Fellowship in Geriatric Medicine

About the Fellowship

The Fellowship in Geriatric Medicine at Massachusetts General Hospital is a one-year ACGME approved fellowship focusing on the care of patients ages 65 and older across the continuum of health care settings. Fellows learn the principles of geriatric medicine by providing care and counsel to patients and families in ambulatory, acute, sub-acute and home settings. They will also learn Palliative Care during their inpatient Palliative Care rotation. Fellows will become skillful at collaborative care by working in an interdisciplinary team of nurse practitioners, geriatric psychiatrists, geriatric social workers, and geriatric case managers. In addition, Fellows will engage in learning activities through Core Didactic Conferences, Case Conferences, Journal Club and Research Conferences and develop teaching and leadership skills through one-on-one mentorship, consulting resources and teaching patients, families, medical residents and students.

Our Faculty

• Sharon Levine, MD, AGSF
  • Section Chief, Geriatric Medicine
• Esteban Franco Garcia, MD
  • Program Director, Geriatric Medicine Fellowship
  • Medical Director, Geriatric Inpatient Fracture Service (GIFTS)
• Katherine Hesse, MSW, MD
  • Senior Health at Home, Outpatient Geriatric Consultations
• Juan Carlos Nunez Medina, MD 
  • Mass General Senior Health. Geriatric Primary Care. GIFTS Program Attending
• Terry O’Malley, MD  
  • Marquis Rehabilitation and Long Term Care.  Senior Health Urgent Care.  Member, Federal Health Information Technology Advisory committee, Cochair:  U.S. Core Data for Interoperability (USCDI) Task force.  Former Medical Director Non-Acute Care PHS and Cochair Clinical Transitions PHS
• Erin Stevens, DO
  • Mass General GIFTS Attending. Palliative Care Attending.
• Chuck Pu, MD
  • Mass General Hospital, Complex Care Team, McGovern Services. Mass General GIFTS Attending, Spaulding Cambridge LTC Geriatric Consultant for Complex Care Patients, Medical Director Partners Center for Population Health, oversees Care Continuum, Post Acute Care Programs (Partners SNF Network, Partners SNF Waiver Program, Transitions Care Program, Advanced Home Programs (Hospital at Home, Mobile Obs, CHF Telemetry) and Partners Hospice Network).
• Erin Scott, MD
  • Geriatric primary care. Palliative Care Attending, Subspecialty Core Educator for Palliative Care and Geriatrics.  Fellow Primary Care Clinic Attending.
• Cornelia Cremens, MD
  • Mass General Senior Health, Geropsychiatry
• Masaya Higuchi, MD  
  • Mass General Senior Health. Geriatric primary care. Harvard Medical School preceptor for 3rd year primary care experience.  Mass General Primary Care Operation Improvement board member. Fellow Primary Care Clinic Attending.

Affiliated Faculty

• Bruce Bonnell, MD
  • Spaulding Cambridge Long Term Acute Rehabilitation Hospital. LTAC fellowship rotation
• Mark Yurkosfsky, MD
  • Spaulding Brighton, Medical Director. Skilled Nursing Facility Rehabilitation Attending
• Sara Emami, MD 
  • Spaulding Brighton. Skilled Nursing Facility Rehabilitation Attending
• Louis Waldman, MD
  • Spaulding Brighton. Skilled Nursing Facility Rehabilitation Attending

Requirements

Requirements for the Geriatric Medicine Fellowship include:

• Completion and passing of all three USLME steps
• ABIM board-certified or board-eligible
• The accepted applicant must obtain a full Massachusetts license (limited license if on visa)
• A valid ECFMG certificate for all foreign medical graduates
• Only J1 visas accepted
• Capacity for leadership in the field
• We do not accept applicants who have not completed a 3 Year Residency in the US

Curriculum

The Geriatric Medicine Fellowship curriculum was designed using a competency-based framework to teach and evaluate based on the Curricular Milestones for Graduating Geriatric Fellows proposed by the American Geriatric Society.

Academic Activities

Weekly activities include:

• Didactic sessions
  • Core Didactic Conferences (boot camp during the summer)
  • Geriatric Medicine Rounds (September through June)
• Interdisciplinary Team meeting at MGH-Senior Health
• Division of Palliative Care and Geriatrics Grand Rounds
• Department of Medicine Grand Rounds

Fellows also participate in:

• Monthly Journal Clubs
• Monthly Case Presentations
• Quarterly seminars on
  • Quality Improvement
  • Evidence-Based Medicine
  • Clinical Teaching
  • Communication
•  Develop poster/abstract to present at national or local meeting
• Develop, implement, evaluate and present a quality improvement activity
• Prepare a presentation under faculty mentoring to give at the Division’s Grand Rounds at the end of the academic year
• Attend the Harvard Medical School Geriatric Review Course
• Attend the American Geriatric Society Annual Meeting

Participate in the Quality Improvement course with the GME-Partners’ Clinical Process Improvement Leadership Program (CPIP)

CPIP has the purpose of engaging clinical teams in the use of process improvement tools to reduce variation in care and improve outcomes for patients. It is a fast-paced, immersion program that gives participants the tools they need to evaluate and improve a process at their own institution, within the span of four months.

