VA Fellowship in Advanced Geriatrics
Program details and application procedures:
The purpose of the VA Advanced Fellowship in Geriatrics is to offer post-specialty education to foster the development of leadership in health care issues of the elderly. The program capitalizes on the international prominence of VA's Geriatric Research, Education, and Clinical Centers (GRECCs) to provide outstanding training opportunities in clinical practice, to contribute to the improvement of clinical practice, and to advance scholarly pursuits that will benefit care for elderly veterans and all older Americans. Physician fellows must have completed an ACGME or AOA accredited residency, and either already be certified or are actively pursuing board certification. This program shall not lead to board-eligibility in Geriatrics for physicians. Non-physicians must be post-doctoral for an associated health discipline.
For many years, the Office of Academic Affiliations (OAA), the Geriatrics and Extended Care Strategic Healthcare Group, and the GRECCs have played a leading role in training health care providers in geriatrics. In 1978, VA established the Geriatric Medicine Fellowship to develop a cadre of physicians committed to excellence in geriatric research, education, and clinical care and interested in becoming leaders of local and national geriatric medicine programs. Presently, approximately one-fourth of all geriatric medicine training slots and almost 1/2 of all geriatric psychiatry slots are financially supported by VA; nearly half of all geriatric medicine residents and 2/3 of geriatric psychiatry residents in the US receive some or all of their training in VHA facilities.
In the mid-1990s ACGME reduced its accreditation requirements for Geriatrics from two years of subspecialty training to twelve months. Consequently, OAA changed the length of its support for individuals in geriatric medicine subspecialty training from two years to one year. Concerned that more than one year of subspecialty clinical training was required to continue leadership in the field of geriatrics, VA's Geriatrics and Extended Care Strategic Healthcare Group, the Geriatrics and Gerontology Advisory Committee (GGAC), and the GRECC Directors in 2000 recommended that OAA establish a fellowship to support advanced training in geriatrics. OAA initially supportedAdvanced Fellowships in Geriatrics at seven of VA's 21 GRECC sites; and in 2006 expanded the number of GRECCs offering Advanced Fellowships in Geriatrics sites to sixteen.
New in 2006-2007
Research efforts in geriatrics, which are understood as key to survival in academic medicine, continue to be predominantly accomplished within medical subspecialties. As the leading proponent for health care geriatric education in the US, VHA has an obligation to offer a wide variety of clinical research training opportunities for postdoctoral geriatrics professionals committed to pursuing careers in academic health care. The fundamentally interdisciplinary nature of geriatric health care necessitates that Advanced Fellowship in Geriatrics training opportunities not be limited to physicians with prior training in geriatrics, but be available to physicians of other specialties and to associated health professionals with advanced training and expertise in geriatric care within their respective disciplines, and who are committed to academic careers in their respective fields.
The two-year curriculum at each site provides basic overviews and opportunities to pursue more intensive training in health services research, research methods, educational and evaluative design, written and oral communication skills, quality improvement methods, leadership skills, patient safety and project management. Each of the SFPAG sites is unique in its own area(s) of expertise beyond those basic skills. Fellows who have not completed approved Geriatrics training shall be offered fundamentals of geriatrics and gerontology in their course of study.
Fellows spend at least 75 percent of their time in scholarly pursuit of geriatrics (coursework and research) and no more than 25 percent in clinical care. Fellows shall develop and implement a research project resulting in some form of professional recognition such as submission of a manuscript to a peer-reviewed journal or presentation at a recognized professional forum. The majority of fellows' clinical care responsibilities are conducted at VA facilities. Every fellow is assigned at least one mentor (preceptor) in the first quarter year of the program, who will provide assistance with project and research methodology and content and guidance in personal and professional development through synthesis of an individualized learning plan.
