Fellow Rotations and Clinical Experiences Include:

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.

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.

Inpatient Consultative Service (1 block)

Inpatient consultation service provides geriatric and palliative consultation within the VA. The interprofessional team hosts learners of all levels and is comprised of physicians, nurses, social workers, psychologists, pharmacists, and chaplains.

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.

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.

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.

Specialty Geriatrics (2 blocks)

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 to experience the approach each specialty takes to the care of the older adult.  Sites for the rotation vary depending upon opportunities, but examples include urogyncology, telehealth to rural older adults, neurology, and rheumatology.

Home Based Primary Care (2 blocks)

The Home Based Primary Care service is an interprofessional team who are in charge of the primary care of homebound older Veterans.  The Home Based Primary Care rotation is the fellow’s primary experience in home care, an integral aspect of Geriatric Medicine.

Hospital in the Home (2 blocks)

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.

Rehabilitation (2 blocks)

The rehabilitation rotation is a mix of multiple experiences within 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.

Rural Geriatric Medicine (2 blocks)

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.

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)

Fellows will all 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.