Mission
We prepare geriatricians for leadership positions in education, research, and clinical care that responds to the evolving needs of the aging population. We train leaders to advocate for the aging population and lead the standard for excellence for clinical care. We are committed to enhancing diversity, equity and inclusion within the education and clinical environments and to providing excellent healthcare to the diverse communities that we serve.
Our curriculum achieves these goals through clinical rotations, structured didactics, mentorship, and support for scholarly work. Our fellows rotate through our Ralston-Penn Geriatrics outpatient clinic, Penn Presbyterian Hospital, Philadelphia CMC-VA Medical center, Penn Presbyterian SNF, and community-faculty affiliated nursing homes. We offer research and leadership opportunities and training. Additionally, all our fellows receive training as teachers and are active in teaching medical students and residents.
Our 1-Year Fellowship "6+2" Curriculum – How it Works
Fellows are scheduled for a combination of clinical block rotations (mix of inpatient and ambulatory experiences) for a total of six (6) weeks, followed by a 2-week ambulatory subspecialty/elective block experience. This “6+2” pattern will be repeated throughout the clinical year, with 12 weeks of dedicated ambulatory subspecialty/elective blocks.
This curricular design allows:
- Have ample clinical time with block rotations at a variety of sites of care including ACE Unit, Skilled Nursing Facility, VA Community Living Center, Home Based Primary Care, Geriatric Surgical Co-Management and Consult service, and Palliative Care.
- Have an ambulatory clinical experience every 6 weeks that combines longitudinal clinical experiences for the entire year (Home Based Primary Care, Nursing Home, and Outpatient Clinics) with subspecialty/elective clinics.
- Develop a true panel of patients in their primary care clinic, nursing home and home-based primary care clinic because of the reliable scheduling of clinic time during the q6 ambulatory blocks
- Explore and customize their clinical and research interests while on the ambulatory subspecialty/elective block
Below are sample Fellows’ Block and Ambulatory Block schedules and descriptions of our longitudinal, “regular” & ambulatory block experiences:
UPENN Geriatric Fellowship (One Year) Sample Training Schedule
| PPMC ACE (3 months) |
| PPMC Co-Management/Consults (1-2 two-wk blocks) |
| PPMC Rehab (1-2 two wk blocks) |
| VA CLC (1 month or 2 two-wk blocks) |
| VA SNF (1 month) |
| Palliative Care (1 month) |
| Ralston Home Care (1 two-wk block) |
| Ambulatory (3 months/6 two-wk blocks) |
| Elective (1-2 two-week blocks) |
| Vacation (1 month/2 two-week blocks) |
Ambulatory Block Grid (Two Weeks)
|
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
| AM |
Home based
primary care |
Ralston
Primary Care |
Nursing Home |
Ralston Consult Clinic |
Wellness/QI |
| PM |
Home based
primary care |
Specialty clinic |
Specialty clinic |
VA continuity clinic |
Didactics |
Curricular Tracks
We are committed to meeting the individual goals of each of our fellows and offer an opportunity to spend more time in each of the following concentrations:
- Education
- Leadership
- Research
- Community Health Equity/ Quality Improvement
- Clinical
Clinical Experiences
Clinical Block Rotations
Acute Care of Elders (ACE) – 3 months (three 4-week blocks)
The ACE Unit at Penn Presbyterian Medical Center, which opened in 1994, is designed specifically to care for the needs of hospitalized older adults. Fellows participate in and lead interdisciplinary team rounds, supervise and teach medical residents and students, and provide patient-centered care that emphasizes shared decision-making.
Co-Management and Consult Service – 2 to 4 weeks (one or two 2-week blocks)
The Geriatric Surgical Co-Management and Consultation service partners with Orthopedic Trauma, General Trauma and Neurosurgery to manage the acute and chronic medical issues of patients 65 and older admitted to these surgical teams. Fellows will provide consultative care for patients admitted to medical and surgical services to identify and manage geriatric syndromes, participate in goals of care conversations, and assist with continuity of care.