Physician fellows must have completed an ACGME- or ECCOPT- accredited physician residency program. Physicians whose initial certification is in Internal Medicine, Family Medicine, or Psychiatry must also have completed an accredited subspecialty residency in Geriatrics or other subspecialty. Special Fellows are expected to be board certified in their primary specialty and either certified or actively pursuing certification in their subspecialty by the time of VA Special Fellow appointment and to meet credentialing and privileging requirements to qualify as a licensed independent practitioner. Physician fellows must have an active, full and unrestricted license to practice in the US. International medical graduates must have the required Education Commission for Foreign Medical Graduate (ECFMG) documentation. Citizens of countries other than the United States must possess an appropriate visa to participate in this program.
Postdoctoral associated health fellows from nursing, dentistry, optometry, psychology, podiatry, pharmacy or audiology / speech pathology must have graduated from an accredited clinical doctoral program including all required residency or internship experiences that prepare them for eligibility for VA employment. Psychology fellows must have completed an accredited doctoral program, including an internship program accredited by the American Psychological Association (APA). In addition, associated health fellows must have completed one year of post-doctoral clinical training in their discipline, preferably but not exclusively in geriatrics. Associated health fellows must be US citizens.
To inquire about the application process and to learn more about the program, interested parties should write to the site(s) of their choice, including a cover letter and current curriculum vitae.
VA Advanced Fellowships in Geriatrics
Geriatric Fellowship Address List
Research Focus: Mobility, infection control, resource utilization in nursing homes, influenza, exercise, assessment measures, healthcare outcomes measures, signal transduction and neuronal survival, immune system, genetics of differential longevity, and autoimmunity
Research Focus: Basic Biomedical: Researchers address the molecular, cellular and genetic mechanisms underlying aging and associated abnormalities in glucose, fat, and lipid metabolism, and the effect of exercise training and weight loss in subjects with diabetes, stroke, obesity and sedentary lifestyles. Applied clinical effects of exercise and diet modification on risk factors for CVD in older veterans.
Researchers address the effects of gene-environment interactions on the mechanisms underlying the effects of exercise and weight loss interventions on hypertension, diabetes and hyperlipidemia. Researchers also examine the effects of task-oriented treadmill training on central and peripheral neural mechanisms, fitness levels, cardiovascular disease risk factor profiles and functional status of older patients with chronic cardiovascular diseases, including stroke, peripheral arterial disease and coronary artery disease.Health Services: Researchers examine the effects of exercise and chronic rehabilitation interventions on functional performance and quality of life in veterans with chronic cardiovascular diseases. Rehabilitation: The rehabilitation (tertiary prevention) involves studies of older patients disabled by stroke, peripheral arterial disease, and coronary artery disease.
Research Focus: The goals of the GRECC research component are to establish scientific excellence with an integrated program of biomedical, clinical, health services and rehabilitation research related to preventing and improving the treatment of urinary and fecal incontinence, nocturia, mobility loss, and symptoms and manifestations of suffering experienced with advanced or life-threatening illness. The ultimate goal is to develop and test interventions to improve and maintain function and prevent and effectively manage physical, emotional, social, and spiritual suffering and thereby improve quality of life for the Veteran population. GRECC Research Cores are the Data Analysis Core, Muscle Research Laboratory, Clinical Exercise Facility and Urodynamic and Anorectal Function Laboratories.
Research Focus: Research programs at the VISN 10 GRECC include: basic and clinical investigation on antimicrobial resistance in the community living centers (CLCs); immunology of influenza, HIV, and HCV; aging and the immune response to vaccines; and infectious diseases and aging. Clinical demonstration projects center upon C. difficile and MRSA in CLCs. Interdisciplinary educational, clinical and research programs study Herpes zoster, UTIs in the elderly, and the effects of circadian light on wellness. We offer a unique research methods curriculum that is designed for trainees.
Research Focus: Basic biomedical: immunology and aging, cardiovascular disease and aging, Applied clinical: Herpes zoster, cardiovascular disease, osteoporosis and Paget’s disease of the bone, exercise interventions to improve functional impairments, Health services: medication appropriateness, transitions of care and drug reactions.Public policy: Nursing home care and preventing re-hospitalization; Education: Clinical teaching skills, Curriculum design and implementation, Quality improvement methods in LTC, Learner-centered teaching and improving communication skills among trainees.
