Rotations

Geriatric Inpatient Unit, Whidden Hospital. This required 6-month part-time rotation at Whidden Hospital's Geriatric Specialty Unit located on Lewis 2, offers fellows the opportunity to work within an active 22-bed inpatient facility. This unit serves a diverse population of patients over the age of 60 who often have co-morbid medical and psychiatric conditions. On-site faculty consists of 4 psychiatrists (with added qualifications in geriatric psychiatry), a geriatric internist, and other multidisciplinary staff. Fellows attend rounds each morning with all staff, and participate in leading interdisciplinary team meetings.

In this rotation, the average caseload consists of 4 inpatients, with full responsibility for managing psychopharmacologic treatment, individual psychotherapy if appropriate, and communicating with outside providers. Fellows will be expected to write daily notes and orders, to assist in coordination of aftercare plans, and to lead family meetings and team meetings. Fellows will have one hour of scheduled supervision each week and daily clinical supervision of ongoing cases, with additional supervision as needed. Supervision will ensure a strong grounding in medical, neurologic, and psychiatric evaluation and treatment of geriatric inpatients. General adult psychiatry residents rotate on the unit monthly, providing fellows with opportunities to teach and supervise other trainees.

While on this rotation, residents will have the opportunity to perform psychiatric consults on geriatric patients in the Emergency Department and on the medical floors at the Whidden Hospital.

Geriatric Outpatient Services. Fellows spend part of their time over 6 months with Geriatric Services at the Central Street Health Center and at the Elder Service Plan. During the training year, fellows provide psychopharmacologic and therapeutic management for a broad range of elderly patients (over age 60) living in the community at various levels of care. Common diagnoses include major depression, dementia, psychotic disorders, anxiety, personality, and substance abuse disorders. Faculty is always on-site and available for consultation. At the Elder Service Plan, fellows gain experience working closely with additional medical staff, including geriatric medicine fellows. Caseloads are regularly monitored to maximize fellows' exposure to a variety of clinical experiences.

In addition to their experience in the outpatient setting, fellows will have the opportunity to work with faculty members on home visits and nursing home evaluations. As training progresses, fellows will be expected to manage these patients more independently. Weekly staff and team meetings allow fellows to discuss and review difficult cases with the Geriatric Service interdisciplinary staff.

Fellows will also have the opportunity to evaluate patients with cognitive disorders at the Cambridge Health Alliance Memory Center under the supervision of faculty from the CHA Neurology and Geriatric Psychiatry departments.

Consultation-Liaison Service, Spaulding Rehabilitation Hospital, Cambridge. The Consultation-Liaison Service of Spaulding Rehabilitation Hospital in Cambridge serves as a required 6-month rotation for geriatric fellows. As part of this rotation, fellows attend daily rounds and a monthly medical/ psychiatry seminar. Fellows also work as consultants with the neurology service during two months of this rotation, performing neurological consultations under the direct supervision of faculty from the Department of Neurology at the Beth Israel Deaconess Medical Center. During this consultation/liaison rotation, fellows typically evaluate and manage geriatric medical and surgical patients with a range of diagnoses including delirium, dementia, depression, and somatoform disorders. Fellows are responsible for psychopharmacologic and psychotherapeutic management, and also communicating with medical and surgical staff. Group rounds are supervised by faculty daily, with individual supervision one hour per week.