Clinical Component

The GEM Fellow will develop expertise in the delivery of both primary care and consultative care for geriatric patients in a variety of health care settings including the emergency department, inpatient units, ICUs, skilled nursing facilities, outpatient clinic settings, and during home visits. Emphasis will be placed on the transitions of care and communication between these various settings, with a particular focus on knowledge sharing across the multiple disciplines that participate in the care of the elderly.

At NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the Fellow will participate as an active member of the health care team on rounds led by attending Geriatricians on the ACE unit, an inpatient unit dedicated to the Acute Care for Elders. The Fellow will also participate in providing clinical care to elderly patients in several intensive care units, including the SICU, MICU, CCU, and Burn Unit. On these units, the focus will be on the interface between ED and ICU management of the critically ill elderly patients. In addition, the Fellow will rotate on the Geriatric Consult service and Palliative Care service, as well as the Medicine/Orthopedic/Trauma Service (MOTS).

The GEM Fellow will also spend 2 weeks at a local skilled nursing facility and inpatient hospice unit. There, the Fellow will gain clinical experience on inpatient floors, taking "call" at night with the on-call doctor responsible for managing emergencies in nursing home patients. The Fellow will also help evaluate patients at the numerous specialty clinics available to their residents. The GEM Fellow will also have clinic time at the Irving Sherwood Wright Center on Aging on the upper East Side, a state of the art community-based outpatient care center, working side by side with some of the preeminent physicians caring for older adults in New York City. The Fellow will have the chance participate in the House Call Program through the Wright Center, which provides health care to older homebound individuals.

The fellow will be an attending physician in the emergency department, working on average one clinical shift per week in the variety of acute and urgent care settings that exist at Weill Cornell Medical Center. Their academic rank will be as an Instructor.

Educational Component

The GEM Fellow will be the educational liaison between the Divisions of Emergency Medicine and Geriatrics and Palliative Medicine. The fellow will be provided with a reading list for each rotation, with focused educational goals that incorporate Geriatric Core Competencies. They will have the opportunity to update the content of this GEM bibliography as advances in this field are made. Working closely with the Emergency Medicine Residency Program Director and the Geriatric faculty, the Fellow will promote a geriatric curriculum for the EM residency, including giving lectures as part of the 36-month geriatric lecture cycle, mentoring the geriatric-focused morning reports, a daily one-hour teaching session for residents, and participating in geriatric case-based simulation sessions, as well as Geriatric Didactic Theme Days. The fellow will also be invited to weekly EM residency conferences (4 hours) and weekly geriatrics conferences (3 hours).

Research Component

In the beginning of the fellowship year, the GEM Fellow will be provided with all the basic tools required for research. Providing this preparation is a shared responsibility of the faculties of Emergency Medicine and Geriatrics. The training begins with an eight-week intensive summer research program in Clinical Epidemiology and Health Sciences Research that provides an introduction and overview to research methodology, biostatistics, databases, decision analysis, qualitative research, and behavioral science and health services research. The Fellow is required to develop a significant research question, as well as the appropriate methodology, statistical analysis, and protocol design to study it, with the goal of obtaining extramural funding. The physician leaders of the Geriatric and Emergency Medicine Departments will supervise the grant application process. The GEM Fellow will be required to write an abstract of the research project and present the findings at a national scientific conference. Upon completion of the project, the Fellow will prepare a manuscript for publication in a peer review journal.