The Duke Geriatrics fellowship program has a long tradition of excellence in training physicians in clinical care, teaching, and research. The first year of the fellowship provides trainees with in-depth experiences with the full spectrum of patients, problems, and settings that geriatricians are likely to encounter, across a variety of clinical settings. Upon successful completion of the year, fellows may take the American Board of Internal Medicine Geriatric Medicine Certification Exam.
In addition to a robust clinical experience, the mentoring and academic activities provided in the course of the fellowship help trainees identify career goals and take the crucial steps toward achieving them, no matter their ultimate area of practice. After the first year, fellows have the option to 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. Please see the Advanced Fellowship Training Page for more information.
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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 follow patients in the skilled nursing facility (Croasdaile Pavilion) throughout their fellowship This population includes a mix of long-term care residents and patients receiving acute rehabilitation after a hospital stay. Fellows round weekly with faculty members and occasionally other trainees.
In addition to weekly rounds, fellows work alongside the facility’s nurse practitioners, social workers, and therapists to learn all facets of nursing home medicine. For fellows interested in post-acute and long-term care medicine, opportunities for research and QA/QI are available.
The Forest at Duke
The Forest at Duke is a continuing care retirement community located10 minutes from Duke’s West campus and is home to almost 300 older adults. Independent living, two levels of assisted living and skilled nursing care are available to residents based on their individual needs. Medical facilities include an outpatient clinic operating five days a week and an Alzheimer’s disease special care unit.
Fellows follow a cohort of patients in the skilled nursing facility throughout their fellowship. These include a mix of long-term care residents and patients receiving acute rehabilitation after a hospital stay. Fellows round weekly with faculty members and occasionally other trainees.
Durham VA Medical Center Community Living Center (CLC)
The Durham VA CLC is a skilled nursing and long-term care facility located with the Durham VAMC. Fellows provide care to veterans admitted for rehabilitation, respite, hospice, or specialized treatments like wound care, radiation therapy or intravenous therapies. Fellows complete two, month-long rotations at the CLC. During their rotation, fellows admit Veterans for rehab after hospitalizations at DVAMC and provide care as a member of an interprofessional team. Fellows also attend interdisciplinary treatment rounds that are tailored to mental health care and supporting long-term care residents. Fellow also supervise and teach medical students and residents principles of post-acute and long-term care medicine.
Acute Care Consultation Service
Geriatrics Inpatient Consultation
This rotation is based at Duke University Hospital. 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. The fellow is responsible for leading the team, which includes trainees from internal and family medicine, as well as students.
Palliative Care and Hospice
Fellows rotate through a variety of clinical settings with the palliative care team. They serve on the inpatient consult service at Duke University Hospital and/or Duke Regional Hospital, round at Duke’s inpatient hospice facility, and participate in home-visits with the home hospice team. During this rotation, fellows receive education on topics important to palliative care, such as symptom management, opioid conversion, adjunctive pain treatments, and end-of-life care. Additionally, fellows will participate in and lead goals of care meetings.
Outpatient Primary Care
Fellows participate in a longitudinal primary care clinic at one of two sites, the Durham VA Medical Center, or the Croasdaile Continuing Care Retirement Community:
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 DVAMC 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.
Croasdaile Village is a continuing care retirement community located near Duke University Medical Center. Community remembers who reside in independent living and assisted living receive their primary care at the Croasdaile Clinic within the facility. Fellows are integrated into the clinic and see patients for both routine primary care, as well as acute care visits for urgent concerns. They work closely alongside Croasdaile medical director Heidi White, MD, and the facility’s three nurse practitioners to a medically diverse population in a variety of care settings, from independent adults to those requiring 24-hour care.
Fellows have multiple opportunities to participate in home care. On their Palliative Care rotation, fellows spend time shadowing various members of the Home Hospice team, including the care nurse and social worker. Operating through the Durham VA Medical Center, fellows also participate in Home Based Primary Care and the Transitions Life Program. TLC 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. They also participate in home visits through the COACH program, an initiative within the Durham VA to keep older adults with dementia safely at home instead of transitioning to long-term care.
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 geriatric nursing. Patients are referred locally, regionally and nationally by healthcare professionals and families for evaluation of multiple geriatric problems including polypharmacy, falls, dementia, and others.
Memory and Movement Disorders Clinic
Duke’s Memory and Movement Disorders Clinic provides diagnostic expertise, cutting-edge treatment and research for memory and movement problems by neurology faculty. Fellows see patients with a variety of memory and movement disorders, including Alzheimer’s disease and other dementias and Parkinson’s disease.
Physical and Occupational Therapy Clinics
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. Fellows also have the opportunity to work with occupational therapists to observe driving assessments.
Metabolic Bone Disease Clinic
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 will also learn to correctly interpret DEXA scans. Fellows see and present all patients to clinic attending, Kenneth W. Lyles, MD.
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.
Fellows have the opportunity to spend time at a local Program for All-Inclusive Care of the Elderly (PACE) program serving Durham and Wake County. At PACE, they work alongside the medical director to provide primary care and attend IDT meetings for participants. Additionally, fellows will learn about the history, regulations, and payment structure of this unique model of care.
Models of Care
Models of care is a unique month-long rotation in which fellows observe and participate in a variety of care delivery models for older adults. Fellows participate in a myriad of clinical experiences, with a flexible schedule, which allows fellows to customize experiences based on their clinical interests. Examples of clinical experiences include:
- E-consults at the Durham VA Medical Center to help primary care providers screen for and diagnosis osteoporosis in patients with recent fractures
- Home-based primary care
- Telehealth consults from participating VA clinics, to provide comprehensive Geriatrics care to patients in rural settings
- Working with a local not-for-profit organization (Senior PharmAssist) to provide local seniors with assistance in medication management, Medicare insurance counseling, and tailored community referrals.
First year fellows will have one month of protected time to pursue an elective project of their choice, tailored to their individual interests and career goals. Program directors work with fellows at the beginning of the year to develop appropriate mentorship and support. Many fellows go on to present their projects at national conferences and/or develop publications as a result of their project.
During my elective rotation, I had the opportunity to work with some of the Duke first year medical students on the Music and Memory Project at Eno Pointe Assisted Living Facility in Durham. It was a privilege to see the effect that personalized music had on residents at the facility!
Charles “Cole” Sims, MD, Class of 2018