Fellows are also encouraged to apply to one or more of the courses offered by the Partners Centers of Expertise Course:

Value-Based Healthcare Delivery Course

Co-sponsored by the Center of Expertise in Health Policy and Management and Harvard Business School

Health care reform will require major strategic and organizational changes in delivery, measurement, and reimbursement.  The course is based on the book, Redefining Health Care by Professors Michael Porter and Elizabeth Teisberg, and features lectures and case study discussions with Professor Porter and other members of HBS faculty, and senior leadership from Partners.  The course considers how to restructure health care delivery around value for patients, starting with providers, and encompasses strategies for health plans, employers, and government.  All sessions are held at Harvard Business School.

This course is typically held over 3 days (Wednesday, Thursday, Friday) the week before or after the MLK, Jr. holiday. Participants are expected to attend 100% of the course.

Health Policy Course

Sponsored by the Center of Expertise in Health Policy and Management

This course welcomes trainees with varying degrees of exposure to health policy, from a range of specialties, different PGY levels, and from across the Partners system. The program provides foundational knowledge in health policy and health care systems through interactive presentations, discussions, and a small group work.  Participants also have the option to participate in a one-day local advocacy experience (funded by the COE) to further their understanding of health policy. Course locations alternate between BWH and MGH.

This course is typically held in March for 5 days (Monday-Friday). Participants are expected to attend a minimum of 80% of the course.

Global Health Symposium

Sponsored by the Center of Expertise in Global and Community Health

This course covers key topics in global health and provides exposure to leaders in the field.  There are opportunities to engage in dialogue with colleagues in similar areas over lunch as well as across specialties throughout the day.  Starting in 2018, a mini-poster fair was incorporated into the symposium.  It highlights global and community health work that has been funded by the COE travel grant as well as the work of other trainees' happening across PHS hospitals.

This course is typically held on a Saturday in October, November or December. Participants are expected to attend 100% of the course.

Clinical Experience

The fellow will learn expert care of older patients across the continuum of care supervised by Mass General Geriatric Medicine faculty. Rotations include acute care, rehabilitation and long-term care and palliative care as well as outpatient continuity experiences through home visits and specialty care.

Block rotations

• Four months inpatient care at the Mass General Geriatric Inpatient Fracture Service (GIFTS)
• Four months Rehabilitation at Spaulding Brighton
• One month Palliative Care at Mass General Inpatient Pall Care consult service
• One month Long-term Acute Care (LTAC) at Spaulding Cambridge
• One month elective

Longitudinal rotations

• Weekly ½ day Continuity clinic at the Mass General Senior Health practice
• Alternating ½ day Thursdays for home visits (during the Rehab months)
• Alternating weekly session at a nursing home for long-term patient care at Marquis, North End
• Alternating Tuesday morning session with Geriatric psychiatry
• Sixteen ½-day sessions in specialty clinics: urogynocology, urology, movement disorder and cultural competence (four sessions in each clinic)

Geriatric Inpatient Fracture Service (GIFTS)

Mass General Hospital

GIFTS is a program developed by the Geriatric Medicine Unit and the Orthopedic Trauma service at Mass General.  This service focuses on the medical comanagement of elderly patient (age 65 and older) who are admitted to the Orthotrauma service with various traumatic fractures. Fellows will learn how to perform a comprehensive geriatric and preoperative assessment focusing on prevention and management of post-operative complications common in these population.

SNF and Acute Rehab

Spaulding Nursing and Therapy Rehab Brighton

Along with acute, ambulatory and home care, rehabilitation and long-term care form the foundation for clinical training of geriatricians.  The fellows will care for patients who are participating in skilled-nursing-facility (SNF) level rehabilitation following acute hospitalization anticipating discharge to home with improved functional ability.  They will also care for the frail elders in the long-term-care (LTC) level for whom discharge to home is unlikely and it is anticipated that they will live their lives in an institutional setting.        

Long Term Acute Care

Spaulding Cambridge Hospital

Spaulding Hospital Cambridge is among one of only a handful of Long Term Acute Care Hospitals (LTACHs) in this country caring for complex medical patients who require an extended inpatient hospital stay. In addition to a PCU/ICU level of medical care, patients at Spaulding have access to multiple subspecialists including a team of physiatrists, physical therapists, occupational therapists, speech pathologists, psychiatrists, social workers, a psychologist and recreational therapists.