Read They Help Care for the Hospital’s Oldest Trauma Patients from our News Blog.
Rehabilitation and Skilled Nursing – 2 to 4 weeks (one or two 2-week blocks)
The Penn Center for Continuing Care, a subacute rehabilitative and skilling nursing facility, is a 19 bed sub-acute rehab (SAR) unit located at Penn Medicine Rittenhouse in Philadelphia’s Graduate Hospital neighborhood. The unit primarily serves post-acute and post-operative patients from PPMC or other downtown hospitals who require skilled care prior to returning to the community. Fellows learn to manage transitions of care in the post-acute setting, triage acute medical complaints, and work effectively as an interdisciplinary team leader.
Read Rittenhouse Welcomes Presby’s SNF Unit from our News Blog.
Palliative Care – 4 weeks (one 1-month block)
The Philadelphia CMC-VA hospice and palliative care unit accepts patients for both end-of-life care and ongoing symptom management and support during palliative chemotherapy or other supportive care. The palliative care team also does inpatient consults and has an outpatient clinic. Geriatric fellows will see a wide range of life-limiting illnesses such as heart failure, cancer, respiratory failure, dementia and stroke. Fellows are supervised by palliative care trained attending physicians, nurse practitioners and social workers, pharmacists, and those providing psychosocial and spiritual care. They will learn to provide management of pain and end-of-life related symptoms, learn communication skills including running a family meeting, and develop a comprehensive care plan for patients nearing end of life.
Ralston Home Care – 2 weeks (1 block)
Ralston summary statement Fellows are assigned to one (1) block with the Ralston House Calls Program at the start of their training as an introduction to Home Based Primary Care. Fellows will learn to provide comprehensive primary care in the home, while working as part of an interdisciplinary and utilizing community supports.
Philadelphia CMC-VA Community Living Center: Long-Term Care and Short-Term Stay – 2 months (4 weeks long-term care, 4 weeks short-term stay)
The VA’s Community Living Center is both a short-term stay and long-term care facility housed in the Cpl Michael J. Crescenz Philadelphia Veterans Affairs Medical Center. The mission of a Community Living Center is to provide a home-like atmosphere with a range of medical, recreational, and social services focused on the veteran’s health, dignity and well-being. Fellows evaluate and discuss admissions, readmissions and acute patient concerns, participate in interdisciplinary, MDS, medical directorship and family meetings. Fellows also evaluate and discuss geriatric inpatient consults and Hospital at Home service referrals.
During Ambulatory Blocks
Longitudinal Rotations
Michael J. Crescenz Philadelphia Veterans Affairs Medical Center (CMC-VAMC) Outpatient Clinic – Thursday PM
At the Philadelphia CMC-VA Outpatient Clinic, fellows learn to provide comprehensive geriatric care in the office setting with the help of an interprofessional team. Each fellow is assigned a panel of patients who they will follow over the course of the year during their weekly continuity clinic.
Nursing Home – Wednesday AM
Fellows are assigned to either Renaissance Healthcare & Rehabilitation Center or St. Ignatius Nursing & Rehab Center. Each trainee will follow a panel of 10-15 patients half day weekly with follow-up as clinically necessary. Fellows learn to recognize and manage common geriatric syndromes such as delirium, falls, multi-morbidity, polypharmacy, and hospital-acquired disability and conduct patient- and family-centered discussions of prognosis and serious illness, care transitions and goals of care while providing care that is tailored to the patient’s well-being and dignity.v
PVAMC Home Based Primary Care – Monday AM/PM
One day per week during the ambulatory clinic block., fellows work with the Philadelphia CMC- VA Home-Based Primary Care (HBPC) program’s inter-professional team of physicians, nurse practitioners, nurse care managers, pharmacists, social workers, occupational therapist, nutritionist, respiratory therapist, and psychologist. Fellows follow a longitudinal panel of patients with support from the HBPC team. They will participate in new admissions to the program and follow-up visits both independently and with a variety of inter-professional team members.
