GOAL

MetroHealth Medical Center's Fellowship in Geriatric Medicine is designed to educate internists and Family Practitioners in the discipline of geriatrics. The expertise attained through this training program will lay the foundation for future practitioners to apply their skills across the continuum of care. Our physicians will be competent clinicians, academicians, clinical researchers, and administrators able to provide care in a variety of clinical settings, including acute, chronic, inpatient, and outpatient, as well long-term care.

PROGRAM OVERVIEW

MetroHealth's one-year geriatric fellowship provides a myriad of clinical settings in the best available training sites, allowing participants to learn and practice geriatric medicine. The fellowship fosters learning and teaching and creates opportunities for future academic faculty positions in geriatric medicine. The successful completion of this ACGME-approved program qualifies fellows to sit for the CAQ (Certificate of Added Qualifications in geriatric medicine) given by one's primary discipline be it ABIM or ABFP.

CURRICULUM

During the fellowship, longitudinal experience occurs in our teaching nursing homes and Senior Health Outpatient Program, where continuity panels of patients are cared for. Weekly, the fellow spends two half days in the Outpatient Clinic providing primary care and consultative assessment of seniors. One half-day per week is spent in the fellow's primary discipline.

Block rotations exist in hospice, geriatric evaluation and management, physical medicine and rehabilitation, subacute nursing home care, wound management to include pressure, vascular and burn, geropsychiatry, geriatric neurology, and PACE (all-inclusive care of the elderly). A unique rotation, "Long Term Care," exposes the fellow to nursing home administration, quality management, and community resources in the continuum of care for the elderly. Elective time also exists in order for the fellow to concentrate in areas of interest. Home care and home visits are also incorporated into the year.

BLOCK ROTATIONS

• Geriatric Evaluation and Management (GEM)
• All-inclusive care of the elderly (PACE)
• Subacute care
• GeroPsychiatry
• Geriatric neurology
• Long-term care administrative
• Hospice
• Elective
• Senior health outpatient (ASH)
• Geriatric consults
• Physical medicine and rehabilitation

CONFERENCES

The geriatric didactic sessions include a variety of settings to cover core curricular topics. Grand rounds, seminars, case based discussion, and evidence-based journal club occur weekly to monthly throughout The MetroHealth System. A mini-course in epidemiology and statistics rounds out the exposure for meaningful interpretation of the literature and a foundation for the development of clinical-based research.

The fellows are also encouraged to become future teachers and leaders in geriatric education. Through the year they are required to provide lectures to family practice and internal medicine residents, give practical inservices to nursing home staff, and serve as the initial preceptor in the outpatient senior health clinic to other junior learners. Presentation at the state and national geriatric level is highly encouraged.

TEACHING SITES

MetroHealth Medical Center is a 728-bed public teaching hospital long recognized both regionally and nationally for the excellence in providing comprehensive health care to the community. MetroHealth is a teaching affiliate of Case Western Reserve University. The mission of MetroHealth is threefold: To provide high-quality primary and tertiary care to the Cleveland community and to Northeast Ohio regardless of ability to pay, to provide excellent training and educational programs, and to conduct research in basic science and clinical medicine.

MetroHealth provides inpatient, ambulatory, and emergency services, as well as rehabilitation care to a diverse clinical population. The medical center includes a Level I trauma center and emergency department, Level I regional burn center, Level I pediatric trauma services and intensive care unit, and a Level III Neonatal Intensive Care Unit. MetroHealth also provides a major regional inpatient rehabilitation center, the second busiest aeromedical helicopter program in the country, and an expansive outpatient plaza. The state-of-the-art Charles H. Rammelkamp, Jr., MD, Center for Education and Research houses the Department of Epidemiology and Biostatistics of CWRU.

MetroHealth provides comprehensive ambulatory care throughout Cuyahoga County. The MetroHealth System has a long history of investment in the community. In 1988 the American Hospital Association bestowed the prestigious Foster G. McGaw Award for Excellence in Community Service. This award honors health care organizations that demonstrate a sustained commitment to their community through innovative programs.

GERIATRIC SERVICES WITHIN THE METROHEALTH SYSTEM

Nursing Homes - Elisabeth Severance Prentiss Center for Skilled Nursing Care at MetroHealth
The Elisabeth Severance Prentiss Center for Skilled Nursing Care at MetroHealth, a 150-bed facility, is committed to providing high-quality nursing care and rehabilitation services for the most complex patients. The caring staff works with residents and their families, providing a healthy, comfortable environment, which promotes a lifestyle that is adjusted to each patient's individual needs and wishes. The facility is a division of The MetroHealth System, which provides both comprehensive inpatient services, outpatient care, and post-acute care services. MetroHealth is renown for its medical geriatric and rehabilitation services. This expertise provides continuous resources to Elisabeth Severance Prentiss Center for Skilled Nursing Care at MetroHealth.

SENIOR HEALTH AND WELLNESS CLINIC

The following is a list of health care services available through Senior Health:

• Comprehensive medical care
• Dementia evaluation
• Falls assessment and consultation, including physical and mental health and psychosocial well-being
• Geriatric primary care
• Incontinence evaluation and treatment
• Medication evaluation
• Social work counseling
• VNA hospice

PACE

PACE is a managed health care program that integrates acute and long-term services for frail older persons who have multiple health problems and require a structured, supportive set of services to remain in the community and avoid frequent hospitalizations and nursing home placement. A multidisciplinary team provides both preventive and ongoing care at the Day Health Center, in participants' homes, and in a hospital or nursing home when necessary.

METROHEALTH ADVANTAGE

This program is specifically designed to meet the needs of adults 55 years and older. Membership provides access to the high-quality, professional medical care offered by MetroHealth through many free programs and services offered exclusively to MetroHealth Advantage members.

HOSPICE OF WESTERN RESERVE