Long Term Care

Marquis North End

The Marquis is a 100-bed skilled nursing facility with over 20 long-term-care residents.  It was originally developed with support from the North End community so long-time residents would not have to leave their Italian neighborhoods.  Over the years, the facility has continued to attract local residents who wish to remain close to family and friends.

Over the year, the fellows will follow a continuity panel of long-term care patients. The emphasis of training in this setting will be:

• To learn the management of advanced dementia and the dependencies and behaviors often associated with it
• To address ethical issues faced by patient, family and staff when caring for the very frail
• To become skilled at management of complications experienced by the physically frail patient such as pressure sores, swallow disorders/aspiration, polypharmacy, depression and behavioral disorders
• To become skilled in the rehabilitation interventions which help the very frail to maintain maximum function
• To become familiar with the unique regulatory and financial issues of long-term care
• To help patients and families address goals of care concerns and to provide end of life care in an institutional setting

Palliative Care

Mass General Hospital

During the fellow’s rotation in the Palliative Care service, they will have the opportunity to care for patients with serious and life-threatening illnesses. Fellows will serve as part of the palliative care team made up of an attending physician, advanced practice nurse, and social worker. They will also work with chaplains and pharmacist. Fellows will round with the team daily, follow hospitalized patients throughout their stay, and perform new consultations under the supervision of the attending.  The rotation is structured to provide exposure mainly to palliative care in the acute, inpatient setting.  However, fellows may have the opportunity to visit patients at home or in a nursing home once they are discharged.   

Mass General Senior Health Primary Care Continuity Clinic

The fellows will attend their primary care continuity clinic weekly, precepted by a Senior Health physician acting as their attending for the year. 

Mass General Senior Health is an interdisciplinary geriatric primary care practice.  It is the first practice at MGH to achieve the Patient Centered Medical Home certification (PCMH).  The primary care geriatricians and a geropsychiatrist focus on office-based care at the Mass General Campus.  They are supported by nurse practitioners, social worker, and a case manager. 

Our patients represent the great heterogeneity of aging.  (Many patients are vigorous and healthy, hoping that care by geriatricians will help them remain functionally active).  Our practice is focused on providing care for patients with multiple chronic diseases ranging from patients who require close evaluation and management but are active with few limitations to providing end of life care for patients in the last stages of their diseases.  An equally important group of our patients have begun to experience functional limitations from their medical conditions and our focus is on improving and maintaining independence. 

A geriatric cardiologist and a geriatric psychiatrist are embedded into the practice in an innovative Integrated Practice Unit (IPU) model to provide coordinated care for patients with advanced cardiac disease and disability.

The case manager of the Integrated Care Management Program (iCMP) focuses on the high-risk patients in the practice to deliver patient care services along with continuum of care, to ensure the institutional standards of high-quality care. 

Despite intensive practice-based care, many of our patients progress to a state of frailty that requires increasing community support to allow them to remain at home.  Our case manager, social worker and nurse practitioners collaborate with the patient’s primary care physician and the practice’s Senior Health at Home physician to provide close and intensive home care.

Because of the complex needs of the frailer patients in each of our care settings, we emphasize the interdisciplinary model of care, which relies on the expertise of other health care disciplines.  Our nurse practitioners, social worker and case manager are integral to our team care.  We focus our care on the needs of the person and support the efforts of their caregivers. We work closely with many community agencies that allow our functionally impaired patients to live at home according to their preference.

Senior Health at Home

A substantial portion of geriatric patients find it difficult to get to a medical office for care because of function, financial or transportation limitations, some are completely home bound without ambulance transport and some may have behavioral or psychiatric problems and may go without care. Others may have acute issues making it difficult to leave their homes.  The Senior Health at Home house calls program sees Senior Health patients at the request of their primary care team to provide evaluation and care to these home-bound or home-limited patients. 

How to Apply

The Massachusetts General Hospital Fellowship Program in Geriatric Medicine will be processing applications through the Electronic Residency Application (ERAS) Fellowships system.

We will offer two fellowship positions through the National Matching Program (NRMP) each year starting July 1.

Please submit the following application materials via ERAS portal by August 15:

• Curriculum vitae
• A personal statement describing the applicant's interest in and commitment to a career in geriatric medicine
• Three letters of recommendation, one of which should be from the applicant's department head, program director or division chief
• USMLE transcript

Timeline

Applications are accepted via ERAS beginning July 15th.

• ERAS Opens         
  • July 15
• Match Opens        
  • August
• Rank List Opens    
  • Late September/Early October
• Rank List Deadline 
  • Mid-November
• Match Day             
  • Early December

Applications are processed and interviews are scheduled by the Education Coordinator, Gail Chin.

Chin.Gail@mgh.harvard.edu
617-643-6514