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Clinical Geriatric Fellowship

Jordan F. Karp, MDLalith K. Solai, MD
Director
Jordan F. Karp, MD
Associate Director
Lalith Kumar Solai, MD

Application Process

Overview

The Geriatric Psychiatry Clinical Fellowship, based at the University of Pittsburgh School of Medicine’s Department of Psychiatry, is a one-year PGY5 program fully accredited by the Accreditation Council for Graduate Medical Education (ACGME). The department’s Division of Geriatric psychiatry has a na­tional reputation for its clinical and educational expertise in late-life mental health, and an international reputation as a research leader in late-life mood and cognitive disorders. Fellows completing this program are eligible for the ABPN’s “Added Qualification in Geriatric Psychiatry.”

Philosophy of Fellowship Education

Fellows are exposed to a complete spectrum of clinical and academic experiences in geriatric psychiatry, geriatrics, and gerontology. In addi­tion to acquiring expertise in using pharmaco­therapy and psychosocial interventions to treat elderly patients with late-life mental disorders, fellows gain experience in understanding their elderly patients in relation to their families and environment. Fellows, under the supervision of faculty, function as the team leaders in all set­tings with supervisory responsibility for resi­dents, medical students, and professional members of the multidisciplinary treatment team. The importance of continuity of care is stressed. Fel­lows have the opportunity to assess and treat patients in multiple settings (inpatient, outpatient, in-home, consultation-liaison, and nursing home) and gain experience with all modalities of treatment during the course of their fellowship year. Finally, fellows have the opportunity to work with mentors in developing research projects and aca­demic pursuits.

Rotation Blocks

Each of these five 10-11 week rotations will be completed by the Fellow. Descriptions of these rotations are provided below. In addition, longitudinal experiences in ambulatory care and nursing home care continue through all rotations. Finally, there is ample time during the Fellowship year for electives or research.

Inpatient Geropsychiatry Program

The Integrated Health and Aging Inpatient program at Western Psychiatric Institute and Clinic provides comprehensive evaluation and short-term hospi­talization for older adults experiencing severe depres­sion, psychosis, anxiety, memory loss with behavioral problems, and other men­tal health problems associated with aging. All patients receive a complete medical, psychiatric, and social/functional assessment. Treatment mo­dalities include pharmacotherapy, psychosocial interventions, family therapy, and electroconvul­sive therapy.

Ambulatory Program

Benedum Geriatric Center

The ambulatory care program of the Benedum Geriatric Center provides outpatient evaluation and treatment for older persons who have com­plex problems requiring multidisciplinary care. The Benedum Geriatric Center focuses primarily on frail seniors who have multiple medical, psychiatric, or psychosocial problems. Its main goal is preserving their health, independence, and well being. Services include comprehensive medical, psychiatric, and social assessments; con­sultation for referring physicians and other community health care providers; environmental planning to help maintain the patient’s residence at home for as long as possible; health care education, counseling, and psychotherapy for patients and families. The center averages over 750 patient visits per month and has more than 2200 active patients. In addition to a three-month rotation, all fellows participate in a weekly clinic throughout the year to gain experience in longitudinal ambulatory care, including psychotherapy.

Geriatric In-Home Support Program

The Geriatric In-Home Support Program currently follows close to 100 homebound older persons with psychiatric and physical illness who would otherwise not receive care or receive it only in a hospital or long-term care setting. The program’s target population are those chronically and persistently mentally ill older patients (60 years of age and older) who are un­able to keep appointments in an outpatient setting and are at risk for institutionalization. These pa­tients are usually the older elderly with medical problems and functional disability, cognitive or psychiatric disorders, and poor social support.

Geriatric Pain Clinic

The Geriatric Pain Clinic at the VA University Drive is a multi-disciplinary clinic dedicated to the treatment of persistent pain.  Physicians, Nurses, Psychologists, Physical and Occupational Therapists provide group and individual pain rehabilitation programs. Treatment is both interventional and conservative. Close cooperation between disciplines is used to educate the patient and re-conceptualize their attitude to the management of pain. Fellows will participate in seven ½ day clinics during their ambulatory rotation.

