The Duke Geriatric fellowship program has a long, proud tradition of excellence in training physicians in clinical care, teaching and research. We believe the experiences and mentoring provided in the course of the fellowship help trainees identify career goals and take the first crucial steps toward achieving them.
The first year of the fellowship provides trainees with in-depth experience with the full spectrum of patients, problems, and settings that geriatricians are likely to encounter. Upon successful completion of the year, fellows may take the American Board of Internal Medicine Certificate of Added Qualifications in Geriatrics. Experiences and training sites include the following:
- Long-Term Care and Rehabilitation
- Acute Hospital Care and Consultation
- Outpatient Primary Care
- Outpatient Consultation and Comprehensive Assessment
- Palliative Care
- Subspecialty Clinics
- Academic Elective
- Geriatric Models of Care
After the first year, fellows also complete an additional year or two of coursework and training and undertake scholarly projects in their field of interest, which may include clinical or basic science research, curriculum design and clinical education, public health and health policy, health administration, quality improvement and patient safety. The format is both intensive and flexible, allowing participants to customize their training to suit their personal career goals.
Experiences in Long-Term Care and Rehabilitation
Croasdaile Village is a continuing care retirement community located 2.5 miles from Duke University Medical Center. Independent living, two levels of assisted living and skilled nursing care are available to more than 500 residents. Medical facilities include an outpatient clinic staffed with three nurse practitioners operating five days a week and an Alzheimer’s disease special care unit.
Fellows assigned to Croasdaile follow a cohort of patients in the skilled nursing facility throughout their fellowship. Formal multidisciplinary teaching rounds occur with Medical Director Heidi White, MD, twice monthly, allowing trainees to experience multiple facets of nursing home medicine. Special project opportunities are available to fellows with special interest in nursing home medicine.
The Forest at Duke
The Forest at Duke is a continuing care retirement community roughly 10 minutes from the Duke campus, which is home to almost 300 elders. On-site assisted living and skilled nursing care units have 30 beds each and offer hospice services and a dementia care unit. First-year fellows assigned to the Forest follow a cadre of patients in the long-term care section under the supervision of Dr. Kimberly Johnson. In addition to traditional long-term care residents, the section has an active panel of patients recently discharged from hospital and those who need “observation stays” from the independent living.
Durham VA Community Living Center (CLC)
The CLC at the Durham VA Medical Center is a long-term care unit where fellows provide care to veterans admitted for rehabilitation, respite, palliative care, or more specialized treatments like wound care, radiation therapy or intravenous therapies.
- Fellows attend bi-weekly interdisciplinary care conferences to discuss care plans.
- The interdisciplinary team includes nurse practitioners, social workers, nurses, dieticians, psychologists, dentists, pharmacists, chaplains and therapists (OT, PT, RT).
Acute Care Consultation Service
Geriatrics Inpatient Consultation
This rotation is based at Duke University Hospital and includes both the geriatric and palliative medicine services. Fellows see patients on medicine and surgery services and learn about a variety of core issues, including delirium, perioperative care, goals of care and management of transitions. The fellow works closely with the Geriatric Consult attendings to provide care for geriatric medicine inpatient consults, and have opportunity to coach housestaff on this rotation.
Outpatient Primary Care
Geriatric Medicine Fellows’ Clinic at the Durham VA Medical Center
Fellows provide primary care and consultative services to elderly veterans, most of whom are octogenarians and have chronic medical problems, such as diabetes, heart disease arthritis and dementia. Fellows follow a panel of approximately 40-50 veterans with scheduled office hours one half-day per week.
The VAMC is a modern, well-equipped hospital with an advanced electronic medical record and a readily accessible array of diagnostic services, allied providers and subspecialists. The on-site interdisciplinary team includes a clinical social worker, a geriatric nurse practitioner, a clinical pharmacist, a registered nurse, a dietitian and an attending geriatrician.
