Department of Medicine

Education

The Division of Geriatrics and Palliative Medicine provides an outstanding learning environment for medical trainees at all levels, including medical students, residents and fellows. Through didactic education, clinical rotations and opportunities for mentored research, the division provides trainees with a wealth of resources to enhance quality of care, working with passionate and talented faculty who assist in developing the skills necessary for successful careers as clinician-educators or investigators. The division also supports creative hospital and community-based initiatives that provide health trainees and practitioners with experiences and opportunities to better serve the needs of patients and patients' families. The division offers innovative learning opportunities that include interdisciplinary case discussion, narrative medicine, psychosocial educational forums, access to elder abuse resources and experts, and involvement in an Aging with HIV primary care program.

Geriatrics Education

Geriatric Education for Fellows

The division is educating the next generation of physicians through accredited fellowship programs in geriatrics medicine as well as hospice and palliative medicine. The fellowships focus on interdisciplinary clinical training and the development of teaching and research skills. The goal of the fellowships is to train participants to become exceptional specialized physicians and to provide future academic leaders and clinicians with an excellent foundation in comprehensive patient care. There is also an emphasis on strong communication and research expertise to improve care delivery.

The Geriatric Medicine Fellowship is a one-year program that integrates outstanding, nationally-recognized academic and clinical resources. Up to four fellows are accepted each year into the comprehensive program. The fellowship is designed for physicians completing training in Internal Medicine or Family Practice. Training occurs in all settings appropriate for a practicing geriatrician, including inpatient geriatrics and palliative care services at NewYork-Presbyterian Hospital (NYPH), the award-winning Wright Center on Aging, our geriatrics house call program, a sub-acute and long-term care facility, and an acute care palliative hospital. In addition, residents and interns have the opportunity to work with experts in elder care in an inpatient setting by participating in the ACE program (Acute Care for Elders).

The Hospice and Palliative Medicine Fellowship is a joint program of the NewYork-Presbyterian Hospital, the Department of Medicine at the College of Physicians and Surgeons at Columbia University, and the Division of Geriatrics and Palliative Medicine at Weill Cornell Medical College. The program is a one-year ACGME approved fellowship with three participating fellows per year. Physicians are trained to develop critical skills to enhance a career in academic medicine or community practice. Palliative Medicine fellows work as part of interdisciplinary teams in diverse settings; they are trained by expert faculty who come from a variety of disciplines and are passionate and dedicated to the highest standards of palliative care.

Geriatric Education for Residents

PGY 2 Rotation

The four-week geriatrics rotation is required for all second-year internal medicine residents. The inpatient component is based at Greenberg 11SB, the Acute Care of Elders Unit at NewYork-Presbyterian Hospital. The outpatient week takes place at different venues across the city.

Each PGY-2 resident is assigned to a four-week geriatric block consisting of two weeks managing a panel of patients on the geriatrics inpatient service, one week covering nights on the geriatrics inpatient service, and one week in an outpatient module that introduces the resident to the systems of care that help meet the medical and psychosocial needs of community-dwelling older adults. During the systems-based practice (SBP outpatient module), residents visit an inpatient hospice site; make geriatric house calls; accompany geriatric care managers on client visits, tour a nursing home, independent living, and other levels of senior housing; visit an elder abuse shelter; visit a community-based organization; and assist with Wright Center walk-ins.

Residents also have opportunities for self-directed learning through readings and online modules and are encouraged to engage with patients/clients, families, and staff across these care settings. The SBP module is not about the physiology or pathophysiology of individuals but of the health care system – how and where health care is currently delivered to older adults. Residents also present one of their own WCIMA patients in the weekly geriatrics team meeting for discussion and advice. An oral exam and debriefing at the end of the week enable the resident to integrate the experiences and put them in context of their inpatient and outpatient responsibilities.

Goals of the geriatrics rotation include many areas that range from the evaluation/management of falls and appropriate administration of medications, to effective communication with patients and the development of optimal patient care plans. A two-week elective in geriatrics is available for interested medical residents.

Geriatric Education for Medical Students

In 2001, the Division of Geriatrics and Palliative Medicine was one of the early recipients of a Donald W. Reynolds grant to enhance geriatrics education at Weill Cornell Medical College. This award allowed faculty the time to focus on stimulating educational experiences using creative and innovative teaching methods. Some of the core topics covered in the geriatrics curriculum include: effective communication between physicians and older adults; the importance of avoiding ageism in the medical encounter; how assessing function can enhance independence and improve quality of life; the impact of chronic illness on the individual and their family; and living well with disability and the importance of practicing humanistic medicine (transitional care, interdisciplinary team, and geropharmacology).