Movement Disorders Clinic

Fellows will participate in the Movement Disorders Clinic under the supervision of Dr. Samay Jain (Neurology). The objectives of this rotation are to learn assessment and treatment skills of neurological disorders prevalent in older adults, including typical and atypical Parkinsonism and their psychiatric co-morbidities. Equally important, the Fellow serves as an invaluable resource to the neurology team as the mental health consultant within this clinic. 

Palliative Care

For two weeks of the Ambulatory Rotation, Fellows will gain intensive experience with Palliative Care. Fellows will round daily with the Palliative Care team at Presbyterian Hospital. During this rotation, Fellows will appreciate the role of the interdisciplinary approach to address physical, psychosocial and spiritual needs of patients and families in end-of-life care, understand and observe the steps to delivering bad news, and gain experience in the advanced care planning process through participation in goal-setting discussions with patients and families.  

Consultation/Liaison Service

The Geriatric Consultation/Liaison Service pro­vides consultation and assessment services to older patients with psychiatric or behavioral problems who are undergoing treatment in the UPMC’s acute care hospitals and medical spe­cialty services. This program provides consulta­tion and education to a variety of medical and surgical services, for both inpatient and ambula­tory care cases.

Geriatric Research, Education and Clinical Center (GRECC)  VAMC-Oakland

The Geriatric Research, Education and Clinical Center (GRECC) at the Oakland VAMC provides an opportunity to work closely with specialists in geriatric medicine and neurology as part of multi-disciplinary teams. This rotation consists of general neurology clinic for elders, geriatric medicine clinics, and late-life addiction clinics.

Veterans Affairs Medical Center – University Drive

The University Drive VAMC provides important training components within the fellowship. Fellows provide in-home psychiatric assessment and treatment for home-bound elders, and each fellow will identify one home-bound elder to engage in a course of short-term problem-solving therapy. Other experiences include Late-life Schizophrenia Clinic, Physical Medicine and Rehabilitation Clinic, and Psychiatric Consultation in Late-life Primary Care.

Long-Term Care – longitudinal experience

The Geriatric Psychiatry program maintains contracts with a variety of long-term care facili­ties in western Pennsylvania and has established several facilities as training sites.  Fellows round weekly at their assigned nursing home under faculty supervision during each of the five rotation blocks.  Pharmacotherapy and psychosocial/family interventions are the primary modes of treatment. Drug interactions, medical co-morbidity, psychosocial stressors, and medico-legal aspects of treating  seniors in longterm care settings are emphasized.

During their Ambulatory Rotation, fellows will gain experience in the long-term care Special Care Unit for residents with severe behavioral problems of dementia or who have serious mental illness and require nursing home level care. This program focuses on the behavioral management techniques, working closely with families and nursing home staff.

Electives

Elective time is provided throughout the year. Fellows are encouraged to identify an area of interest within which, during the fellowship, they will participate in a working research project, complete a review article, or gain intensive clinical experience. Supervision and mentorship are provided by faculty with ex­pertise in the chosen area. In recent years, elec­tives have included research projects with mentorship provided by faculty associated with the Advanced Center for Intervention and Services Research in Late-Life Mood and Anxiety Disorders, the Geriatric Psychopharmacology Program, and the Alzheimer Disease Research Center as well as clinical work specializing in neuropsychiatry and electroconvulsive therapy. Alternative electives can be independently ar­ranged by the fellow with approval by the program director.

Research

Fellows are given the opportunity to participate in multiple areas of research.  The NIMH-funded Advanced Center for Intervention and Services Research in Late-Life Mood and Anxiety Disorders (Charles F. Reynolds MD, PI), the NIA-funded Alzheimer’s Disease Research Center are only two of the research resources available to fellows.  Fellows who are interested in continuing their research training can apply to the NIMH Research Fellowship in Geriatric Psychiatry.  This two-year program, directed by Charles F. Reynolds, MD, will accept qualified candidates who have completed their clinical fellowship.  Close collaboration between the clinical and research fellowships provides a comprehensive clinical and research training experience for fellows interested in pursuing that career path.

Following completion of the clinical fellowship, Fellows have the opportunity to apply for a fellowship in either physician-educator track or physician-researcher track at the John A. Hartford Foundation Center of Excellence in Geriatric Psychiatry. This center is funded by the John A. Hartford Foundation and is one of the two sites in the nation in geriatric psychiatry.

