Geriatric Psychiatry Residency Training Program

Director: Daniel Sewell, M.D.

The Geriatric Psychiatry Residency Program at the VA San Diego Healthcare System (VASDHS) and the University of California, San Diego (UCSD) is offering two one-year, VA-funded, full-time positions beginning July 1, 2009. This ACGME accredited, PGY-V residency is intended for psychiatrists who have recently completed their residency and have interest in an academic career in geriatric psychiatry.

Residents learn the fundamentals of clinical geriatric psychiatry in both outpatients and inpatients. Residents are immersed in a rich variety of formal and informal educational experiences, including journal clubs and research seminars and lectures. In addition, the residency provides a valuable clinical experience not only in caring for patients, but also in dealing with the special clinical and administrative issues. Stipends are currently $48,448. The VASDHS and UCSD are equal opportunity employers.

OBJECTIVE

The primary objective of our geriatric psychiatry fellowship training program is to train academically knowledgeable, clinically astute and caring geriatric psychiatrists. Our clinically based program offers experiences in inpatient, outpatient, consultation-liaison, nursing home, and comprehensive geriatric assessment. Throughout training, biological, psychological and sociocultural factors are integrated so that the fellow develops skills specific to the care of the geriatric patient, learning to select and utilize the most current methods of pharmacotherapy, psychotherapy and sociotherapy. While emphasizing clinical geriatric psychiatry, the program provides opportunities to learn and develop administrative, teaching and research skills.

Our faculty is deeply committed to the intellectual growth and emotional well being of our fellows. Learning is reinforced through careful supervision of all clinical work; comprehensive didactic seminars that build on each other and are integrated with the clinical program, case conferences, grand rounds, journal clubs and the mentorship program. Fellows actively participate in all levels of training and planning. Evaluation of the program, its trainees and its faculty, receives the highest departmental priority.

CLINICAL OPPORTUNITIES

One of the major strengths of UCSD's geriatric psychiatry fellowship program is the diversity of available clinical experiences. Our fellows receive training in a variety of settings that reflect the spectrum of geriatric psychiatric practice today.

VISA REQUIREMENTS

Non-citizens of this country may pursue residency and fellowship training at UCSD Medical Center while holding permanent resident status or while holding a J exchange visitor visa under the sponsorship of the ECFMG.

EDUCATIONAL EXPERIENCES

• Core curriculum

  • Patient care

  • Medical Knowledge

  • Interpersonal and Communication Skills

  • Practice-based learning and improvement

  • Systems-based practice

  • Professionalism

• Grand rounds and visiting lecturers

• Specialty rounds

• Journal clubs

• Supervision

• Teaching

• Research

ROTATIONS

Geriatric Psychiatry Longitudinal Experience: Geriatric Psychiatry Outpatient Clinic
and Geriatric Psychiatry Consultation/Liaison Experience

The VASDHS is the primary site of training for the residency in geriatric psychiatry. The VASDHS is completely integrated with UCSD Medical Center. All faculty appointments in psychiatry are made by the Department of Psychiatry. The facility is located adjacent to the UCSD Campus in La Jolla. It is a general hospital with 700 beds of which 103 are Psychiatric. The general adult inpatient psychiatric facilities at the VASDHS are comprised of three units: a psychiatric intensive care unit, a step-down unit, and an open unit. In addition, there is a Comprehensive Outpatient Mental Health Unit, and Alcohol and Drug Treatment Unit, a Primary Psychiatry Service, a Psychiatry Emergency and Urgent Care Clinic and a Consultation/Liaison (C/L) Service.

The breadth of clinical experience for the geriatric psychiatry residents includes: a required geriatric psychiatry longitudinal experience at the geriatric psychiatry outpatient clinic (3 days per week for 6 months followed by 3½ days per week for 4½ months) and a required geriatric psychiatry consultation/liaison experience (½ day per week for 10½ months). Many of the seminars, clinical case conferences, and journal clubs take place at the VA San Diego Healthcare System

Geriatric Psychiatry Inpatient Unit – Senior Behavioral Health Unit

Senior Behavioral Health Unit is an acute inpatient psychiatric/medical treatment unit designed to effectively treat the unique psychiatric and physical health care needs of the senior patients with behavioral or cognitive problems. The facility, located inside UCSD Medical Center in Hillcrest, California, is 12 miles from the primary training site. The design includes mood-enhancing bright light, hand-picked paintings that show seniors in positive activities, and specially designed furniture geared to older neuropsychiatric patients. Senior Behavioral Health Unit offers a structured treatment program where care is provided around the clock, seven days a week. A multidisciplinary team of health care professionals works cooperatively to provide the highest level of psychiatric and medical treatment. The team includes psychiatrists, geriatric internists, psychologists, social workers, occupational and physical therapists, a dietitian, and psychiatric nurses. The team's objective is to provide each patient with a safe, caring and supportive treatment environment which stimulates independent positive living. Patients are admitted to the program voluntarily and receive a complete physical and psychiatric evaluation. An individualized plan of treatment is then outlined by the multidisciplinary treatment team. Patients are encouraged to participate in their own treatment through structured therapeutic groups and individual therapy. This is a required rotation scheduled for 8 weeks at 80% time (4 days per week).

