Elder Care (Geriatrics)
Wakefield Campus Fellowship Programs
Montefiore Medical Center Wakefield Campus, located at 600 East 233rd Street in the Bronx, is a 360-bed community hospital serving the northeast Bronx and lower Westchester. The hospital is located in the Woodlawn-Wakefield community of the Bronx, in reasonable proximity to the world-famous Bronx Zoo, Bronx Botanical Gardens and the New York Yankees. A university hospital of Albert Einstein College of Medicine, this major teaching facility offers a full spectrum of medical and surgical care. The Division of Geriatrics is one of the strengths in the Department of Medicine at the Wakefield Campus.
Geriatric Medicine Program Overview
The Wakefield Campus of Montefiore Medical Center provides inpatient and outpatient primary and consultative care for communities of the Bronx. In an academic environment, primary care training is offered in internal medicine and several of its subspecialties, with geriatric medicine providing significant strength. The residency program in internal medicine is well linked to the geriatric medicine program for daily operations.
The philosophy of the training program is to present a highly organized and closely supervised education program. The guiding teaching methodology is the integration of didactic subject matter into the daily delivery of inpatient, long-term care and ambulatory healthcare to patients. The program's goal is to produce high-quality geriatricians who will provide compassionate and humanistic care to patients in academic or private practice settings. This goal has been substantiated from the experience of prior trainees who graduated from the program.
The Wakefield Campus is a center of academic excellence. As a teaching hospital, we have medical students at all levels rotating through our hospital and ambulatory care settings, enhancing the residency and fellowship experience. We have strong medicine subspecialty clinical directors, who are interested in teaching and training enthusiastic, bright young physicians.
The Division of Geriatrics
The Division of Geriatrics opened on April 1, 1992, and the Fellowship Program was instituted in 1993. The inpatient Acute Care Units (ACE Units) located on the 4th floor of the hospital, are dedicated for the care of acutely ill adults over the age of 60 years. The units are uniquely designed to meet the needs of geriatric patients with several "gerodesign" features. Patients in these units have access to residents in internal medicine, fellows in geriatric medicine and certified faculty geriatricians for 24-hour care.
Ambulatory care is provided in modern outpatient settings at two sites; patients are provided care by fellows in geriatric medicine, under the supervision of faculty geriatricians, with back-up specialty and ancillary services. Home care experience is provided, with the opportunity for fellows to work closely with geriatricians and nurses from the Montefiore Home Care program.
Long-term care experience (nursing home care) is offered to fellows as a part of training at several sites in the Bronx; opportunities for rotations include traditional skilled nursing facilities, sub-acute units and dementia programs. As in all other areas, there is direct everyday supervision of the trainee by staff faculty geriatricians.
The Geriatric Medicine Fellowship Program
Sponsored by Albert Einstein College of Medicine, the Geriatrics Medicine Fellowship Program at the Montefiore Medical Center Wakefield Campus emphasizes the development of strong clinical and teaching skills, while also providing opportunities for research. Acute, ambulatory, and long-term care settings provide continuity of care for geriatric patients within a solid physician faculty framework.
This fully accredited fellowship program is one of the largest programs in the country, and currently offers a complement of 10 fellows. Fellows are offered a wide range of experience, serving a heterogeneous geriatric population comprised of individuals of many ethnic groups, in multiple settings. The faculty-fellow ratio is quite favorable due to the presence of several core faculty members in geriatrics (and other related specialties) who hold teaching appointments at the college. The program has remained fully accredited since its inception. The fellows are responsible for regular admission and follow-up of patients, both for primary care and for consultations. Every case is discussed with the attending physician, on or off rounds, on at least a daily basis. Patients are admitted through the emergency room or direct referrals, and originate from both the community and the nursing homes. Consultations are offered for older patients in the adult inpatient psychiatry service. If patients are transferred to critical care units, follow-up care is continued by the fellows. Performance improvement learning is emphasized as a learning experience during the year of fellowship training.
Didactic conferences are presented thrice a week in the mornings and cover the entire syllabus twice a year. In addition, there is a weekly grand round in medicine and a monthly journal club (literature review). Optional fellows conferences offer brief discussions in the afternoons on some days a week.
Aside from the above conferences, a geriatric medicine Board Review is offered by the faculty during the months of April through June annually. This review provides high-standard case discussions to offer an excellent learning experience for the trainees. Practice and optional examinations with multiple choice questions are offered before and after the board review. While the tests do not count towards board certification, they offer an abundance of experience in dealing with the real-life examinations after completing the fellowship year.
Cases are also followed in the ambulatory care clinics (presently conducted four times a week) by fellows under direct attending geriatrician supervision. In the nursing homes, each fellow provides care to a panel of residents at one or more units, again under direct faculty supervision. Between the hospital, community, and long-term care experiences, the fellows gain a full spectrum of clinical experience, from healthy adult to a wide range of chronic diseases and acute illness. Cases are followed by the trainee from admission to discharge and post discharge, allowing continuity of care between community, hospital, and nursing home settings.
The Geriatric Medicine Faculty
Board-certified faculty physicians are responsible for providing clinical, basic science, and research experience to the fellows; they are available on a 24-hour basis, including weekends. All faculty members are board certified in internal medicine and geriatric medicine, and some in additional areas. Faculty geriatricians work closely with the fellows and are easily contacted at any time of the day or night. The faculty members participate in most of the didactic conferences offered as teaching experience.
In addition to the program director, T.S. Dharmarajan, MD, the geriatric medicine faculty members include: