Neurology Rotations (Memory Disorders Clinic, Neuropsychological Assessment Clinic):
During their Duke block, fellows do a one day every week of memory disorders clinic where they work with a neurologist, Dr. James Burke, and evaluate patients presenting with memory disorders. Fellows learn about evaluation and management of memory complaints across the spectrum from Mild Cognitive Impairment to advanced Alzheimer’s dementia and other types of dementia.
Fellows also work one day a week with Dr. Kathleen Welsh-Bohmer and participate in neuropsychological assessments of older adults with memory complaints. Fellows learn about various cognitive batteries, how to interpret testing data, and about neuropsychological profiles seen in various forms of dementia.
Geriatric Psychiatry Outpatient Program:
The Geriatric Evaluation and Treatment Clinic (GET Clinic) at Duke, the Psychiatric Outpatient Clinic (POPC) at Duke, and the Durham VA Geropsychiatry Clinic serve as the three outpatient sites for geriatric fellows. Dr. Harold Koenig at the GET Clinic, Dr Mugdha Thakur at the POPC, and Dr. Tracey Holsinger at the VA Clinic work closely with the fellows in these settings. Fellows also have group psychotherapy teaching with Mr. Stephen Hawthorne, a clinical social worker with many years of experience working with older adults.
The fellows work in the GET clinic and the VA outpatient clinic every other week throughout their Duke and VA blocks (8 months). The POPC clinic is the fellows’ continuity clinic and happens half day each week all year long. The goals for the outpatient experience are to provide a setting for evaluating psychiatric outpatients and then following them longitudinally while developing evaluation skills for assessment and diagnosis of psychiatric and neuropsychiatric disorders of late life. Each clinic is unique in the types of patients seen, opportunity for interaction with colleagues in medicine, and length of follow up provided.
Nursing Home Rotation:
During the Duke block, fellows work weekly in 2 nursing homes in Durham, Rose Manor and Croasdaile Retirement Community under the supervision of Dr. Robert Williams, who is an expert on nursing home consultation, and Dr. Mugdha Thakur respectively.
Specific goals of this rotation are the development of an understanding of the psychosocial impact of nursing home admission and residence in a long term care setting; ability to perform comprehensive evaluation of the roles of environmental, psychosocial, medical, and psychiatric factors that cause or contribute to disturbances of mood, cognition, and behavior in nursing home residents; expertise in behavioral interventions, supportive psychotherapy, and pharmacotherapy, and skill in supervising other health care providers in using these interventions; strategies for effective communication with primary care attending physicians; knowledge of the federal regulations that affect psychiatric care in the nursing home; and diversification of consultation skills that are applicable to patient care, staff liaison and training, forensic assessment, and administrative consultation.
Geriatric Psychiatry Inpatient Program, Central Regional Hospital (CRH), Butner, NC:
This rotation is done almost full-time over a 4 month period in the CRH block, under the guidance of Dr. Jody Miller, a fellowship-trained geropsychiatrist. The goals of the rotation are inpatient evaluation; gain expertise in behavioral, psychodynamic, psychopharmacologic, somatic, and family interventions as they are used in geriatric patients; coordinate concurrent management of co-morbid medical conditions and associated disabilities; develop competency in leadership of an interdisciplinary team; and develop skills for teaching and supervision of non psychiatrist mental health professionals. CRH geropsychiatry unit provides inpatient care for older adults with a variety of conditions including mood and anxiety disorders, behavioral disturbance associated with dementia, psychotic disorders, and other psychiatric disorders. The fellow’s primary responsibility is for up to 10 patients with clinical supervision readily available, while allowing the fellow to be the primary decision maker.
The Inpatient Geriatric Psychiatry Unit is staffed with an interdisciplinary health care team, which affords trainees experience in team leadership. The patient population has a high prevalence of medical comorbidity and disability, providing fellows with extensive opportunities for interaction with consultants in internal medicine, surgical specialties, physical therapy, occupational therapy, and speech and language therapy.
Electroconvulsive Therapy Program:
The Duke ECT program is one of the most reputed ECT programs in the country where psychiatrists come from all over the world to learn about this effective somatic therapy. During their Duke and VA blocks, fellows do one day of ECT every other week over an eight month period. They participate in ECT administration in the morning, and ECT seminars, rounds and consultations in the afternoon. The goal of this rotation is to develop expertise in this somatic therapy frequently used for treatment of severe depressive disorders in the geriatric population. Developing this expertise involves gaining increased skills in assessing patients for ECT; increasing knowledge about disorders usually treated with ECT in the geriatric population; gaining confidence in the techniques of administering ECT; increasing understanding of options for minimizing impact of treatments on cognitive functioning; gaining experience in using ECT in the medically frail elderly; and following outpatients receiving maintenance ECT for a longitudinal perspective. Supporting these clinical goals is the development of a greater understanding of the physiology and implications of seizure induced therapies.
At the end of the rotation, fellows earn certification in ECT that may be required for future credentialing for hospital ECT privileges.
The objectives of this research experience are to introduce fellows to all phases of the conduct of clinical research including hypothesis generation, literature search and review, study design, data collection and analysis, and presentation and publication of research findings; and to teach methods for establishing the validity and reliability of clinical measures. These objectives are accomplished by faculty serving as research preceptors for fellows who express interests in the research and request to work with that faculty person. The Program Director reviews research options with each fellow and assists in locating the most appropriate preceptor as needed. For those fellows not interested in research, a suitable elective clinical experience is identified and substituted.
The overall didactic program has several objectives. It:
• Provides a broad and intensive review of the essentials of geriatric psychiatry, which gives the fellow a sound foundation of knowledge and background for providing clinical care, consultation a geriatric psychiatrist;
• Complements and supports the goals of the clinical experiences described above;
• Reinforces the appreciation of the need for an interdisciplinary approach to the care of older adults;
• Provides information, references, and teaching approaches that may be used by fellows in their current and future teaching efforts; and
• Stimulates some fellows to pursue clinical research training in neuropsychiatry and geriatric psychiatry.
Please refer to the conferences section for details of various conferences and seminars held through the year.
Evaluation of Fellows’ Performance:
Fellows are given continuous feedback during supervision by individual preceptors. Fellows are evaluated formally by faculty every 3 months on all ACGME competencies. This feedback is shared with fellows electronically. Fellows also meet with the program director twice a year for a formal evaluation and more frequently for reviewing their progress and discussing their educational needs. Whenever necessary because of performance problems, the residency program director schedules additional meetings with the fellows to provide feedback and to develop an appropriate plan for remediation. Fellows are also evaluated on their teaching by medical students and residents. Additionally, fellows are required to obtain written feedback from peers and patients.
Evaluations by the fellows:
The program director solicits feedback regarding the program and fellows' training experience directly from each fellow on an ongoing basis. This feedback is essential in tailoring the fellowship to meet the training needs of fellows and to ensure the achievement of the objectives outlined above. Fellows have the opportunity to confidentially evaluate their supervisors every 3 months. They also have the opportunity to provide written feedback on rotations, on lectures, as well as on the entire program. This feedback is important in selecting targets for program improvement each year.
Fellows are not required to be on overnight or after hours in house call.