Outpatient Consultation and Comprehensive Assessment
The Duke Geriatric Evaluation and Treatment (GET) Clinic
The Duke GET Clinic was one of the nation’s first outpatient geriatric assessment clinics. It provides multidisciplinary assessment of elderly women and men by geriatricians, geriatric psychiatrists, social work and nursing. Patients are referred locally, regionally and nationally by health-care professionals and families for evaluation of multiple geriatric problems including:
- optimal management of medical conditions
- functional decline
- social issues
Fellows evaluate and manage patients and families with the attending physician, nurse and social worker team two half-days a week. Fellows present their patients at the weekly clinical case conference with geropsychiatry fellows and faculty.
Transitional Care (TLC) Service at the VA
Operating through the Durham VA Medical Center, The TLC program is transitional program that supports the hospital-to-home transition of older veterans who are at high risk for rehospitalization, emergency department visits, or institutionalization led by a nurse practitioner and social worker who work at the Geriatrics Clinic at the Durham VA. Fellows will work with program staff to see patients in the hospital and then again in the home setting. Through the TLC program, program sponsors aim to reduce rate of rehospitalization, hospital days of care, emergency department visits and institutional care of patients; and promote preparedness and reduce burden among informal caregivers.
Memory and Movement Disorders Clinic
Duke’s Memory Disorder Clinic provides diagnostic expertise, cutting-edge treatment and research for memory and movement problems by neurology faculty. Fellows assigned to this clinic will work with faculty in neurology seeing patients with a variety of memory and movement disorders, including Alzheimer’s disease and other dementias and Parkinson’s disease.
Physical Therapy Falls Clinic
At the Physical Therapy Falls Clinic, fellows work with physical therapists specializing in gait assessment and fall prevention. Fellows will learn a variety of skills, including formal gait and balance evaluation, gait training, prescription of walking-assist devices and application of specific rehabilitative programs, including aquatic therapy.
Metabolic Bone Disease Clinic In The Duke Clinics
At Duke’s Metabolic Bone Disease Clinic, fellows provide specialty care and consultation to patients with metabolic bone diseases, including osteoporosis, Paget’s disease of bone, vitamin D deficiency, hyperparathyroidism and other disorders.
Fellows see and present all patients to clinic attending, Kenneth W. Lyles, M.D. Physical therapists and a nutritionist also work at the clinic. Bone mineral density is measured in the clinic so that fellows learn to interpret the results on patients they evaluate. Radiographs are reviewed on subjects attending the clinic so that fellows become comfortable assessing the radiographic findings of fractures and Paget’s disease.
The Gerofit program is an outpatient exercise and health-promotion program for older veterans. The purpose of the fellowship rotation through Gerofit is to:
- Understand the impact of exercise on physical function, and mental and physical health.
- Gain proficiency in performing a targeted history and physical exam on an older patient with chronic diseases desiring to initiate an exercise program.
- Practice prescribing an exercise program for older adults.
- Gain proficiency in educating older adults about the benefits and methods of exercise.
- Work with a multidisciplinary team, observe several introductory consultations to Gerofit, participate in the intake of one to two patients, and then track these patients over a six-week period to monitor improvement.
Fellows work with Geropsychiatry faculty and fellows in a variety of settings, including an outpatient consultation clinic at the Durham VAMC where they care for patients with dementia, depression, anxiety disorders and a variety of behavior and thought problems. In addition, fellows round on inpatient long-term care and acute care services with geropsychiatry faculty seeing patients with a variety of problems, including delirium.
Fellows spend several clinic sessions in a urogynecology-based interprofessional clinic seeing patients with lower urinary tract problems, including various types of incontinence and voiding problems. They learn about approaches to therapy, including non-pharmacologic, pharmacologic and surgical options.
Fellows work with faculty in PM&R and rheumatology seeing patients with musculoskeletal complaints and working on relevant exam and procedural skills.