Many of our faculty act as formal and informal mentors to medical students and actively provide guidance to those interested in pursuing geriatrics and palliative care.

Clinical Training

Geriatric Medicine Elective

Fourth-year medical students have an opportunity to interact with older adults in a variety of settings, including: in the Hospital's Acute Care for Elders Unit, through our Consultation Service, at The Wright Center on Aging (ambulatory practice), in home environments via our House Call program, and at a nursing home. Additional areas that may be explored include geriatric psychiatry, neuropsychiatric testing, rehabilitation medicine, palliative medicine and hospice. The student will participate in Geriatrics Team meetings and will be expected to prepare and deliver a lecture to the geriatrics faculty and staff. We attempt to individualize the experience for the student as much as possible. Please note that this elective is only open to students from Weill Cornell Medical College and former MSTAR/Adelman Scholars.

Longitudinal Experience to Advance Patient Care (LEAP)

A collaborative effort with faculty from a variety of different departments and disciplines creates opportunities for students to be paired with patients. They follow these patients throughout their entire four years in medical school. The LEAP program offers students an opportunity to conduct home visits on patients of all ages, often accompanied by geriatric faculty member. The goals of this course include: a close pairing of basic science and clinical experience; seeing disease processes evolve over time; learning the art of relationship building with patients and colleagues; and appreciation of the complexities and challenges patients face within the health care system.

The Division of Geriatrics and Palliative Medicine plays an important role in the LEAP curriculum development and clinical mentoring of students as the four-year process unfolds. Home visit program students have the opportunity to spend an afternoon with geriatric faculty as they make their scheduled home visits together.

Didactics

In their foundational science courses, first- and second-year medical students receive lectures on topics such as communication and the older patient, functional assessment, and chronic disease management. During their Primary Care Clerkship, students are provided with didactic sessions on such areas as dementia, urinary incontinence, falls, and elder abuse and neglect.

Summer Research Programs

Each summer, selected Weill Cornell medical students (typically students just completing their first-year of medical school training at WCMC) experience an enriching experience in aging-related research, didactics, and clinical experiences, under the mentorship of top experts in the field, experts that they might not otherwise interact with during their medical school training. These student scholars are selected and funded by the Medical Student Training in Aging Research (MSTAR) program, administered by the American Federation for Aging Research (AFAR), and funded by the National Institute on Aging (NIA) and other organizations, or the Henry Adelman Fund for Medical Student Education in Geriatrics and the generous support of friends of the Division of Geriatrics and Palliative Medicine. The Adelman Scholarship was created to honor the memory of Henry Adelman, father of Ronald Adelman, MD, Professor of Clinical Medicine and Co-Chief of the Division of Geriatrics and Palliative Medicine at Weill Cornell. MSTAR awardees may receive anywhere from 8 to 12 weeks of funding, as determined by the student and his/her research mentor. Adelman Scholars receive funding for an 8-week period.

Special Interest in Aging

Established in 1999, the Geriatric Interest Group (GIG) is an enthusiastic group of medical students who are interested in the aging population for a variety of reasons. The students in GIG recognize that older adults are a diverse and interesting group of people who lead meaningful lives and that the population is becoming increasingly older with people age 85 years and older comprising the fastest growing segment of the total US population. GIG meets at various points throughout the academic year to discuss topics related to aging.

Areas of Concentration

In the Geriatric Medicine concentration, students are offered a broad exposure to the field of Geriatrics through core didactic lectures as well as participation in a variety of clinical experiences. The demographic imperative of a rapidly aging population has made Geriatric Medicine an increasingly important area of study. Geriatrics embraces the medical and psychosocial issues challenging older adults with particular focus on function and maximizing quality of life while living with chronic illness. Specific areas of study may include: neurodegenerative disorders, rehabilitation medicine, psychiatry, pharmacology and palliative medicine. Exposure to the interdisciplinary approach to patient care that incorporates social work, OT, PT, psychiatry and other makes Geriatrics a unique learning experience for students.

In the Palliative Medicine concentration, students receive training that encompasses care didactics, experiential teaching activities and clinical exposure, as well as a scholarly project in Palliative Medicine that culminates in a peer-reviewed dissemination. This AOC will prepare students to be leaders in palliative care throughout the continuum. Ultimately, nurturing skills in palliative care is essential for all physicians, whatever subspecialty they practice. Students will learn to understand the conceptual framework of palliative care throughout the continuum of illness, to apply palliative care principles by participating in experiential educational activities and classical exposures with structured feedback, and to apply research methodology while developing a structured research project in palliative medicine resulting in an oral and/or written dissemination at the local, regional or national level.