Clinical Experience

Geriatric Psychiatry Specialty Clinic

This rotation is designed as a 9 month, half-time assignment in collaboration with Geriatric Medicine for the care of older patients suffering from concomitant medical and psychiatric illnesses. Geriatric psychiatry fellows work with physicians from geriatrics and primary care to co-manage complex patients. Fellows have the opportunity for formal and informal consultations with on-site faculty from psychiatry and medicine. The clinic serves as a training site for students from the Yale University School of Medicine, and PharmD students from the University of Connecticut School of Pharmacy. It also serves as a training site for PGY2 -PGY4 residents from the Department of Psychiatry. Fellows play an active role in the education of students and residents from these diverse disciplines. Case based teaching includes interdisciplinary perspectives and review of pertinent evidence based literature.

Geriatric Psychiatry Inpatient Program

This rotation is designed as a 3 month, part-time rotation. Fellows will develop clinical expertise in the diagnosis and management of complex psychiatric and medical disorders in older patients, and learn sophisticated strategies for pharmacologic and behavioral treatment of geriatric disorders in the inpatient setting.

Fellows serve as a "junior attending" taking leadership of the interdisciplinary treatment team. In that capacity they learn management and decision making skills necessary to run an inpatient unit. Fellows have the opportunity to further develop educational expertise providing direct supervision of PGY-2 psychiatry residents and Yale medical students.

The training experience is enhanced for the fellows by daily interdisciplinary teaching rounds and individual faculty supervision. Case based teaching includes interdisciplinary perspectives and review of the pertinent current literature.

The Yale-Alzheimer's Disease Research Unit (ADRU)

This rotation is designed as a yearlong clinical experience in which fellows rotate through half-day clinics. Fellows join an interdisciplinary clinical and research team that provides clinical care, caregiver support, and conducts research trials. Fellows learn state-of-the-art methods for assessment of dementia, are exposed to the latest developments in neuroimaging and treatment for Alzheimer's disease, and have the opportunity to learn about current theories of the pathophysiology of dementia and the rationale for investigational therapies.

Fellows serve as an integral part of this treatment/research team and have supervisory and teaching opportunities with Department residents and Yale medical students rotating through the Unit.

The training is enhanced by individual faculty supervision and research meetings where fellows learn skills necessary to critically evaluate both research methodology and current findings in the literature. ADRU faculty provide a monthly didactic session for fellows and trainees from multiple disciplines to enhance their understanding of the neurobiology of cognitive disorders and to review current research in the field.

Nursing Home Consultation

This rotation is a continuous year long, half-day assignment, where fellows learn the comprehensive assessment and consultation skills of a geriatric psychiatrist in the nursing home setting. Fellows gain expertise in the evaluation and management of residents with co-morbid psychiatric and medical illnesses. Management of behavioral disturbances associated with dementia is a fundamental task in the nursing home setting. Fellows work closely with nursing home staff to evaluate behavioral problems and develop management strategies. They also collaborate with the patient's medical physician to investigate possible medical causes of delirium or behavioral change. Fellows have the opportunity to learn about the significant psychological and social impact of nursing home placement on an older individual and his/her family, and to gain an understanding of the financing of such care.

Supervision is provided on-site by geriatric psychiatry faculty. Opportunity also exists for fellows to assist in the in-service training of nursing home staff.

Geriatric Psychiatry Case Management Service

This rotation is designed to provide fellows with consultation experience for home-bound elder patients with neuropsychiatric illnesses. Fellows develop an understanding of the array of complex issues facing both the patient and caregiver as they attempt to manage and maintain the optimal quality of life at home. Fellows develop skills in functional home assessment, and working with the non-physician team. At times they are called upon to assess decision making capacity and/or safety concerns around the home.

ECT

This rotation is designed to provide in depth training for the indications and application of ECT.

Neurology Movement Disorders Clinic

Fellows rotate through the Neurology Movement Disorders Clinic to gain experience in the diagnosis and treatment of the variety of movement disorders common in later life.

Palliative Care Service

This rotation is designed to provide Fellows with experience with the biomedical, social, psychological and ethical issues confronting patients and care givers at the end of life.

Community Based Outpatient Clinic

This rotation provides Fellows experience in the care of older adults in an outpatient setting providing care to a largely underserved population.