Geriatric Assessment Clinic – SOCARE

SOCARE (Seniors Only Comprehensive Assessment and Retirement Evaluation) is an outpatient geriatric assessment clinic located at the UCSD Medical Center, 12 miles from the primary training site. The SOCARE program entails a comprehensive evaluation by a multidisciplinary team of geriatric specialists from the following disciplines: Internal Medicine, Psychiatry, Neurology, Neuropsychology, Nursing, and Social Work, who identify current and potential health problems and make appropriate recommendations for treatment and care. Most patients are referred by private physicians in the community for a comprehensive assessment and consultation. Diagnoses are mainly dementias, including Alzheimer's disease and vascular dementias. The SOCARE assessment protocol involves: an initial comprehensive evaluation by geriatric medicine; neuropsychological testing; a psychiatric evaluation; a safety and residential care or home evaluation and care planning by a social worker; and a final conference with the SOCARE team, patient, and family members. Treatment includes pharmacotherapy, individual and family therapy/education, as well as assessment and preparation of report and recommendations to be implemented by primary care team. This is a required rotation scheduled for 6 months at 10% time (½ day per week).

General Medicine Primary Care Clinic – San Diego VA Mission Valley Outpatient Clinic

The San Diego Mission Valley Outpatient Medical Clinic is 12 miles from the primary training site. It serves San Diego Veterans who reside in San Diego County south of Interstate 8. The most common medical conditions include diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, and arthritis. Patients also frequently have functional deficits, a history of falls, and other common geriatric syndromes. Fellows spend Friday mornings working in the clinic for six consecutive months. Supervision is provided by two UCSD geriatric internal medicine faculty members. This is a required rotation scheduled for 6 months at 10% time (½ day per week).

Long-Term Care Rotation – Silverado Senior Living

Silverado Senior Living, Inc. is a 122-bed residential care facility that specializes in treating patients with Alzheimer’s disease and other dementias. A minority of patients also have Axis I diagnoses such as anxiety disorders, depressive disorders, and psychoses. The range of severity of dementia is from the early stages to end of life care in hospice. It is located in Encinitas, California, 14 miles from the primary training site at UCSD/VA Medical Center. In addition to pharmacotherapy, the treatment approach includes behavioral intervention, family education and support, and a variety of activities to promote physical, social, and emotional well being. Silverado facilities in Southern California are affiliated with research programs at UCSD, UCLA, and USC in pursuit of new and innovative care, treatment, and prevention techniques for dementia-related illnesses. This is a required rotation scheduled for 6 months at 10% time (½ day per week).
 

OUR CENTER

The Geriatric Psychiatry Residency Training Program is a part of our NIMH-funded Advanced Center for Interventions and Services Research. Under the direction of Dilip V. Jeste, M.D., our Center focuses on community-based research in middle-aged and elderly people with schizophrenia and other chronic psychotic disorders. We are proud of our record of peer-reviewed publications, community outreach, federal and non-federal grants, a growing pool of junior and senior investigators working in this area, and unique and successful training programs. A number of our findings have had a significant impact on the clinical practice and research in the area of study. We believe that our Center has become a national and international resource for studies of this largely neglected patient population. Our Center provides a research infrastructure to promote investigations that improve real-world practice. Our primary community partner is the San Diego County’s Adult Mental Health Services. Additional community partners include VA San Diego Healthcare System, community-based psychiatrists, homeless shelters, and collaborators from other parts of the country.

RESIDENCY FACULTY

Primary Faculty Mentors

Professional Faculty and Staff

PRELIMINARY APPLICATION

If you are interested in applying, please send the following:
a) Curriculum vitae
b) Three letters of recommendation
c) One-page letter of intent/personal statement

to: Sandra Kent
VA San Diego Healthcare System
3350 La Jolla Village Drive
Bldg. 13, 4th Floor
San Diego, CA 92161

Applications may be faxed (858-552-7404) or e-mailed (skent@vapop.ucsd.edu). Should you plan to be in San Diego in the future, please let us know so that we can meet with you and introduce you to our Program. Please contact our office to schedule a visit (858-534-4020). Please feel free to call us if you have any questions or would like to discuss the program further.