Through the UAB Outpatient Geriatric Continuity Clinic, you will provide care for complex older adults with multiple medical, social, and psychological problems. In most situations, you will provide ongoing primary and geriatric subspecialty care for these patients. For fellows more interested in a primary care career, the frequency of the continuity clinic experience may be increased to meet individual learning and career goals.

Fellows also attend the VA Geriatrics Assessment Clinic several times per month while on a block month rotation, providing outpatient consultative care focused on comprehensive geriatric assessments where you will become accomplished at assessing, diagnosing, and managing many geriatric syndromes including mood disorders and dementia. You may function as “junior attendings” in this clinic in the second half of your fellowship year.

You will provide care for patients in skilled post-acute care and long-term care settings. Common conditions include post-hip fracture or joint replacement, infections, stroke, metabolic disorders, cardiovascular disorders, musculoskeletal pain syndromes, malnutrition, and polypharmacy. Common conditions for the long-term stay residents include the same spectrum of medical illnesses, but also include a high incidence of geriatric syndromes such as dementia, incontinence, falls, and pressure ulcers.

The most common medical conditions and geriatric syndromes will be assessed and managed in the home setting. Emphasis is placed on the interprofessional team approach. The goal of this experience is to build your skills in the diagnosis and management of medical problems in frail, homebound adults and to align care plans with patient and family/caregiver-oriented goals. There are two sites where you will have a home based experience during your UAB fellowship: House Calls through the UAB Geriatrics Clinic, and Home Based Primary Care through the Birmingham VA. Each is unique and offers a slightly different experience for fellows.

You will carry your own panel of home visit patients through the UAB Geriatrics Clinic. Home visits will occur approximately once monthly and may be in lieu of an in-clinic session. The goal will be for you to visit patients independently, or with a member of the interprofessional House Calls team as needed.

You will also perform home visits with the VA Home-Based Primary Care (HBPC) team. These sessions are usually scheduled once weekly over the course of three months during Block rotations, and are made simultaneously with an attending and may include other members of the HBPC interprofessional team.

The inpatient consult rotation provides experience in preventing, evaluating, and managing geriatric syndromes in hospitalized older adults. As a member of an interdisciplinary team and as a geriatrics consultant, you provide recommendations on management of common geriatric syndromes such as cognitive impairment, delirium, polypharmacy, falls, complex discharge situations, elder abuse, depression, pain, and facilitate discussion of goals of care.

Timing: UAB Consults/Acute Care of the Elderly (ACE) Unit is a month-long rotation, usually scheduled during the first six months of fellowship. You will spend up to one week on the ACE Unit at UAB Highlands participating in ACE activities and performing consults. The remainder of the month will be spent on the geriatric consult service at University Hospital (and UAB Highlands at times). You may have an additional 2-4 weeks in the second six months, acting as “junior attending,” performing consults more independently but still with attending supervision.

You will also perform inpatient geriatric consults at the Birmingham VA, and this experience is typically scheduled for one week at a time during block months. You will always work with an attending and have appropriate supervision.

You will gain experience in both inpatient and outpatient Physical Medicine & Rehabilitation by attending a wide variety of clinics and will spend a quality time learning principles of rehabilitation consultation. In addition to working in UAB Spain Rehabilitation Center, a state-of-the-art free-standing acute rehabilitation facility on the UAB campus, settings also include the VA Cerebrovascular Disease (“Post-Stroke”) Clinic, UAB Movement Disorders Clinic, VA Fall Prevention and Mobility Clinic, Physical Therapy, and Speech Therapy. Most of these highly specialized clinical venues are described below under “Subspecialty Clinics.”

Timing: Activities are usually scheduled over the course of one to two months during the second six months of fellowship in conjunction with Geriatric Psychiatry activities and other Block months.

You will join psychiatry attendings in several geriatric psychiatry settings (private practice clinic, UAB Memory Disorders Clinic, VA Home-Based Psychiatry, and VA inpatient palliative care psychiatry) with the goal of building experience in the diagnosis and management of psychiatric problems in older adults.

Timing: Clinical activities are usually scheduled over the course of one to two months during the second six months of fellowship. Activities occur during the same month as Physical Medicine and Rehabilitation activities, although some activities may also occur during Block months. You will also have the option to observe electroconvulsive therapy and a competency hearing at UAB.

In this rotation, you will gain experience in the provision of palliative medicine care to geriatric patients in a variety of settings, with an emphasis on complex pain and non-pain symptom management, management of palliative care emergencies, managing conflict and establishing goals of care, estimating and communicating prognosis, managing withdrawal of advanced life-sustaining therapies, and caring for the imminently dying patient.

Timing: This rotation is usually scheduled in the first six months of fellowship, spending two weeks at the VA and two weeks at UAB. Additional time can be arranged based upon a self-assessment of your needs.

During your Health Care Leadership rotation, you will work with health system leaders and medical directors in the hospice, nursing home/assisted living, managed care, and inpatient settings at UAB, the VA, local hospice(s), and VIVA (the health insurance agency for UAB) to gain expertise in health system leadership and medical direction in hospice, nursing home, managed care, and inpatient settings.

Timing: Activities are usually scheduled over the course of one month during the second six months of fellowship.

