51吃瓜网

Location: Montreal General Hospital E16-145

Program Information:

Duration of fellowship: 1 or 2 years

Name of the Fellowship Program Director:
Dr. Carolyn Pavoni, Assistant Professor, Department of Medicine, 51吃瓜网, Division of Geriatric Medicine, Montreal General Hospital

Hospitals involved in training:

1. Jewish General Hospital
2. 51吃瓜网 Health Centre (Montreal General Hospital and Royal Victoria Hospital)
3. Douglas Mental Health University Institute
4. Montreal Neurological Hospital/Institute
5. St. Mary鈥檚 Hospital

(Subject to change based on availability and preference)

Background:

With the aging population, the incidence and prevalence of cognitive disorders, including dementia and delirium, and their complications, will increase. Basic science and clinical research in cognition is an active field, while memory clinics, although increasing in number, remain relatively rare.

Established in 1991 and considered a pioneer in the field, the Anna & Louis Goldfarb Jewish General Hospital/51吃瓜网Memory Clinic offers internationally recognized expertise in the early diagnosis and treatment of memory disorders and dementia and is well positioned, in conjunction with the other memory clinics in existence at 51吃瓜网, to provide specialized training in the field of cognition, the translation of research into clinical practice, and an increase in the number of clinical experts in the field.

Furthermore, prevention, treatment and management of inpatient delirium is an important aspect associated with cognitive trajectories in the older adult. Further experience in psychogeriatrics, behavioral neurology and neuropsychiatry will be acquired at the Douglas Mental Health University Institute and the Montreal Neurological Institute.

Research Activity:

A research project during the fellowship is encouraged but not mandatory. There exist adequate supervisors from members in the division as well as access to the Center for Excellence in Geriatric Medicine and the Lady Davis Institute of the Jewish General Hospital, which together can provide supervision and guidance for a research project.

Mission:

Our mission is to provide fellows with clinical experience in the early detection, diagnosis, and management of cognitive disorders and in the management of their complications during their evolution. Included in the curriculum will be the application and integration of biomarkers and disease-modifying agents into the clinical setting, which are emerging aspects of Alzheimer鈥檚 disease diagnosis and management. Furthermore, it is important for fellows to develop a clinical experience in diagnosing, managing, and treating delirium, which can often be a precursor to dementia in hospitalized frail patients.

The fellowship curriculum will be tailored based on the clinical background of the fellow. For example, a neurology resident will have more training in clinical geriatric management of cognitive disorders such as delirium in addition to further training in geriatric psychiatry than would a fellow applying from geriatric medicine. A fellow from geriatric medicine would therefore have more training in neurology.

Names of the teaching faculty:

Division of Geriatric Medicine
Geriatricians:

Dr. Elise Levinoff
Dr. Dan Liberman
Dr. Catherine Talbot Hamon
Dr. Miruna Anohim
Dr. Howard Bergman
Dr. Claire Goddard-Sebillotte
Dr. Don Doell
Dr. Susan Gold
Dr. Ruby Friedman
Dr. Johanne Monette

Neuropsychologists :

Dr. Leonard Babins
Dr. Nora Kelner

Department of Neurology

Dr. 脡tienne DeVillers-Sidani
Dr. Lesley Fellows
Dr. Maia Gedes
Dr. Chenjie Xia

Department of Psychiatry

Dr. Ren茅 Desautels
Dr. Monique Desjardins
Dr. Michel Elie
Dr. Anne Charlotte Thiffault

Department of Radiology

Dr. Jean-Paul Soucy

Academic Facilities:

The facilities will include the 51吃瓜网 teaching hospitals listed above. More specifically, the inpatient and outpatient units, along with the administrative support available in each division site will be used. Access to the library and multimedia learning materials will be provided.

