Rotation Descriptions
Block Rotations
Geriatric Evaluation and Management (GEM): 3 blocks per year. The GEM months focus on the care of geriatric patients in the post-acute care setting, with emphasis on optimizing transitions from hospital to facility and from facility to home. This rotation also serves as a primary teaching service for Internal Medicine residents, Med-Peds residents, and Primary Care interns, offering fellows the opportunity to serve as team leaders, supervise clinical care, and provide education to trainees.
Home Based Primary Care (HBPC): 4 weeks per year and longitudinal. Early in the year, fellows will experience the collaborative, interdisciplinary approach of the VA HBPC team and acquire 2-3 continuity patients to follow throughout the fellowship. During the month-long rotation time is spent with an attending physician doing admissions and establishing skills to see patients independently in the home, as well as experiencing visits with other team members including occupational therapy, social work, and nutrition and participating in the weekly HBPC interdisciplinary meeting. Fellows then continue to follow continuity patients once every month throughout the year and attend HBPC meetings once every 1-2 months to present the plan of care for their patients. Both the HBPC month long rotation and continuity experiences are anchored by didactic and group educational activities focused on core home care topics including home safety and adaptive equipment, home health care and community resources for homebound patients, transitions of care, nutritional assessment and food security, and social determinants of health.
Palliative Care: 4 weeks per year. Fellows complete 2 weeks of inpatient consults and 2 weeks of outpatient palliative care clinic. During this rotation, fellows gain knowledge and skills to expertly manage patients with serious illness through a team based approach with collaboration from social work, psychology, nursing, and chaplain providers. Skills gained from this rotation include navigating family meetings, goals of care conversations, advance care planning, and determining hospice eligibility. In addition to assessing and treating both chronic and acute pain, training includes the art of providing relief by gaining knowledge on the psychosocial and spiritual aspects of suffering.
Community Nursing Home/Medical Directorship: 4 weeks per year. Fellows learn the administrative and leadership responsibilities involved in the Medical Director role while working with community-based providers in a variety of community nursing home settings. This rotation offers fellows exposure to a variety of clinical and career models to demonstrate the potential for incorporating Medical Directorship into their future careers. Through participation in administrative meetings, fellows learn approaches to quality assurance and patient safety in the long-term care setting.
Rehabilitation: 4 weeks per year. Fellows will learn alongside our Physical Medicine and Rehabilitation specialists the geriatric approach to peripheral joint injections, trigger point injections, musculoskeletal ultrasound, EMG for neuropathy evaluations, spasticity management and interventional spinal therapeutics. During this rotation, fellows also work with physical and occupational therapy in both inpatient and outpatient settings to gain insight into the roles of these important interprofessional collaborators.
Neuropsychiatric Medicine: 4 weeks per year. Fellows will spend time in a variety of settings with neurology, psychiatry, and psychology providers to learn about the geriatric approach to cognitive and movement disorders. Fellows gain exposure to management of late-stage movement disorders through work in VA and University Neuropalliative Care Clinics. Fellows have the opportunity to work with a Behavioral Neurologist specializing in frontotemporal dementias and primary progressive aphasias, who is involved in clinical trials with the University of Colorado Alzheimer’s and Cognition Center. Fellows will also spend time with a VA geropsychologist performing neuropsychiatric evaluations and providing support and counseling to patients and caregivers. Additionally, fellows will spend time with a VA geropsychiatrist performing dementia and psychiatric evaluations of older adults at the VA site and in the community nursing home setting. During the rotation fellows also have exposure to VA Dementia caregiver support groups and capacity evaluations.
Program for All-Inclusive Care of the Elder (PACE): 2 weeks per year. The CU Geriatric Medicine Fellowship partners with two Denver Metro area PACE programs: Tru Community Care and InnovAge. Fellows will spend 2 weeks working in an interprofessional team environment at PACE. During this rotation, fellows participate in care across a spectrum of locations including PACE centers, nursing homes, locked memory unit, and assisted living facilities. This comprehensive care model for dual eligible (Medicare and Medicaid) patients provides a unique opportunity for fellows to experience a community based multidisciplinary approach to geriatric care.
Acute Care of the Elder (ACE): 2 weeks per year. The ACE inpatient service is a primary teaching service for residents and students at University Hospital providing care to hospitalized older adults. Fellows participate in interdisciplinary team meetings and rounds each day and provide geriatric teaching to residents and students during this rotation, serving as a geriatric content expert for the team.
