The Baltimore Veterans Affairs Medical Center
The Baltimore Veterans Affairs (VA) Medical Center is the major medical and surgical facility for the VA Maryland Health Care System (VAMHCS), and offers the full range of medical, surgical and psychiatric specialty services. Major components of the clinical, research and educational programs of the Division of Gerontology and Geriatric Medicine are located at the VA, including the Geriatric Evaluation and Management Unit (GEMU), consultation service, Geriatrics/Dementia Clinic and several other clinics. The GEMU is an intermediate care unit for subacute rehabilitation of elderly patients who have sustained significant functional declines due to acute illness. The GEMU is staffed by an interdisciplinary team, including an attending geriatrician, fellow, residents, nurse practitioner and social worker, with readily available physical, occupational and speech-language therapists.
The Consultation Service in Geriatric Medicine at the VA responds to referrals from any of the medical, surgical and psychiatric services at the medical center. A thorough evaluation from the perspective of Geriatrics is performed, with particular attention to geriatric syndromes, geriatric pharmacology, functional status, social situation and rehabilitation potential. The principles of Geriatric Medicine are disseminated to the medical center by the fellows and the consultation team through this mechanism.
The Ambulatory Rotation of the fellowship program at the VA is comprised of the Geriatrics/Dementia, Geriatric Primary Care, Arthritis, Women’s Health and Bone Metabolism Clinics, and home visits through the Home Based Primary Care Program. The Geriatrics/Dementia Clinic is an interdisciplinary setting where clinicians representing Geriatric Medicine, Geriatric Psychiatry, Neuropsychology, Clinical Pharmacy, Nursing and Social Work collaborate to provide comprehensive evaluations and treatment plans for older patients with cognitive complaints. In the Geriatric Primary Care Clinic, each fellow assumes primary care responsibility for a panel of elderly patients with a variety of care needs, ranging from preventive medicine to management of multiple chronic illnesses. These clinics are staffed by core Geriatrics faculty. Fellows also work closely with other subspecialists in other clinics, including Arthritis, Women’s Health and Bone Metabolism Clinics.
The University of Maryland Medical Center and the R Adams Cowley Shock Trauma Center
The Division of Gerontology and Geriatric Medicine is one of twelve divisions of the Department of Medicine at the University of Maryland School of Medicine (UMSOM). The Department of Medicine is by far the largest department at the UMSOM, responsible for the training of over 140 medical residents and 100 fellows each year. The Department offers the full complement of educational experiences, including lectures, seminars and teaching rounds. The Geriatric Medicine fellows have many opportunities to interact with other fellows, residents and medical students as they rotate through the geriatric services. The Geriatric Medicine fellows participate in teaching medical students both during their clinical rotations, as well as by participating as small group instructors for the Introduction to Clinical Medicine course taken by all first and second-year students.
The University of Maryland Medical Center and the R Adams Cowley Shock Trauma Center, a regional Level 1 Trauma Center, serve the acute hospital needs of persons living in greater Baltimore, more remote regions of Maryland and neighboring areas of Pennsylvania, Virginia, Delaware and West Virginia. In 2009, a Geriatric Medicine Program was initiated to serve the growing number of older patients admitted each year. Geriatric Medicine Fellows rotate as members of the Consultation Service at Shock Trauma. This opportunity provides a unique experience in geriatric assessment, team management and trauma care. Fellows also attend a number of conferences, family meetings, discharge planning rounds and other academic activities.
Loch Raven Community Living Center
The Loch Raven Community Living Center (CLC) is a 100-bed long-term care facility in the VAMHCS. There are separate units for traditional nursing home care, subacute care, rehabilitation and hospice. Acute rehabilitation, clinical pharmacology, wound care, nutrition and other forms of therapy are emphasized. Fellows assume primary responsibility for a panel of patients at the CLC. During the CLC block rotation, fellows have the opportunity to rotate through the different units at the CLC, and learn the role of the medical director in a long-term care facility.
The Home Based Primary Care (HBPC) Program at the VA is based at Loch Raven. Through HBPC, fellows and nurse practitioners make home visits to housebound patients. The purpose of this experience is for the fellow to learn to manage patients in the home environment, and to gain an appreciation for the social and economic circumstances of these patients.
The Hospice and Palliative Care Service responds to requests for consultations from any of the inpatient services at the Baltimore VA Medical Center. The consultation service assists with advance care planning, pain control, evaluation for appropriateness for hospice care and conduct of family meetings. Under the guidance of Palliative Care specialists, fellows evaluate and manage patients admitted to the inpatient hospice unit at the CLC.