FELLOWSHIP IN GERIATRIC PSYCHIATRY
Beth Israel Medical Center
BACKGROUND
Beth Israel Medical Center is a 949-bed full service teaching hospital which has been serving New York City for the past century. Beth Israel has an academic affiliation which Albert Einstein School of Medicine and is a major clinical campus for the medical students’ psychiatry rotation. Over the years, Beth Israel has developed a reputation for a caring involvement with its surrounding communities, such as the East Village, Gramercy Park, Loisida and Stuyvesant Town. A commitment to the excellent clinical care of the community and research into the best methods of delivering such care are hallmarks of Beth Israel, the Department of Psychiatry, and the Division of Geropsychiatry.
The Division of Geropsychiatry, now in its sixteenth year as a clinical and teaching entity, was the first Geropsychiatry division in Manhattan. The Medical Center has given strong institutional support to the Division since its inception. This support has continued despite the current economic problems New York hospitals are facing.
Our extensive experience in psychiatric services for the elderly enable us to offer our fellowship candidates a comprehensive curriculum that is integrated with the rest of the department, yet preserves its independent status as a subspecialty division. Moreover, our curriculum complies with the recommendations of the Curriculum Committee of the American Association for Geriatric Psychiatry (AAGP), and we are accredited by the ACGME. As a result, we are uniquely able to prepare our Fellows for the American Board of Psychiatry and Neurology’s recently approved Examination for Added Qualification in Geriatric Psychiatry. The duration of this fellowship is one year, from July 1, 2002 through June 30, 2003.
CURRICULUM
The foundation of our curriculum consists of the following:
DIDACTIC CURRICULUM
The Division’s faculty presents a weekly core lecture series, Overview of Geropsychiatry, to our Fellows. The course presents in a systematic way the essential data base of Geropsychiatry. The topics covered include:
Psychiatric Assessment of Geriatric Patients Medical Evaluation of Geriatric Patients
Functional Assessment of Geriatric Patients Psychosocial and Family Assessment of
Physiological Changes with Aging Geriatric Patients
Cognitive Changes with Aging CNS Changes with Aging
Evaluating Competency Epidemiology of Late-life Disorders
Mood Disorders in the Elderly Dementias
Depression and Cognitive Impairment Anxiety Disorder in the Elderly
Bereavement Delusional Disorder in the Elderly
Sleep Disorders in the Elderly Neuropsychiatric Syndromes
Iatrogenic Disorders in the Elderly Psychotherapy with Older Patients
Drug and Alcohol Abuse in the Elderly Elder Abuse
Sexuality and Aging Electroconvulsive Treatment
Neuroimaging Medicare, Medicaid & Community Resources
As a supplement to the core lecture series, there is a bi-weekly Geropsychiatry Seminar consisting of presentations by nationally known experts in geriatrics, a journal club, and case presentations. Speakers at the Seminar during the past years have included:
George Alexopoulas, M.D. “The Course of Late Life Depression.”
Carl Cohen, M.D. “Homelessness and the Elderly”
Neil Kremen, M.D. “Practical Issues in Inpatient Geropsychiatry”
John Rogers, M.D. “Geriatric Movement Disorders”
M. Katherine Shear, M.D. “Anxiety Disorders in the Elderly”, “OCD in the Elderly”
James J. Kocsis, M.D. “Dysthymia in the Elderly”
Brian Lawlor, M.D. “Dementia and Depression in the Elderly”
Richard Brown, M.D. “Anticonvulsants for Geriatric Bipolar Disorder”
James Jefferson, M.D. “Bipolar Disorder in the Elderly and the Use of Lithium”
Richard Rosenthal, M.D. “Substance Abuse in the Elderly”
Bruce Saltz, M.D. “Tardive Dyskinesia in the Elderly”
Howard Fillit, M.D. “Estrogen in Alzheimer’s”
The department offers a full schedule of additional didactic activities in general psychiatry, including Grand Rounds, which often features topics of interest to the geriatric psychiatrist.
INPATIENT ROTATION
During this rotation, the fellows functions as the Assistant Service Chief of our 15-16 bed inpatient geropsychiatry service and has direct responsibility for its day-to-day operations. The educational aims are to gain experience as an administrator, as a supervisor of junior trainees, and as a researcher on our inpatient protocols. More importantly the Fellow will come into contact with a large number of geropsychiatry inpatients and will have direct responsibility for the supervision of the care of 6 to 8 cases, and may carry a few cases themselves.
