Experiences and Training Sites

Geriatrics Inpatient Consultation

Rotation Director: Dr. Neema Sharda
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 medical students.

Croasdaile Village

Rotation Directors: Dr. Heidi White and Dr. Neema Sharda

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 with 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 quality improvement are available.

The Forest at Duke
Rotation Directors: Dr. Gwendolyn Buhr and Dr. Milta Little

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)
Rotation Director: Dr. Katja Elbert-Avila

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.

Geriatrics Evaluation and Treatment clinic is a consultative clinic located in Durham. We receive referrals from the local area and from different states to manage older adults with complex medical conditions. Fellows work with different faculty and inter-professional staff to care for the patients in this setting.

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
• COACH Program at the VA Medical Center - caring for the veterans and their caregivers in their home setting to prevent institutionalization
• Telehealth consults from participating VA clinics, to provide comprehensive Geriatrics care to patients in rural settings

Senior Community Care of North Carolina is a comprehensive health care program for seniors living in select counties in Wake, Durham, and Granville counties and is a Program of All-Inclusive Care for the Elderly, also called PACE. Fellows will get to work with the medical director and inter-professional providers to learn about this model of care. https://www.seniorcommunitycarenc.org/

Fellows rotate through a variety of clinical settings with the palliative care team.  They serve on the inpatient consult service at the VA Medical Center 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.

Rotation Director: Dr. Shelley McDonald

POSH is a VA based rotation where a team-based approach in which surgeons, geriatricians, anesthesiologists, nutritionists, therapists, and patients work together to head off potential problems before surgery. Older adults are at risk for complications because they are more likely to have more than one medical condition, multiple prescriptions, and decreased strength, vision, hearing, and/or cognition. The POSH team follows the patients before and after surgery at the VA Medical Center.

Rotation Director: Dr. Mamata Yanamadala

Fellows will have the option to choose from different tracks to learn more about their area of interest within a 3 weeklong rotation. The tracks are designed with the goal to expose fellows to a broader context in their areas of interest. 

In-patient geriatrics track - Fellows will get to explore implementation of Age-Friendly health system along with inter-professional providers. Fellows will attend leadership meetings for Age-Friendly health system teams and meet with hospital leadership one-on-one to learn more about inpatient geriatrics care from a leadership perspective. They will also get to learn some aspects of medical billing in this context.

Out-patient geriatrics track - Fellows will meet different leaders in ambulatory care and attend leadership meetings to learn about administrative aspects on ambulatory care. They will participate in different care models focused on care coordination for complex older adults. They will get to learn some aspects of medical billing in this context.

Academic track - Fellows will be connected with mentors to explore their areas of interest in research/education/policy/quality improvement. They will get to work on a project in their area of interest under the guidance of their mentors.

Geriatric Medicine Fellows’ Clinic at the Durham VA Medical Center

Rotation Director: Dr. Laura Previll

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.

Rotation Director: Dr. Serena Wong

The clinics rotation provides options for exposure to numerous geriatric focused subspecialty clinics at Duke and the Durham VA Medical Center.

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 the Durham VA's Bone and Calcium Disorders 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, Dr. Richard H. Lee

Geriatric Psychiatry
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.

Incontinence Clinic
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.

Croasdaile Clinic

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.