Requirement for the Geriatric Psychiatry Subspecialty Program:
Applicants should have completed four years of an ACGME approved general psychiatry residency program.

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Goals and Objectives:
The Heersink School of Medicine, Department of Psychiatry and Behavioral Neurobiology, Division of Geriatric Psychiatry provides a comprehensive training experience in the Geriatric Psychiatry Subspecialty Program (PGY-V). The central objective of this training is to assure competency in Geriatric Psychiatry through a structured learning experience based on inpatient, outpatient, partial hospitalization, long-term care, and consultation modalities for the treatment of the severely mentally disordered and behaviorally disturbed geriatric (65 years and older) patient. The fellowship experience includes:

I. Development of clinical skills pertinent to the evaluation of elderly patients

• Mental status examination pertinent to a variety of psychiatric disorders.
• Bedside assessment of global cognitive function.
• Physical examination skills with the ability to diagnose and rule out commonly seen medical problems in the elderly, as well as the development of familiarity with the differences of illness presentation in the aged, and the proper treatment approach.
• Neurological examination – becoming familiar with findings from commonly seen neurological conditions in the elderly.
• Knowledge of appropriate use of diagnostic studies.

II. Treatment of Psychiatric illnesses in the Elderly

• The resident will be thoroughly familiar with psychopharmacology as it relates to the geriatric patient population including pharmacokinetics, metabolism, drug interactions, and polypharmacy. The resident will be familiar with those drugs which are relatively contraindicated in elderly patient populations and be familiar with the problems involved with compliance with prescribed drug regimens.
• The resident will be familiar with the intrapsychic conflicts which are most prominently seen in the elderly patient population, and be familiar with the psychological and psychiatric treatment modalities for those psychodynamic issues.
• The resident will be instructed in the psychiatric impact of acute and chronic physical illness common to the geriatric patient population and in relation between those illnesses and mental illness in the elderly patient population.
• Latrogenic illnesses frequently encountered in the geriatric psychiatric patient population will be known well by the resident at the end of the Fellowship year. Treatment of these illnesses, particularly delirium and its sequelae will be well appreciated by the resident.
• The resident, under careful supervision, will develop skills involving the use of electroconvulsive therapy (ECT), its indications, its risks, and efficacy in the geriatric patient population. The resident will be accomplished in the use of ECT and will have completed a minimum of 25 ECT treatments with appropriate documentation under the direct supervision of one of the geriatric psychiatry attendings.
• At the end of the Fellowship year the resident will be competent and capable of diagnosing those psychiatric illnesses which are particularly seen and treated most commonly in the geriatric patient population, which include the varying dementias and their behavioral sequelae, major depression with and without psychotic features, thought disordered illnesses including late-life onset schizophrenia, other mood disordered illnesses including bipolar affective disorder, and all of the most commonly seen illnesses in the geriatric patient population.

III. Professional Development

• The resident’s scholarship will be advanced through participation in multiple seminar series which are required.
• The resident’s knowledge of the neuroanatomical correlates of psychiatric illnesses in the elderly patient population will be accomplished through the attendance of formal neuroanatomical lectures and through brain cutting and also by participation in the outpatient neurology clinic.
• The resident’s ability to successfully handle complex clinical problems which involve multiple systems, that is, medical illness concomitantly seen with neurological illnesses and psychiatric illness, will be developed.
• The resident’s ability to make appropriate decisions regarding complex medically and psychiatrically ill patients, the management of psychiatric illnesses and their appropriate social disposition will be achieved.

IV. Resident will develop familiarity with the biological and psychological aspects of normal aging and illnesses

• The resident will be familiar with cognitive changes that occur with normal aging.
• The resident will be familiar with the appropriate methods by which geriatric patients are reimbursed for their medical expenses. He will become familiar with long-term care in the geriatric patient population. He will be familiar with the common economic issues with which the geriatric patient population is faced.
• The resident will be intimately familiar and aware of the biological and psychosocial aspects of the pathology of primary psychiatric disturbances beginning in or continuing into old age
• The resident will be familiar with the psychiatric impact of acute and chronic physical illnesses.

V. The resident will develop knowledge of the multi-dimensional biopsychosocial concepts of treatment and management of geriatric patients

• The ability to diagnose, treat, and manage acutely psychiatrically ill geriatric patients will be learned throughout the Fellowship year with careful supervision by the attending physicians. Long-term care of the geriatric patient population as it relates to medical illnesses and to psychiatric illnesses will be accomplished by the resident attending home care training sessions weekly for a minimum of 6 months with the VA Geriatric Medicine Home Care Assessment Team, and also through weekly visits to the nursing homes which are associated with the state mental institutions, and to a nursing home in the private sector.
• The resident will become familiar with the medical and iatrogenic aspects of illnesses as he progresses through the year and evaluates geriatric psychiatry patients on the inpatient wards, in outpatient clinic settings, in the nursing home, and with the geriatric medicine attendings at the VA Hospital.
• Sociocultural, ethnic, economic, ethical, and legal considerations that affect psychiatric management will be learned and developed by the resident as he progresses through the complex series of multidisciplinary programs as outlined.