Advanced Residency Training

Geriatric Psychiatry Fellowship Training Program

Overview

The Geriatric Psychiatry Fellowship Training Program at Yale offers a rich combination of experiences designed to provide psychiatrists with expertise in the diagnosis and treatment of neuropsychiatric disorders in late life, to develop skills as educators, and to stimulate interest in research. The program provides opportunities to learn about the social, legal, and financial issues associated with the care of older adults. The program is an ACGME approved 12-month fellowship, with the opportunity to pursue an additional year of research training within the field of Geriatric Psychiatry. The program provides supervised clinical training in a broad array of settings including: outpatient specialty clinics, inpatient units, nursing home settings, inpatient and outpatient consult-liaison services, home based services, community based offices and clinics, and both inpatient and outpatient based research programs. Yale-New Haven Hospital and the VA Connecticut Healthcare System are the primary facilities where training occurs.

CLINICAL EXPERIENCE

Geriatric Psychiatry Advanced Residency Training Program

This rotation is designed as a 6 month, half-time assignment in collaboration with Geriatric Medicine for the care of older patients suffering from concomitant medical and psychiatric illnesses. Geriatric Psychiatry and Medicine fellows care for patients within the same clinic setting and often co-manage complex patients. Fellows have the opportunity for formal and informal consultations with on-site faculty from psychiatry and medicine on a daily basis for both new and established patients. The clinic serves as a training site for students from the Yale University School of Medicine, advanced practice students from the Yale University School of Nursing, and for students from the University of Connecticut School of Pharmacy. It also serves as a training site for Department of Psychiatry residents from the PGY3 -PGY4 years. Fellows play an active role in the education of students and residents from these diverse disciplines in the evaluation and treatment of older patients presenting with neuropsychiatric illnesses.

The training experience is enhanced by a weekly didactic seminar series held jointly with geriatric medicine, and a weekly journal review session with fellows, residents, and medical students rotating on the geriatric psychiatry service.

Geriatric Psychiatry Inpatient Program

This rotation is designed as a 6 month, part-time rotation. The educational objectives are to develop clinical expertise in the diagnosis and management of complex psychiatric and medical disorders in older patients, and to learn sophisticated strategies for pharmacologic and behavioral treatment of geriatric disorders in the inpatient setting.

Fellows serve as a "junior attending" taking leadership of the interdisciplinary treatment team. In that role they learn management and decision making skills necessary to run an inpatient unit. Fellows have the opportunity to develop educational expertise as they provide direct supervision of PGY-2 psychiatry residents and Yale medical students.

The training experience is enhanced for the fellows by daily interdisciplinary teaching rounds and individual faculty supervision. Case based teaching includes interdisciplinary perspectives and review of the pertinent current literature.

The Yale Alzheimer's Disease Research Unit

This rotation is designed as a yearlong clinical experience in which fellows rotate through half-day clinics. Fellows join an interdisciplinary clinical and research team that provides clinical care, caregiver support, and conducts research trials. Fellows learn state-of-the-art methods for assessment of dementia, are exposed to the latest developments in neuroimaging and treatment for Alzheimer's disease, and have the opportunity to learn about current theories of the pathophysiology of dementia and the rationale for investigational therapies.

Fellows serve as an integral part of this treatment/research team and have supervisory and teaching opportunities with Department residents and Yale medical students rotating through the Unit.

The training is enhanced by individual faculty supervision, weekly research meetings where fellows learn skills necessary to critically evaluate both research methodology and current findings in the literature, and by weekly case conferences, which often include a didactic component.

Nursing Home Consultation

This rotation is a continuous yearlong, half-day assignment, where fellows learn the comprehensive assessment and consultation skills of a geriatric psychiatrist in the nursing home setting. Fellows gain expertise in the evaluation and management of residents with co-morbid psychiatric and medical illnesses. Management of behavioral disturbances associated with dementia is a fundamental task in the nursing home setting. Fellows work closely with nursing home staff to evaluate behavioral problems and develop management strategies. They also collaborate with the patient's medical physician to investigate possible medical causes of delirium or behavioral change. Fellows have the opportunity to learn about the enormous psychological and social impact that nursing home placement has on an older individual and his/her family, and to gain an understanding of the financing of such care.

Supervision is provided on-site by geriatric psychiatry faculty. Opportunity also exists for fellows to assist in the in-service training of nursing home staff.

