Units and Rotations
ACE Unit and Consultation Service at Saint Louis University Hospital
The fellow assists in the initial consultation and day-to-day management of patients on medical and surgical services. Consultations are often called for patients on the "hip fracture service," the "palliative care service," and the acute inpatient geriatric psychiatry unit.
During this rotation, the fellow also coordinates the daily interdisciplinary team meeting (Monday-Friday) on the acute care of the elderly (ACE) Unit. Responsibilities include:
- Timely management of the meeting.
- Facilitation of information from team members.
- Education of team members.
Geriatric Evaluation Management Unit
This rotation provides a subacute care experience on a 15-bed unit at the Jefferson Barracks Division of the St. Louis VA Medical Center. This unit offers an interdisciplinary health care team and a multidimensional geriatric assessment for patients 65 years or older, with multiple medical problems.
The team approach includes interdisciplinary care planning, medical treatment, rehabilitation, health promotion and social service interventions. The fellow is responsible for day-to-day management of these complex patients under the supervision of a geriatric medicine attending. Fellows also attend five half-day VA ambulatory care geriatric clinics.
Acute Geriatric Psychiatry Inpatient Unit
This one-month rotation takes place at the David P. Wohl Senior Memorial Institute Psychiatric Hospital at the Saint Louis University Medical Center. Fellows are under the supervision of a geriatric psychiatry attending.
The fellow provides day-to-day psychiatric care for elderly in-patients and participates in a multidisciplinary care team. Exposure to electroconvulsive therapy is provided on this rotation.
Elective - Physical Medicine and Rehabilitation
During this rotation, the fellow works in outpatient physical medicine and rehabilitation clinics at the St. Louis VA Medical Center under the supervision of a psychiatrist. Time is spent in audiology, prosthetics/orthotics, physical, occupational and speech therapy settings. The fellow may also work in a variety of medical clinics such as urology, gynecology, ophthalmology, and dermatology to gain experience with disorders common to the older adult.
During this rotation the fellow has a flexible schedule and can work on clinical research, write articles for publication, prepare geriatric teaching materials and engage in other scholarly work.
Life Care Center of St. Louis
This is a 12-week rotation in a 100-bed subacute care facility. Fellows care for medical and surgical patients who recently transferred from the acute hospital setting. The subspecialty resident is responsible for the day-to-day care of these patients under the supervision of a geriatric medicine attending.
The fellow attends weekly multidisciplinary care planning meetings, admits new patients, and coordinates discharge and follow-up care.
Des Peres Hospital ACE Unit
Des Peres Hospital is a community-based teaching hospital. An acute care for the elderly (ACE) unit was established there under the guidance of SLU division of geriatric medicine in 2003.
Fellows care for elderly patients in the hospital and on the ACE unit. Fellows also attend the daily ACE unit multi-disciplinary meeting and assist the staff in improving the quality of care for acutely ill patients. The fellow may attend several geriatric medicine outpatient clinics at the Des Peres professional building.
Community Nursing Home Rotation
Fellows gain experience in long-term care through work at two large community-based nursing homes: NHC Healthcare, Maryland Heights and NHC Healthcare, Town and Country. Along with a geriatric physician and nurse practitioner, the fellow performs routine and acute care visits, admissions, and discharges for residents at these facilities. More than 100 residents are under the primary care of the geriatric medicine team in these homes.
Continuity of Care Experiences
Approximately four to six new and follow-up patients are seen each clinic day at the Saint Louis University Ambulatory Care Clinic. Approximately five to six patients are followed in the division's Home Care Program. Fellows also see patients in the clinics at the Veteran's Affairs Medical Centers.
In the second year, those fellows planning on an academic career continue the outpatient continuity care clinics and may serve as junior attending on the geriatric evaluation management unit.
The remainder of the year is devoted to research/academic management activities. Presently, this position is available only for citizens or permanent residents of the United States.