Integrated Lectures

A lecture series focusing on the multi-disciplinary aspects of geriatric psychiatry is offered weekly as well as an ongoing psychotherapy seminar. Approximately 50% of these weekly lectures are shared with the Geriatric Medicine Fellowship Program.  In addition, each rotation offers individual didactic / learning opportunities, such as the consultation / liaison series, joint lectures with geriatric medicine fellows during the Oakland VAMC rotation and inpatient clinical case conferences.  Fellows also have the opportunity to  teach residents and medical students. Fellows and faculty participate in “Career Planning” sessions with convene bi-monthly at a local restaurant.

The Geriatric Psychiatry Journal Club, scheduled at the home of the faculty, provides an atmosphere of collegiality and scholarship.  

Application Process

All application requests should be addressed to:

Jordan F. Karp, MD
Director Geriatric Psychiatry Fellowship Program
Western Psychiatric Institute and Clinic
3811 O’Hara St.
Pittsburgh, PA 15213
Phone: (412) 246-6048
Fax: (412) 246-6030
E-mail: karpjf@upmc.edu

The application form can be downloaded from this link.

Applications will be reviewed by the Geriatric Psychiatry Fellowship Committee.

Qualifications

Applicants must have completed or be about to complete an ACGME-approved residency training program in general psychiatry, have passed the USMLE STEP III examination and be ABPN board eligible at the completion of residency. They must also be eligible to obtain a license to practice medicine in the Commonwealth of Pennsylvania.

Applicants must provide a letter of verification that they completed or will complete their residency training program in good standing.

Faculty

Chairman: David A. Lewis, MD

Fellowship Director: Jordan F. Karp, MD
Associate Professor of Psychiatry
Academic interest: Pain/depression interface

Howard Aizenstein, MD, PhD
Associate Professor of Psychiatry
Academic interests:  fMRI, Late-life depression

Carmen Andreescu, MD
Assistant Professor of Psychiatry
Academic interests: Late-life anxiety

Paul Bulgarelli, MD
Assistant Professor of Psychiatry
Academic interests: Education

Meryl Butters, PhD
Associate Professor of Psychiatry
Academic interest: Neuropsychology

Alexandre Dombrovski, MD
Assistant Professor of Psychiatry
Academic interest: Late-life Suicide

Mary Ganguli, MD, MPH
Professor of Psychiatry and Epidemiology
Academic interest: Epidemiology

Ari Gildengers, MD
Assistant Professor of Psychiatry
Academic interest: Late-Life Bipolar

John Kasckow, MD
Professor of Psychiatry
Academic interest: Late-life psychosis

William Klunk, MD, PhD
Professor of Psychiatry
Academic interest: Dementia/ PET Imaging

Robert S. Marin, MD
Associate Professor of Psychiatry
Academic interest:  Neuropsychiatry

Mark Miller, MD
Associate Professor of Psychiatry
Academic interest:  Psychotherapy

Richard Morycz, PhD, LSW
Associate Professor of Psychiatry
Chief of Geriatric Service
Academic interest:  Family burden

Charles F. Reynolds III, MD
Endowed Professor of Geriatric Psychiatry
Academic interest: Late-life mood disorder

Keith Stowell, MD
Assistant Professor of Psychiatry
Academic interest: Dementia and education

Lalith Kumar Solai, MD
Assistant Professor of Psychiatry
Associate Director of Geriatric Psychiatry Fellowship
Academic interest: Delirium education

Robert A. Sweet, MD
Professor of Psychiatry
Academic interest: Neurobiology and genetics of psychosis

James Tew, MD
Assistant Professor of Psychiatry
Academic interests: Transitions in care

Crystal White, MD
Assistant Professor of Psychiatry
Academic interest:  Geriatric mental health teaching

Ellen Whyte, MD
Assistant Professor of Psychiatry
Academic interest: Depression  and stroke

Staff

Sharon Altman, MD
Assistant Professor of Psychiatry
Academic interest:  Consultation-liaison

Tejal Bhojak, M.D.
Staff Psychiatrist
Academic interest:  Inpatient geriatric

Esther Teverovsky, MD
Clinical Assistant Professor of Psychiatry
Academic interest:  (BEST) Bellefield Enhanced Support Team Program