Fellows will have 2 sessions a week devoted to elective time. They are required to complete a minimum 6 sessions in geriatric psychiatry, neurology, rehabilitation medicine, and medical directorship. Additional time will be devoted to these disciplines during the acute inpatient rotation. Fellows will do at least one geriatric consultation a week on the Geriatric Psychiatry Inpatient unit, and will conduct geriatric consultations in the Acute Rehabilitation Unit at Bridgeport Hospital whenever the opportunity arises.

The additional sessions may be divided into other areas of interest for the fellows based on the learning objectives outlined for their portfolios prior to their mid-year evaluation with the program director or associate program director. Additional electives include assisted living facility experience, wound care, and the REACH program (outpatient psychiatric day program). Some of this elective time may be used for office administration and telephone triage.

The Psychiatry elective will utilize multiple settings including inpatient and long term care. Fellows will perform geriatric psychiatry consults in the acute setting and in the nursing home. Additional time will be spent at the REACH program which is an outpatient adult partial day program. Here they will experience non-institutional outpatient programs with an emphasis on psychiatric issues.

The neurology elective will utilize both inpatient consultations and outpatient office based consultation and practice.

The Rehabilitation Medicine elective will be mostly in the acute rehabilitation setting and acute hospital consults. Fellows will have the opportunity to work with and observe rehabilitative specialists from the allied health professions in the nursing home as well.

Fellows are expected to identify a research interest by the 3^rd month of the fellowship. They are expected to write a research proposal with a timeline for their portfolios. They are expected to meet quarterly with the program director/ associate program director or research advisor to review progress of the project. Fellows are expected to write and submit an abstract for a local/state/ or national meeting. If accepted, they are expected to present their abstract in poster form. Fellows will be encouraged to have drafted a manuscript of their work prior to graduation from the program.

By the end of the rotation, fellows will be able to:

• Demonstrate proficiency in recognizing, diagnosing, managing, and referring psychiatric disorders in late life including generalized anxiety disorder, depression, psychosis, and dementia with behavioral disturbances (medical knowledge/patient care)
• Demonstrate proficiency in diagnosis, management, and pharmacotherapy of various psychiatric disorders including dementia, delirium, depression, psychosis, and behavioral disturbances (medical knowledge/patient care)
• Explain the pharmacology, indications, and adverse effects if antidepressants, anxiolytics, and antipsychotics (medical knowledge/patient care)
• Review the federal regulations surrounding management of psychiatric medications in the nursing home setting (systems based practice)
• Effectively interact with an interdisciplinary team (interpersonal skills and communication/professionalism)

By the end of the rotation, fellows will be able to:

• Perform a complete neurological evaluation (medical knowledge/patient care)
• Recognize the appropriateness for referrals to a neurological specialist (medical knowledge/patient care/systems based practice)
• Perform a cognitive assessment (medical knowledge/patient care)
• Describe the differences in approach to cognitive evaluations between a neurologist and a geriatrician (systems based practice/medical knowledge)
• Appropriately and cost effectively prescribe pharmacotherapy for cognitive disorders (medical knowledge/patient care/systems based practice)
• Demonstrate proficiency in diagnosis and management of neurological conditions such stroke, Parkinson’s Disease and Parkinsonism, neuropathies, and dementias (medical knowledge/patient care)

By the end of the rotation, fellows will be able to:

• Demonstrate proficiency in recognition, diagnosis, and management of common musculoskeletal and neurological disorders (medical knowledge/patient care)
• Identify appropriate utilization and use of assistive devices (medical knowledge/patient care/systems based practice)
• Recognize the appropriateness for referrals to a rehabilitation specialist (medical knowledge/patient care/systems based practice)
• Demonstrate effective interaction with an interdisciplinary team (interpersonal skills and communication/professionalism)

By the end of the rotation, fellows will be able to:

• Effectively interact with an interdisciplinary team (interpersonal skills and communication/professionalism)
• Summarize federal regulations governing nursing home care (systems based practice)
• Explain the MDS and uses for the MDS (systems based practice)
• Recognize the responsibilities of the medical director (systems based practice/patient care/professionalism)
• Participate in quality assurance meetings (systems based practice/interpersonal skills and communication)

By the end of the rotation, fellows will be able to:

• Plan and implement a research project (medical knowledge)
• Assess and critique medical literature (systems based practice/ practice based learning)
• Prepare and abstract of their research project or an interesting case and design a poster for presentation at a local, state, or national meeting (systems based practice/ practice based learning/professionalism/medical knowledge)

By the end of the rotation, fellows will be able to:

• Competently triage telephone calls (patient care/medical knowledge/interpersonal skills and communication)
• Identify systems for review and action on lab and radiology data (systems based practice/patient care/medical knowledge)
• Demonstrate proficiency in care plan review (systems based practice/patient care)

By the end of the rotation, fellows will be able to:

• Describe the payment system for assisted living (systems based practice)
• List criteria for placement in an assisted living facility (systems based practice/ patient care)
• Recognize the limitations of caring for someone in an assisted living facility (systems based practice/ patient care)
• Demonstrate proficiency in the primary care work-up and evaluation of frail elders in the assisted living environment (patient care/ medical knowledge)
• Demonstrate effective interaction with an interdisciplinary team (interpersonal skills and communication/professionalism)

By the end of the rotation, fellows will be able to:

• Classify different types of wounds (patient care/ medical knowledge)
• Define the stages of pressure ulcers (patient care/ medical knowledge)
• Demonstrate the ability to properly diagnose and treat different wounds (patient care/ medical knowledge)
• List various wound care products and their uses, costs, and limitations (medical knowledge, systems based practice)
• Demonstrate the ability to interact with wound care nurses and infection control personnel in the assessment and treatment of wounds (interpersonal skills and communication/professionalism)

By the end of the rotation, fellows will be able to:

• Recognize patients who benefit from outpatient partial day programs (medical knowledge/patient care/ systems based practice)
• Demonstrate an ability to interact with the staff of a non-institutionalized day program (interpersonal skills and communication/professionalism)

Teaching will occur with direct patient care and subsequent discussions between attending and fellow in the inpatient, outpatient, and nursing home setting. Directed reading from the geriatric literature is expected. The fellow will have opportunity for independent reading. Formal didactic session will occur during the didactic conferences and individually based on case discussion with the attending.

Goals of the rotation will be reviewed with each fellow by the program director at the beginning of the year and at the mid year review. The supervising attending is expected to provide feedback during or at the end of each session. Additionally, the attendings will be asked to submit a formal written evaluation of the fellow’s progress at the completion of the 6 sessions of elective. Written evaluations will be forwarded to the program director for review and will be kept in the fellow’s file. Fellows may review their evaluations at anytime, however they will be required to meet with the program director biannually to review and discuss their performance. Fellows will be asked to complete a quarterly evaluation of their rotations and attendings as well. This material will be forwarded to the program director to review and utilize to assess that goals of the rotations are being met and to make changes to the rotations where needed to better meet those goals. At the discretion of the program director, should he/she feel that fellows are not meeting the specific goals of the rotation, review of these goals will be scheduled with each fellow. The fellow will also have quarterly review of his/her research project with both written evaluation and formative feedback at the time of the meeting. The written evaluation will be forwarded to the program director for review and will be kept in the fellow’s file. Fellows may review their evaluations at anytime, however they will be required to meet with the program director biannually to review and discuss their performance.