Ralston Outpatient Clinic – Tuesday AM/PM and Thursday AM
The Ralston Penn Center provides primary care for approximately 1000 older adults with multiple chronic comorbid conditions and functional limitations who are able to travel to the clinic. The clinic has a team of geriatricians, nurse practitioners, nurse case managers, medical assistants and a social worker.
Fellows participate in ambulatory clinic and a consultative clinic during their ambulatory block where they learn to manage disease prevention and intervention, complex co-morbidities, age-related physiology and cognitive changes, pharmacotherapy, psychosocial concerns and navigating transitions of care for a longitudinal patient panel.
Ambulatory Subspecialty Elective Rotations
Mercy LIFE West Philadelphia (Living Independently For Elders) – Trinity Health PACE
Mercy LIFE is a day center modeled on the innovative Program of All-Inclusive Care for the Elderly (PACE) that strives to provide high quality, integrated cost-effective care for dually eligible Medicare-Medicaid older adults.
Parkinson’s Disease Research, Education and Clinical Center
The Philadelphia Veterans Affairs Medical Center is one of 6 centers nationally that hosts a Parkinson’s Disease Research, Education and Clinical Center (PADRECC), a collaboration of a consortium of providers with movement disorder expertise. Fellows shadow physicians and physical and occupational therapists in the PADRECC clinic and learn about a range of treatment modalities including pharmacotherapy and surgery.
Penn Memory Center
Penn Memory Center, supported in part by the National Institute on Aging, is a specialized clinic located in the Perelman Center for Advanced Medicine that provides services to patients age 65 and older seeking evaluation, diagnoses, treatment and research opportunities related to symptoms of progressive memory loss. Fellows shadow geriatricians, neurologists, psychologists, social workers and other members of an interdisciplinary team providing care to individuals with Alzheimer’s disease, mild cognitive impairment (MCI) and other age-related progressive memory disorders. Fellows will learn about the range of cognitive and neuropsychological assessments for this population including interpretation of lab data and imaging, and how these results and their implications are communicated to patients and caregivers.
Sleep Medicine
Fellows shadow sleep specialists at Penn's Center for Sleep and Circadian Neurobiology in the Division of Sleep Medicine who provide clinical care for obstructive sleep apnea, insomnia, and rapid eye movement (REM) sleep disorders.
Rheumatology
Fellows shadow physicians’ clinics in Penn’s Rheumatology Division and also at the PVAMC to learn about osteoarthritis, gout and other joint-related (e.g. knee, shoulder) rheumatological conditions and medical management options specifically in older adults. Fellows will have the opportunity to perform intra-articular knee injections for pain relief for osteoarthritis.
Urogynecology
In the Urogynecology clinic, Fellows will learn about treatment of pelvic floor disorders that especially impact older women such as urinary and fecal incontinence, fistulas, urethral diverticulum, and pelvic organ prolapse.
Geripsychiatry
Fellows will spend time with both geriatric psychiatrists and psychologists in the Philadelphia CMC-VAMC Psychiatry Outpatient Clinic, Community Living Center (CLC) and Penn outpatient clinics providing mental health services to older adults.
Elective
Fellows will have 2 weeks of elective time that can be used to explore a clinical interest or devote additional time to research or independent study.
Fellows' Nursing Home/SNF Call
Fellows take overnight and weekend call one (1) day per week and (1) weekend a month for the nursing home services (Renaissance Healthcare & Rehabilitation Center and the Philadelphia Veterans Affairs Medical Center’s Community Living Center) and addition for Penn Center for Continuing Care at Rittenhouse. All call is performed from home and there is NO in-house call required. Fellows will receive training during orientation in triage and telemedicine and will always have backup faculty support.