Research Focus: Health services research, clinical epidemiology and outcomes research, quality improvement, implementation research, health informatics, family caregivers of older adults, clinical decision-making, fall prevention, stroke prevention, and end-of-life care issues
Research Focus: Exercise physiology, cellular aging, Alzheimer's disease pathogenisis, nutrition and metabolism, outcomes research.
Research Focus: Basic and clinical research programs in osteoporosis, osteoarthritis, fracture repair, wound healing, falls, immunosenescence, Alzheimer's disease and neoplasia in aging, cellular aging, bone-cartilage-lymphocyte cell biology, sleep disorders, nursing home quality of care, barriers to VA care utilization, innovative geriatric programs and educational research in undergraduate and graduate medical care training in geriatrics and gerontology.
Research Focus: Please contact site for more details.
Research Focus: Musculoskeletal problems, neuroregeneration, falls prevention, use of avatars as pedagogical agents for older patient education and self management, geriatric virtual patient simulations, computer-based clinical decision support and just-in-time training, virtual worlds in geriatric education, telecare, prostate cancer, arthritis, osteoporosis, healthy aging, and prevention and management of diabetes and cardiovascular disease in the elderly. Many more opportunities are available based on trainees’ interests. Please contact site for more information.
Research Focus: Alzheimer’s disease and other age-related neurodegenerative diseases, patient safety and outcomes research, vascular factors associated with cognitive decline, palliative care (dementia), traumatic brain injury, cognitive neuroscience and neuropsychology, polypharmacy in the elderly
Research Focus: Applied Clinical: Alzheimer’s disease, arthritis and other degenerative diseases and the development of psychotherapies for late life depression and anxiety.
Health Services Research: clinical decision support systems, health preferences of older adults (quality of life), Research in geriatric nephrology.
Basic Biomedical: Adult stem cells, dysmobility in aging, cellular and molecular biology of aging, physiological and metabolic concomitants of aging, endocrinology and metabolism of aging, autoimmunity in aging, immune system cell biology and cancer, cellular and molecular impact of oxidative stress on aging and cancer, role of aging and dyslipidemia in metabolic syndrome, diabetes and associated cardiovascular complications, cellular and molecular mechanisms underlying autoimmune and degenerative arthritis affecting elderly and role of immune responses and inflammation in Alzheimer’s disease and aging.
Research Focus: Mechanisms of ischemic neuronal cell death, new therapies to treat stroke, mechanisms of gait instability, treatment of aphasia, quality of life outcomes for stroke survivors, treatments that reduce stroke factors, reducing polypharmacy in aging. More opportunities are available. Please contact site for more information.
Research Focus: Neuroendrocrinology, neurogenetics, health services research, molecular genetics, psychopharmacology, andrology, prostate cancer, medical ethics, end of life care, metabolic basis of Alzheimer’s disease and blood-brain – barrier function.
Research Focus: Dr. Bair is board certified in Internal Medicine, Geriatric Internal Medicine, Psychiatry and Geriatric Psychiatry. He obtained a special MBA for physician administrator from the David Eccles School of Business at the University of Utah. He is currently the Director: of the Veterans Rural Health Resource Center – Western Region which is a field office for the VA Office of Rural Health located in Washington D.C. He is also the Director: of the Geriatric Medicine and Psychiatry Program as well as the Geriatric Medicine Psychiatry outpatient clinic. He is a Professor of Internal Medicine and Psychiatry at the University Of Utah School Of Medicine and an Adjunct Professor of Nursing at the University Of Utah School Of Nursing. His research interests include health care delivery systems, decision support systems, and disruptive behaviors in cognitively impaired elders
Research Focus: Osteoblast function and second messengers, risk factors associated with development of frailty, disability in nursing home residents, medical decision making in long term care, health professionals education in geriatrics and gerontology, genetic influences in aging, wound healing, animal models of aging, ethnicity and aging.
Research Focus: Hormonal interventional trials, nutrition in the elderly, aging in the blood brain barrier, aging in African-American populations, molecular biology of aging, aging-related memory deficits, aging related osteoporosis, end of life care, health services research, quality improvement in the nursing home.
Research Focus: Please contact site for more information.