Consultation-Liaison Service

This rotation is a 2 month, quarter time rotation where the geriatric psychiatry fellow serves as the consultation-liaison psychiatrist assessing elder patients on the medical/surgical wards of a large tertiary care hospital. Fellows develop skills in assessing and treating elderly patients with complex medical, psychiatric, and psychosocial disabilities. Fellows will learn about the psychiatric and behavioral manifestations of acute medical illness in the context of a busy acute care medical setting. They will also gain experience in analyzing complex drug interactions and interpreting laboratory and imaging data sets. Fellows will gain expertise in consultation-liaison techniques and learn to effectively communicate with other medical colleagues. They will also gain experience assessing decision-making capacity and knowledge of the medico-legal issues facing older patients in the context of acute inpatient medical/surgical care.

Supervision is provided at the bedside by attending faculty in geriatric psychiatry and consultation-liaison psychiatry. While the fellow is on this service she/he also attends weekly consultation-liaison rounds that consist of case presentations and pertinent literature review.

Geriatric Psychiatry Case Management Service

This rotation is a 6 month, half-day per week experience wheJanuary 14, 2008ng home visits to home-bound elder patients with neuropsychiatric illnesses. Fellows develop an understanding of the array of complex issues facing both the patient and caregiver as they attempt to manage and maintain the optimal quality of life at home. Fellows develop skills in functional home assessment, and working with the non-physician team. At times they are called upon to assess decision making capacity and/or safety concerns around the home.

Weekly individual faculty supervision and weekly interdisciplinary case management rounds in which the fellow participates enhance this training experience.

ECT

This rotation is designed to provide in depth training in the indications and application of ECT.

Neurology

On this rotation Fellows rotate through the Neurology Movement disorders Clinic to gain expeerience in the diagnosis and treatment of the variety of movement disorders

Hospice

this rotation is designed to provide Fellows with experience diagnosing and treating psychiatric disorders in older adults within a palliative care setting.

DIDACTIC CURRICULUM

Geriatric Psychiatry and Medicine Fellows Seminar

This weekly seminar is run jointly by the faculty in Geriatric Psychiatry and Medicine, and is designed to give fellows from both disciplines thorough grounding in the essential topics in geriatric psychiatry and medicine. The seminars include a review of the relevant literature and give the fellows the opportunity to consolidate knowledge about the fundamentals of geriatric medicine and psychiatry. The fellows also have the opportunity to foster their own scholarship and develop skills for the critical analysis of the research literature around a pertinent topic.

Geriatric Psychiatry Fellows Tutorial

This is a weekly tutorial for the geriatric psychiatry fellows that give them the opportunity to dig deeper into a topic of interest that may have arisen in a clinical situation. The tutorial is a blend of case discussion and relevant literature review, and gives the fellow another occasion to pursue independent scholarship.

In addition to these activities, many of the rotations offer site-specific rounds/seminars that include case based discussion and relevant literature review.

Clinical Research Preceptorship

Fellows have the opportunity to pursue research interests during their clinical year of training. The faculty serves as research mentors and assists the fellow in the development of a research project. Opportunity also exists for fellows to participate in ongoing research projects. Fellows have the opportunity to apply for an additional year of research training.

Faculty

A variety of faculty participate in fellowship education. Six faculty, Paul D.S. Kirwin, M.D., Christopher H. VanDyke, M.D., Rajesh Tampi, M.D., Carl Edelen, M.D., Louis Trevisan, M.D, and Robert M. Rohrbaugh, M.D. are primarily involved in the geriatric psychiatry training program. Other faculty (such as Karl Otto Liebmann, M.D., and Joseph F. Fickes, M.D.) provide supervision on specific services. Seven of our faculty have added qualifications in geriatric psychiatry. The faculty in geriatric psychiatry have been recognized for their outstanding educational contributions. In recent years the geriatric psychiatry faculty have received eight outstanding teaching awards from the Yale Residents Association.

A variety of faculty participate in research. Their projects include studies in geriatric depression, dementia, normal aging, neuroimaging, traumatic grief, and effects of stress in the elderly, to name a few. These faculty welcome the involvement of fellows.

To Apply Contact:

Rajesh R. Tampi, M.D., M.S.
Program Director
Geriatric Psychiatry Fellowship Training Program
Yale University School of Medicine

Aimee Patel, Administrative Coordinator
VA Health Care Administration, #116A
950 Campbell Avenue
West Haven, CT 06516
(203) 932-5711 ext. 2473
e-mail: Aimee.patel@va.gov

Applications Should Include:

The Application form which can be downloaded from this web-site, a letter of interest or personal statement, Curriculum Vitae, and three letters of recommendation, including one from your Program Director.

Yale is an equal opportunity, affirmative action employer. Women and minority group members are encouraged to apply.

Application information is available here

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