Fellow duties and responsibilities:

• Attendance in Geriatric Medicine Grand Rounds, journal clubs and other academic activities related to cognition
• Attendance in clinic and inpatient units
• There will be no mandatory call responsibility
• Supervision and teaching of more junior trainees, depending on the background of the fellow
• Research project (optional)

Mandatory rotations:

• Memory clinics in the various sites of the division, along with multidisciplinary rounds associated with each clinic. Fellows will be expected to evaluate, diagnose and treat cognitive disorders in the outpatient setting. Longitudinal follow-up of patients will also occur. Rounds will include the correlation of clinical, radiological and pathological findings
• Neuropsychology clinic with neuropsychologists to learn about the purpose and use of the various psychometric tests used
• Consultations in emergency room and inpatient consultations for concerns of cognition and the complications, as well as delirium, behavioral management and disposition planning, including the support of caregivers. Consultations will be screened by an attending physician for appropriateness for the fellow

Non-mandatory rotations based on the background of the fellow:

• Psychogeriatrics (consult, ward and clinic)/ Neuropsychiatry
• Movement disorders clinic and associated cognition assessment and treatment
• Clinics in Geriatric Medicine
• Geriatric Medicine wards
• Neurology
• Neuroimaging: structural (CT, MRI) and functional (FDG-PET)

Training expectations

At the end of this fellowship, the fellow is expected to have gained the following competencies:

Medical expert:

• Assess patients with geriatric syndromes, particularly related to cognitive disorders
• diagnose common and uncommon etiologies of dementia in the clinical setting
• formulate a treatment plan for patients with typical and atypical dementias
• Become familiar with the neurocognitive evaluation of cognition performed by neuropsychologists.
• Understand and apply cognitive trajectories and their outcomes as they pertain to older inpatient adults with delirium
• Become familiar with and be able to perform competency assessments of patients with cognitive disorders
• Understand the utility and correlate ancillary tests (radiology, CSF and plasma biomarkers) with clinical pictures to formulate a diagnosis and treatment plan

Communicator:

• Establish therapeutic relationship and provide effective and empathetic counseling to families and caregivers of older adults, particularly those with cognitive disorders
• Attend and lead multidisciplinary team meetings as well as meetings integrating the clinical, radiological and pathological presentations of cognitive disorders.

Collaborator:

• Interact effectively with multidisciplinary team and with community health care teams.
• Participation in clinical trials for pharmacological and non-pharmacological interventions for management of cognitive disorders

Leader:

• Effectively use health care resources, effectively manage time.

Health advocate:

• Recognize and effectively respond to situations which require advocacy on the part of patients with dementia and cognitive impairment with respect to the social, educational, and economic aspects that may adversely impact their health and their access to health care
• Initiate advocacy and understanding in the outpatient setting the approach to care and management of cognitive disorders in the context of the health care system

Scholar:

• Demonstrate expertise in appraising the clinical research literature and applying it to clinical practice
• Assist with teaching residents and medical students

Professional:

• Demonstrate integrity, dependability, and a desire for continuous learning and improvement.
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Curriculum

Case load: Clinics will involve the assessment of 1-2 new patients and the follow-up of 0-4 patients per half day. Inpatient services will vary depending on where the rotation takes place but should be capped at no more than 10 patients. There is no maximum on consultation services.

Key articles in cognition will be reviewed.

There will be weekly multidisciplinary meetings associated with outpatient clinics and wards, in which the fellow is expected to participate.

Division of Geriatric Medicine Grand Rounds and site-specific journal clubs are mandatory. Attendance at any rounds within the divisions of Geriatric Medicine, Neurology and Psychiatry pertaining to cognition will be strongly encouraged and supported.

Attendance at the annual Canadian Conference on Dementia or the Canadian Geriatrics Society will be supported. Attendance at other conferences pertinent to the fellowship will be also encouraged.

If a research project is undertaken, it will be expected the fellow will prepare a presentation at a scientific meeting which will be supported.

Fellows will be involved in the administrative aspects of memory clinics to provide them with a better understanding of how memory clinics are established and function.

Assessment

The Program Director will meet with the Fellow every three months; the fellow鈥檚 progress in the clinical environment will be explored. If a research project is pursued, the fellow will have monthly meetings with the research supervisor to discuss progress on the research project, and this will be used to compile the fellow鈥檚 evaluations. Evaluations in the form of ITERs (In training evaluations) will be reviewed at progress meetings every three months. At the completion of the fellowship, a final written evaluation will be completed and placed in the Fellow鈥檚 file. The Fellow will have the opportunity to provide feedback to the Training Committee and Fellowship Program Director anonymously. The Residency Training Committee will assess the quality of the curriculum of the Fellowship, on an annual basis.

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