outpatient geriatric psychiatry and memory clinics.
Neurology (1 block)
The Neurology rotation is based in the UT Health San Antonio Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases. Fellows gain experience with cognitive neurology, neuropsychology, and movement disorder specialists.
Rehabilitation (2 blocks)
The rehabilitation rotation is a mix of multiple experiences within the University Hospital Reeves Rehabilitation Center and the Audie L. Murphy VA Polytrauma, Spinal Cord, and other rehab services. Fellows will work with physicians, physical therapists, occupational therapists, speech therapists, and Kinesiotherapists to expand their knowledge of rehabilitation modalities for older adults.
Wound Care (1 block)
The Wound Care Rotation allows fellows learn the basics of wound care management from specialists at University Hospital and the Texas Diabetes Institute.
Specialty Geriatrics (1 block)
The Specialty Geriatrics Rotation is an opportunity for fellows to explore subspecialties important in the care of the older adult. Fellows will spend half-days in different clinics with a primary focus on pharmacy and medication management.
Hospital in the Home (1 block)
The HIH team is an interprofessional team that manages vulnerable older adults in the home who would otherwise meet criteria for hospital admission. Their primary goals are to minimize iatrogenic events, maintain function, and prevent readmissions.
Medicine Specialty / Sensory (1 block)
The Medicine Specialty / Sensory rotation focuses on medical subspecialties related to the care of older adults such as oncology and urogynecology. Additionally fellows have experiences in audiology and low-vision clinics.
Community Living Center (2 blocks)
The Community Living Center (CLC) in the San Antonio VA is comprised of a subacute rehabilitation unit and an inpatient hospice unit. Fellows will gain experience in both units.
VA Palliative Care Consult Service (1 block)
Inpatient consultation service provides palliative consultation within the VA. The interprofessional team hosts trainees of all levels and is comprised of physicians, nurses, social workers, psychologists, pharmacists, and chaplains.
UHS Palliative Care Consult Service (1 block)
While on the Palliative Care Consultation Service at UHS, fellows will work with an inter-professional team to provide patients with expert palliation of symptoms, intensive communication for patients and their families, end-of-life goal-centered care, and appropriate spiritual and psychosocial care for patients and their families.
Elective (3 blocks)
Electives serve as an opportunity for fellows to explore their interests in Geriatric Medicine further. Fellows may choose to repeat a previous rotation, continue working on their scholarly project, or create an experience tailored to their own needs.
Research (1 block)
UT Health San Antonio is home to multiple centers of excellence in geroscience and aging research. In this rotation, fellows will have the opportunity to observe multiple clinical trials and interact with research faculty. Additionally, all fellows will pursue scholarly projects during the course of their training that can lead to abstract submission to the Annual Meeting of the American Geriatrics Society. The research rotation give protected time to work on these projects as well as to observe clinical research activities within our affiliated institutions.
Introduction to Clinical Research (1 block)
This course is a collaboration between the Geriatric Medicine, Hospice and Palliative Medicine, and Pulmonary and Critical Care Medicine Fellowships. Fellows will gain training in research and quality improvement methodology and design their own scholarly project.