We currently accept five clinical fellows per year and we value these fellows by providing:

• Rotations precepted by enthusiastic clinician educators.  We often find that fellows are excited about geriatric medicine but are not sure what path their career may take.  By rotating through multiple institutions across the Portland area and experiencing different careers, the fellow has ample time to find their passion.

• Frequent formal and informal feedback and evaluation.  Each rotation experience has a tailored evaluation to ensure that the fellow meets their milestones.  Likewise, we ask for fellows to provide written and verbal feedback on each rotation so that we may optimize it for the next class.  The program director has an open-door policy and remains readily accessible to the fellows.

• Dedicated coaches to encourage self-reflection, optimize wellness, and provide support during this busy year.  Each fellow is paired with a coach with whom they meet quarterly (or more often if the fellow requests) throughout the year.  Many of our fellows have accessed the Resident and Faculty Wellness at one time or another – read more about this nationally recognized program here.

• Full access to the OHSU House Officers Association benefits. These include a housing stipend, relocation reimbursement, education reimbursement, four weeks of vacation time and many more. Read more about all the HOU does for our geriatric fellows here.

Our fellows rotate throughout the Portland area experiencing a wide array of geriatric medicine careers.  These include:

• Inpatient Hospice/Palliative care – This is a two-month rotation, with one month spent at the Vancouver CLC inpatient palliative/hospice wing and the second month spent at the Portland VA providing inpatient palliative care consultation.  Efforts are made to guide patient/family towards goal-directed care. Fellows receive formal and bedside teaching by palliative medicine specialists and have the opportunity to teach Internal Medicine residents and OHSU medical students. Community Living Center and VA Portland Health Care System 

• Acute inpatient delirium/hip fracture service – This two month rotation provides the fellows the opportunity to be a geriatric medicine hospitalist at Legacy Good Samaritan Hospital, a large community-based hospital.  Fellows will evaluate inpatients with hip fractures, hospital acquired delirium, cerebrovascular disease and common geriatric problems encountered in the inpatient setting. Legacy Good Samaritan Medical Center 
   
• Post-acute rehabilitation – This is a two month rotation at Kaiser Permanente, the largest managed care organization in the U.S., where the fellow serves as a “SNF”ist – providing admission consultation and follow-up visits on patients recently discharged from the hospital. The fellows participates in interdisciplinary team coordination to meet the patient’s rehab and discharge goals.  Fellows receive formal and bedside teaching by SNF clinicians and geriatricians. The fellow will work with physical therapy, speech therapy, and occupational therapy to broaden their rehabilitation education. Kaiser Permanente 
   
• Program for all-inclusive care of the elderly (PACE) – This one month rotation provides fellows a team-based experience in a capitated system that is centered out of adult day health facilities. PACE ElderPlace is a comprehensive care program that offers health, housing, social service, and care coordination to older adults. Providence ElderPlace 
   
• Neurology/urology – This month is dedicated to neurology and urology outpatient experiences throughout the city – dizziness, movement disorder, stroke, urinary incontinence.  The fellow participates in clinics with physician providers as well as physical therapists to tackle some of these complex syndromes.
   
• Specialty clinics – This two month rotation offers experiences in wound healing, geriatric assessment, driving evaluation, osteoporosis, geriatric psychiatry, low vision evaluations, movement disorder, and house calls so the fellow can provide their geriatrics expertise to these clinics while also deepening their subspecialty internal expertise.  VA Portland Health Care System and Oregon Health & Science University
   
• Acute care for the elderly (ACE) consult service - This one-month rotation at OHSU allows the fellow to serve as a geriatric medicine consultant to medical and surgical services.  Working with a team of geriatricians, physician assistants, nurse practitioners, pharmacists, and rehabilitative therapists, the fellow provides geriatric medicine consultation while learning how to work effectively in a team.  Oregon Health & Science University
   
• Elective month -  This month long rotation is determined by the fellow and serves as a platform to pursue personal career interests.  Specific options include informatics/data science, quality improvement, long-term care medical directorship, or additional training in geriatric syndrome of interest.

Longitudinal experiences
Our fellowship also emphasizes longitudinal experiences to foster continuity of care. These include:

• ½ day per week of outpatient geriatric medicine primary care practice (VA or OHSU)
• ½ day every other week at a community long-term care facility
• ½ day monthly with Fall Assessment clinic (VA)
• ½ day monthly with Neurology Cognitive Care clinic (VA)

Call expectations
Fellows do at-home call only, an average of every 5^th day Monday-Thursday, every 5^th weekend, and one federal holiday.  The at-home call is for the ~60 bed nursing home facility for the Portland VA.

1. Geriatrics Fellows Conference: weekly review of topics essential to the field of geriatric medicine including the biology, psychology and clinical aspects of care of older adults. 
2. Journal Club: fellows and faculty alike participate in regular journal clubs to provide critical assessment of recent literature addressing specific geriatric problems.
3. Geriatric Fellowship Faculty Development Series: a quarterly conference series to provide ongoing training in important non-clinical topics including trainee evaluation and feedback, physician wellness and self-care, care of underserved populations, diversity and inclusion.
4. Geriatric Boards Support: we are proud to share that our fellows have a 100% boards pass rate.  Beyond weekly didactic curriculum and clinical learning, we support our fellows in their efforts to prepare for their geriatric medicine boards by providing access to learning opportunities such as GRS and the UCLA Intensive Course in Geriatrics Medicine and Board Review.
5. Local and National Conferences: fellows are given support and time-off to attend the Oregon Geriatrics Society Annual Conference. Support is also provided if presenting at national meetings such as the American Geriatrics Society Annual Conference.
6. Optional Interdisciplinary Learning Opportunities: fellows are encouraged to participate in the lectures put on by our collaborating departments including the All City Palliative Care conference, Department of Medicine Grand Rounds, the Cognitive and Neurosciences conferences, the Parkinson’s Department (PADRECC) conferences, and the Research in Progress Seminars.

• IHI Modules: fellows participate the IHI’s Open School modules to provide a foundation in quality improvement science.
• QI Project: To support critical thinking and scholarship, the fellows work collaboratively on their own quality improvement project and population management strategies within their outpatient continuity clinic.
• Medical Education: fellows are also provided with several opportunities to teach house staff and medical students alike as we are affiliated with over 30 other residency and fellowship programs, as well as the OHSU School of Medicine.
• Teaching to Teach: Fellows participate in a unique curriculum design series where they learn basic curriculum development principles and methodologies, then apply those principles to create a novel educational product related to diversity, equity, and inclusivity. Finished products are used as part of the following year’s internal medicine residency geriatrics rotation.
• Community-wide Education: fellows are welcome to participate in institution-wide efforts to enhance geriatric knowledge, including involvement in the Oregon ECHO network .
• Independent Research: fellows are supported in efforts to pursue additional scholarly projects including clinical research, publications and participation in national meeting presentations. Select faculty research projects are highlighted here.

Our geriatric fellowship is committed to improving diversity, equity and inclusion within our program, our institution and the patients we care for. We welcome applicants of all backgrounds and deeply believe that diversity helps us provide better care for patients and better training for fellows. We are fortunate to have the support of OHSU’s Center for Diversity Inclusion as we continually strive to do better.  Read here to learn more about our institution’s ongoing efforts.