The inpatient service is also a teaching service for Albert Einstein medical students and Beth Israel Psychiatry residents. It is a multi disciplinary service with a full-time attending psychiatrist, a full time psychologist, specialized nurses, an experienced social worker, occupational therapists, and psychology graduate students. Trainees from all disciplines enhance its relaxed and collegial environment.
The Unit Chief supervises the Fellow on this rotation. Depending on the interest and needs of the Fellow, we will arrange additional supervision to focus more intensively on certain clinical issues as well as on administrative or group process issues.
During the inpatient rotation the Fellow will also see outpatients and will consult at our nursing home once or twice monthly.
OUTPATIENT ROTATION
With nearly 400 visits a month, the Geropsychiatry Clinic serves a large, ethnically diverse population of seniors in the New York City area. The educational goals for the Fellow’s outpatient rotation are the following: mastery of a comprehensive psychiatric evaluation of an ambulatory geriatric patient, training in psychotherapeutic and psychopharmacologic treatment of geriatric outpatients, training in leading group therapy with elderly patient living in the community. During this rotation, the Fellow will have a vivid and varied clinical experience in the diagnosis and treatment of mood, anxiety, cognitive and psychotic disorders in elderly outpatients. The fellow will gain administrative experience as part of the outpatient rotation.
The fellow will be a member of our multi disciplinary team consisting of two attending geriatric psychiatrists, three Beth Israel psychiatric residents and two geropsychiatric social workers. The Director of the Clinic will provide supervision for the Fellows in diagnostic and treatment issues; additional supervision in group therapy issues is also available.
NURSING HOME CONSULTATION-LIAISON
Beth Israel is affiliated with the Isabella Geriatric Center, an extended care teaching facility in upper Manhattan. The Division of Geropsychiatry is responsible for consultations on one of the floors. The Nursing Home provides the Fellow with a variety of important educational opportunities including psychiatric consultation on the facility’s residents and liaison with their families and staff. The Fellow will also be part of a multi disciplinary team including internist with geriatric subspecialty training. The ACGME has determined that these activities are essential components of geropsychiatry training.
NEUROBEHAVIOR CENTER
A free-standing Neurobehavior Center is currently in its fourteenth year of operation at Beth Israel. The Center specializes in the diagnosis and treatment of patients with psychiatric problems secondary to neurological disorders, many of whom are elderly. Our Fellow may attend conferences and teaching rounds or set up an elective at the Neurobehavior Center Clinic.
MOVEMENT DISORDERS
The Beth Israel Department of Neurology has a National Parkinson’s Foundation “Center of Excellence”. Fellows attend monthly lectures and presentations in movement disorders with neurology fellows and participate in a monthly clinic evaluating and treating psychiatric problems in patients with movement disorders. Research projects in this area are ongoing.
CONSULTATION WITH GERIATRIC MEDICINE
Part of the Fellow’s training will involve consultations on medical units and at several medical clinics near the hospital including the Meltzer Clinic in a senior housing facility near First Avenue and Houston; and Penn South, another senior housing facility at Eighth Avenue and 28th Street. Other settings are currently being developed. These experiences will give you the opportunity to consult with medical colleagues in a primarily medical rather than psychiatric setting. This will provide you both didactic and clinical training in doing functional assessment, observing the altered signs and symptoms of physical illness, and identifying physical illnesses and iatrogenic factors that can alter mental status and behavior.
HOME VISITS
Fellows perform house calls, evaluating home-bound geriatric patients in association with a community agency.
ECT ELECTIVE
Fellows can elect to spend 1 month gaining expertise in our active ECT program.
BENEFITS
Beth Israel Medical Center supports a generous package of benefits to its trainees and staff. The Fellowship stipend for 2002-2003 is still to be determined, but should be around 51,000. Also included are malpractice coverage, health insurance, as well as dental, optical, and hearing aid benefits. Fellows may contribute to a tax-deferred annuity through the Medical Center. Housing may also be available through the Medical Center at attractive rates.
Beth Israel has an excellent full-service medical library, the Seymour J. Phillips Library. It is conveniently located on the 12th Floor of Fierman Hall.
Finally, the Division of Geropsychiatry as well as the Department of Psychiatry is sincerely interested in fostering a pleasant and collegial working environment at Beth Israel. The concerns of trainees are taken seriously. There are also many opportunities to socialize both within the Department and with other medical colleagues.
Those interested in the Fellowship should send a completed application, three letters of reference and a CV with cover letter to:
Melinda Lantz, M.D.
Physician-in-Charge, Geropsychiatry
Beth Israel Medical Center
First Avenue at 16th Street
New York, N.Y. 10003
or call at : (212) 420-2457
email: mlantz@chpnet.org
©2012 Beth Israel Medical Center
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