The goal of Morristown Medical Center’s Geriatric Fellowship Program is to provide fellows with expertise in the assessment, treatment and management of geriatric patients in all settings, including ambulatory, home visits, acute care and long term care. Skills will be acquired through a combination of supervised clinical experiences, formal didactic conferences and team meetings. Fellows will also develop the leadership and interpersonal skills, professional attitudes, and practical experiences required of a geriatrician.
By the end of the fellowship, fellows will be able to exhibit proficiency in the following areas:
- Current scientific knowledge of aging and longevity, including theories of aging, the physiology and natural history of aging, pathologic changes with aging, epidemiology of aging populations, and diseases of the aged.
- Aspects of preventive medicine, including nutrition, oral health, exercise, screening, immunization and chemoprophylaxis against disease. Instruction and experience with community resources dedicated to these activities is included.
- Performance and interpretation of a geriatric assessment, including medical, affective, cognitive, functional status, social support, economic, and environmental aspects related to health; activities of daily living (ADLs); instrumental activities of daily living (IADLs); appropriate use of the history; physical and mental examination; and laboratory.
- Interdisciplinary coordination of multiple health professionals, including physicians, nurses, social workers, dieticians and rehabilitation experts, in the assessment and implementation of treatment.
- Understanding of diseases that are especially prominent in the elderly or that have different characteristics in the elderly, including neoplastic, cardiovascular, neurologic, musculoskeletal, metabolic and infectious diseases.
- Knowledge of pharmacologic problems associated with aging, including changes in pharmacokinetics and pharmacodynamics, drug interactions, overmedication, appropriate prescribing, and adherence.
- Assessment of psychosocial aspects of aging, including interpersonal and family relationships, living situations, adjustment disorders, depression, bereavement and anxiety.
- Economic aspects of support services, including Title III of the Older Americans Act, Medicare, Medicaid, capitation and cost containment.
- Ethical and legal issues especially pertinent to geriatric medicine, including limitation of treatment, competency, capacity, guardianship, right to refuse treatment, advance directives, living wills and durable power of attorney for medical affairs (health care proxies).
- General principles of geriatric rehabilitation, including the use of physical medicine modalities, exercise, functional activities, assistive devices, environmental modification, patient and family education, and psychosocial and recreational counseling.
- Management of patients in long-term care settings, including palliative care, knowledge of the administration, regulation, financing, and the continuum from short- to long-term care.
- Research methodologies related to geriatric medicine, including clinical epidemiology, decision analysis and critical literature review.
- Perioperative assessment and involvement in management.
- Latrogenic disorders and their prevention.
- Communication skills with patients, families, professional colleagues and community groups. Emphasis is placed on the ability to lecture and present case reports, literature searches, and research papers to peers and lay audiences.
- The pivotal role of family in caring for the elderly and community resources (formal support systems) required to support both patient and family.
- Cultural aspects of aging, including demographics, ethnicity, access to health care, cross-cultural assessment and use of an interpreter in clinical care.
- Home care, including the components of a home visit and accessing appropriate community resources for this setting.
- Hospice care, including pain management, symptom relief, comfort care and end-of-life issues.