Wound Care: 2 weeks per year. Fellows will learn to diagnose, investigate, and treat different types of wounds from specialists at the VA in both the inpatient and outpatient setting. Fellows learn when and how debridement is appropriate and apply knowledge to wound healing for the selection of dressing and other topical wound care products and devices. Fellows leave this rotation trained to apply evidence-based medicine to complex wound care.
Urogynecology: 2 weeks per year. Fellows will spend two weeks in urogynecology clinics learning a multidisciplinary approach to care including collaborative care with colorectal surgery specialists. Fellows learn basics of pessary fitting and management and core concepts related to the care of older adults with incontinence.
Elective: 6-8 weeks per year. Fellows can tailor their elective experiences towards a particular area of clinical interest, to fill gaps in knowledge, or for career planning and exploration.
Research: Each fellow receives protected time to complete Quality Improvement and other scholarly projects, either in a block rotation or a longitudinal model, depending on the fellow’s needs and interests.
Longitudinal Experiences
VA Geriatric Clinic: 1 half day per week. Fellows spend one half-day a week at the Rocky Mountain Regional VA GeriPACT clinic. This clinic brings a multidisciplinary approach to care with imbedded social work and geropsychology within the clinic. Our geriatric trained pharmacist completes a medication reconciliation prior to all new visits and is available for chronic disease management. Fellows provide geriatric primary care and outpatient geriatric consultation to complex older adult veterans, including but not limited to comprehensive cognitive assessment and advance care planning.
University of Colorado Seniors Clinic: 1 half day per week. This clinic serves a culturally, linguistically, and socioeconomically diverse population of patients >75 years old from the Denver metro area and throughout the state. This clinic offers fellows the opportunity to provide geriatric primary care to medically complex patients in a well-supported clinical environment that includes a large interprofessional team. Fellows master principles of geriatric primary care while learning to collaborate with nursing, clinical pharmacy, integrated behavioral health, and social work team members in order to optimize patient care.
State Veteran’s Home Long-term Care: Monthly visits. Fellows care for a panel of long-term residents at the Colorado State Veterans Home, located on the CU campus. Fellows serve as the primary care provider for these patients, working with the interprofessional care team at the State Veterans Home to provide high level care to these complex patients.
Home Based Primary Care: Monthly visits. Fellows follow continuity patients, as their primary care provider and case manager, once every month throughout the year and attend HBPC meetings once every 1-2 months to present the plan of care for their patients. Fellows also play an important educational role in HBPC by including medical students in their home visits and through collaborative work with the geriatrics pharmacy resident. Both the HBPC month long rotation and continuity experiences are anchored by didactic and group educational activities focused on core home care topics including home safety and adaptive equipment, home health care and community resources for homebound patients, transitions of care, nutritional assessment and food security, and social determinants of health.
Unique Clinical Experiences
Vulnerable Elder Services, Protection, and Advocacy (VESPA) Consult Service: The VESPA team is a unique, interprofessional service at the University of Colorado providing elder abuse consultation. This team is the first of its kind in Colorado and only the 2nd in the nation. Fellows have the opportunity to observe, participate in, and perform elder abuse consults, to follow patients longitudinally across health systems, and to participate in collaborative care with community based partners including law enforcement, adult protective services, and social services. This is a unique opportunity to learn core principles of elder maltreatment recognition, reporting, treatment, and care coordination.
In addition, fellows have the opportunity to participate in VA Telehealth clinic providing virtual cognitive evaluation services to rural veterans, as well as in Fall Prevention Clinic, and Healthy Aging Group Visits. Fellows also have scheduled didactic and clinical sessions in audiology, vestibular testing and rehabilitation, and driver safety evaluations.
Conferences
In addition to direct clinical teaching, fellows receive education through a series of core conferences including Geriatric Grand Rounds, Geriatric Journal Club, brief pre-clinic conferences, Complex Case Review conferences, interprofessional case conferences through both GRECC and the University Seniors Clinic, and weekly Fellows Conferences.
Fellows are sponsored through the Division of Geriatrics each year to travel to and participate in the annual American Geriatrics Society meeting.
Fellows are also encouraged to attend the Futures Program at the Society for Post-Acute and Long-Term Care annual conference, as well as the local Colorado Medical Directors Association annual conference.
Research Opportunities
All fellows will complete a Quality Improvement project in collaboration with faculty mentors. Fellows are given the opportunity to collaborate with a research mentor on established research and quality improvement projects, or to develop and implement a new project during fellowship. Fellows receive dedicated QI and research training and mentorship on a longitudinal basis throughout fellowship. In addition, CU offers several opportunities for additional post-graduate training in research and medical education.
T32 Training Grant – Physiology of Aging
T32 Training Grant – Palliative Care and Aging