University of Wisconsin
School of Medicine and Public Health

Geriatrics and Gerontology Education

Introduction

The University of Wisconsin (UW) Division of Geriatrics and Gerontology and the Madison Veterans Affairs (VA) Geriatric Research, Education and Clinical Center (GRECC) have worked collaboratively for over 25 years to promote excellence in education, clinical care, and research to improve the health of older adults. The following sections describe the programs sponsored by the UW and VA to accomplish the major goals of the Division of Geriatrics.


Education

The UW Division of Geriatrics and the Madison VA GRECC faculty sponsor educational programs at the UW School of Medicine and Public Health that integrate interdisciplinary principles of Geriatric Medicine into undergraduate, graduate, and continuing medical education. These educational programs are designed to improve the health of older adults by providing training in 1) the approach and care of older adults, 2) the identification of unique presentations of disease in older persons, 3) differentiating disease states from "normal aging", 4) managing geriatric syndromes, and 5) clinical research in aging and aging-related diseases. In addition, our faculty members work closely with undergraduate students as well as advanced practice trainees in social work, nursing, physician's assistant training, and physical therapy. Our educational focus is to provide innovative and effective means for clinicians of all disciplines to be competent in the care of older persons. Acknowledging that only a small percentage of all health professionals will specialize in geriatrics, we look to infiltrate geriatric principles across different levels of training and within multiple care settings. In most cases this is accomplished by integrating teaching into existing educational programs and into the context of practice as appropriate to the learner. We also recognize the need to expose students to those older adults who are aging well and remaining functional in the community. Meeting learner needs and providing for learner choice are key ingredients in maximizing utilization and program success.


Medical Student Training in Geriatrics
There is a continuum of professional growth between medical school, residency and practice in which the evolving physician achieves progressively more sophisticated competencies. In order to influence the attitudes of physicians-in-training, we have created a number of experiences that span the four years of the medical school curriculum.

These offerings include:

Care Across the Life Cycle (CALC) Geriatrics Rotation: During the clinical years, during their Phase 2 CALC rotation, medical students spend two weeks in the geriatrics clinics in conjunction with Ob/Gyn and Pediatrics training.  These second and third year students experience geriatrics primary care, memory clinics, falls/frailty evaluation, comprehensive geriatric evaluation, pre-operative evaluation, PT/OT, skilled nursing facility care, and community experience such as memory support groups.

Geriatrics in the Hospital Setting on the Acute Care for Elders Consult Team: Dr. Elizabeth Chapman oversees this 2 week experience for Phase 3 medical students. This interdisciplinary team provides consultation to the entire University of Wisconsin Hospital serving a population of vulnerable and medical complex hospitalized older persons.  It incorporates a proactive approach that emphasizes patient safety, deprescribing and strategies to minimize functional losses.

Geriatrics Elective: A two-week ambulatory and community-based experience exists for medical students with a specific interest in geriatrics. This rotation is directed by Dr. Barczi and includes involvement in UW and VA clinics in both geriatrics primary care, and geriatrics specialty clinics (12 different options) as well as visits to area assisted-living sites, nursing homes, and patient homes.

Research Mentoring for Medical Students: The VA GRECC and the UW Division of Geriatrics have supervised MD-PhD students for over 10 years. Additionally, the UW Clinical and Translational Research Core (formerly known as GCRC) and other university-based summer fellowship programs have sponsored medical students to work in laboratories within the Division of Geriatrics, such as: Dr. Carnes (National Center for Excellence in Women's Health), Cindy Carlsson, MD, MS, (Alzheimer's disease prevention), Sanjay Asthana, MD (treatment of Alzheimer's disease) and many other investigators within the Wisconsin Alzheimer's Disease Research Center. Dr. Carlsson offers a medical student Summer Externship for research at the Wisconsin Alzheimer's Institute.

Residency Training in Geriatrics

Geriatrics Ambulatory Rotation for Internal Medicine (IM) Residents: Two to three residents rotate through this experience per month. This experience provides an exposure to the continuum of geriatric care services within the clinic, hospital, nursing home and community. Based at the VA Hospital, University of Wisconsin Hospital and Clinics and Madison Community, this rotation balances a primary care and specialty focus with a strong emphasis on interdisciplinary teams. Housestaff rotate through the following specialty clinics: Osteoporosis, Geropsychiatry, Geriatrics Evaluation and Management (GEM), Memory Assessment, Geriatric Sleep, Geriatrics Palliative Care and GRECC Connect (a geriatric telemedicine program). They are mentored in geriatric primary care clinics at 3 sites. They also spend time at the teaching nursing home at Capitol Lakes Continuing Care Retirement Community and on the Acute Care for Elders (ACE) team at the UW Hospital. Housestaff all participate in Observed Structured Clinical Exams that use standardized patients with faculty observation and feedback to hone their skills in addressing cognitive impairment, late life depression and falls/ immobility. The Wisconsin STAR method, an educational tool promoting a systematic approach to complex geriatric patients, is introduced as an evaluation method for older patients.

Continuity Clinics in Geriatric Medicine: A select number of IM residents choose to have two-year continuity clinics within the UW and VA primary care geriatrics clinics. They are mentored by a primary care geriatrician and become part of these outpatient geriatric interdisciplinary teams.

Geriatrics Elective for IM and Family Medicine Residents: This one-month rotation tailors experiences in 1 of 3 tracks for second- and third-year residents with a particular career interest in geriatric medicine. These domains include community geriatrics, long-term care and geriatric specialty care.
 

Academic Fellowship Training in Geriatrics

Fellows with interest and aptitude can receive an additional two years of training in research methodology, teaching, education administration as well as complete course work for a Masters in Population Health Sciences and Clinical Research. This mentored time allows trainees to partake in the rich research opportunities described above with an objective to produce independently-funded physician-scientists or clinician-educators.

Geriatric Psychiatry Fellowship Training

The UW and Madison VA GRECC Geriatric Medicine Fellowship Program has had a longstanding close alliance with Geropsychiatry faculty and trainees for over two decades. Under the leadership of Lisa Boyle, MD, the Madison VA GRECC sponsors up to two geropsychiatry fellows annually who participate in training experiences in the VA Memory Assessment Clinic and other Madison GRECC-sponsored clinics. In turn, Geriatric Medicine fellows rotate through the Geriatric Psychiatry clinic. Geropsychiatry faculty direct the case-based Geropsychiatry Colloquium for Geriatric Medicine and Geropsychiatry fellows twice monthly. These collaborative relationships have provided a rich training experience in neurobehavioral disorders for Geriatric Medicine and Geropsychiatry fellows alike.

Clinical Care

The UW Division of Geriatrics supports a nationally-recognized, comprehensive clinical program that provides a variety of primary and subspecialty care services to older adults. Its fellowship-trained geriatricians work closely with geriatric psychiatrists, advanced practice nurses, neuropsychologists, psychologists, social workers, physical therapists, and occupational therapists to provide comprehensive clinical care to older adults. For over 26 years, the program has served the needs of aging adults in the community and throughout the State of Wisconsin. The primary clinical mission of the Division is to deliver exceptional geriatric specialty care, primary care and hospital-based services as it works alongside other world class clinical programs within the UW system. The strong links between the aging research and clinical programs provide distinctive translation of state-of-the-art, compassionate care to all of our patients and their families.