On these rotations, you will gain experience in the diagnosis and management of a variety of common geriatric syndromes by working with interprofessional teams in various UAB and VA Outpatient Subspecialty Clinics. You will have 2-4 Subspecialty Block rotations throughout the year with clinics typically scheduled on a weekly basis. These ambulatory clinics include:

• UAB Memory Disorders Clinic: provides care for patients with a variety of neurological disorders affecting cognition and behavior, including age-related memory loss, Alzheimer’s disease, frontotemporal dementia, Parkinson’s-related cognitive impairment, vascular dementia, Creutzfeld-Jakob disease, and other related conditions.
• UAB Movement Disorders Clinic: specializes in neurological disorders that affect movement, including Parkinson's disease and other Parkinsonian disorders, providing diagnostic services utilizing treatment approaches including medications, physical, occupational, and speech therapy, deep brain stimulation, and surgery.
• UAB Osteoporosis Clinic: provides evaluation of patients, including assessment of bone mineral density, nutritional counseling, physical therapy evaluation, treatment, and rehabilitation.
• UAB and VA Continence Clinics: provide evaluation and treatment for patients with bladder and bowel issues including incontinence, pessary fittings for prolapse and stress incontinence, Percutaneous Tibial Nerve Stimuation (PTNS) for overactive bladder (OAB), constipation, pelvic pain, incomplete bladder emptying, recurrent UTIs, nocturia, and urinary frequency.
• UAB and VA Wound Care Clinics: provide comprehensive assessment and treatment recommendations for patients with wounds due to a variety of conditions (chronic wounds, diabetic ulcers, wounds from traumatic injury, wounds from vascular disorders, venous or arterial insufficiency, radiation-induced tissue injury, or burns).
• VA Cerebrovascular Diseases Clinic (aka Stroke Clinic): provides evaluation for patients with ischemic and hemorrhagic stroke including evaluation of stroke mechanism, determination of secondary stroke prevention, rehabilitation assessments, psychosocial/cognitive screening following stroke, and risk factor/lifestyle modification counseling.
• VA Fall Prevention and Mobility Clinic: provides evaluation and intervention for patients with a history of falling. Patients are evaluated for strength, balance, and gait abnormalities and their medications are reviewed with a focus on those that are associated with falls and mobility problems. Interventions include prescribed ambulatory devices, adaptive equipment and exercise programs based on results of their individualized assessment.

Beginning in the Fall, you will have at-home call for the UAB Geriatrics Clinic and Nursing Home 2-4 weeknights per month and 2 weekends per quarter. You will have attending back-up for your call nights.

You will meet quarterly with Palliative Medicine fellows to plan, develop, and present a scholarly or quality improvement project. Workshop topics include: 1) Defining a Question, Methodologies, and Mentorship, 2) Works-in-Progress, 3) Abstracts and Posters, and 4) Presentation and Dissemination. Over the course of your fellowship, you will submit your scholarly project to local and national meetings, present 1-2 journal clubs, 1-2 case conferences, and the final Grand Rounds presentation of your scholarly project.

You will play an important instructional role in the clinical education of medical students and residents rotating in Geriatrics. We provide mutliple resources to aid you in this part of your role.

UAB Gerontology, Geriatrics and Palliative Care Division Grand Rounds is held most Thursdays at noon throughout the year and includes talks on Clinical, Inter-professional, and Educational topics related to the treatment of Geriatric Medicine and Hospice & Palliative Medicine patient populations.The goal of these conferences is to provide educational opportunities and updates on the latest research within the division and globally within the field of geriatrics and palliative medicine.

Research and Innovations in Medical Education (RIME) Week is an annual conference for clinician-educators that promotes teaching skills, fosters curriculum innovation, and showcases scholarship and research findings in medical education for the 21st century. This conference includes a special speaker at the weekly Department of Medicine (DOM) Grand Rounds, an abstract poster competition, and a half-day fellows’ workshop. Fellows will attend the work-shop and are encouraged to participate in the abstract competition should they have any special cases or scholarly project prepared.

Mini Quality Academy (MQA) is a half-day GME-sponsored quality and patient safety training that is standardized throughout UAB Medicine. This important quality initiative is intended to provide a focused set of information and methods to allow you to understand the basic building blocks for Quality Improvement and Patient Safety, along with some practical, hands-on group activities that you can take back to your work environment.

Mini Healthcare Disparities Academy (HDA) is a half-day GME-sponsored educational session designed to illuminate healthcare disparities and highlight strategies resident and fellows can use to provide culturally competent care and reduce health disparities.

Fellows will participate in a monthly Fellows’ Most Difficult Case Conference (FMDCC) and will have the opportunity to present their own case once during their fellowship year. FMDCC was created by our geriatric medicine partners at Aurora Sinai in Wisconsin and brings together fellows from coast to coast, as well as geriatrics and psychiatric teaching faculty from leading academic programs including UAB to provide a biopsychosocial model (the Wisconsin Star Method) as a rubric to address particularly challenging cases.

The UAB Geriatric Medicine Fellowship will support the travel and registration expenses for 2 conferences a year, the American Geriatric Society (AGS) Annual Meeting and the Society for Post-Acute and Long-Term Care Medicine (AMDA) Annual Meeting. Fellows are strongly encouraged to create a scholarly project such as an abstract/poster to submit and present at the AGS Meeting which is held during the month of May.