Geriatrics Fellowship Rotation Sites | UC Davis Health

Core Clinical Experiences:

Outpatient Geriatric Medicine Fellows gain comprehensive experience in the ambulatory setting to evaluate and manage older adults with complex, multimorbid conditions. Emphasis is placed on geriatric syndromes such as cognitive impairment, falls, polypharmacy, and frailty, utilizing structured assessment tools including the comprehensive geriatric assessment (CGA). Fellows work collaboratively within an interdisciplinary team to develop individualized, patient-centered care plans that align with patients' goals and functional status.

Home Health Care This rotation provides fellows with direct exposure to the unique medical, functional, and psychosocial needs of homebound older adults. Fellows conduct in-home assessments that allow for a firsthand evaluation of the patient's living environment, safety risks, caregiver support, and barriers to care. The experience emphasizes care coordination, community resources, and primary care providers to optimize the manage complex, functionally limited patients.

Nursing Home / Skilled Nursing Facilities Fellows develop clinical expertise in the post-acute and long-term care setting, managing a diverse population of older adults requiring rehabilitation, complex medical care, or ongoing skilled nursing support. Emphasis is placed on transitions of care, goals-of-care conversations, pain and symptom management, and the prevention and treatment of common geriatric conditions such as delirium, pressure injuries, and functional decline. Fellows also gain experience navigating the regulatory, ethical, and interdisciplinary dimensions unique to institutional long-term care environments. Fellows have a nursing home continuity care experience and elective time focused on geropsychiatry in the nursing home.

Inpatient Geriatric Medicine Fellows participate in the acute hospital-based care of older adults with complex medical conditions, focusing on the recognition and management of geriatric syndromes that commonly complicate hospitalization, including delirium, falls, malnutrition, and functional decline. The rotation emphasizes the application of age-friendly care principles, appropriate medication management, and early discharge planning in collaboration with an interdisciplinary team. Fellows refine their skills in goals-of-care discussions, prognostication, and the coordination of safe transitions to post-acute or community-based care settings.

Geriatric Emergency Department: Fellows develop specialized skills in the acute evaluation and management of older adults presenting to the emergency department with complex, high-acuity conditions, including falls, altered mental status, sepsis, and acute functional decline. The rotation emphasizes the application of geriatric-focused screening tools such as delirium assessments, frailty screening, and medication reconciliation to identify vulnerable older adults at risk for adverse outcomes. Fellows work closely with specialized geriatric emergency medicine physicians, social workers, and care coordinators to facilitate appropriate disposition planning, ensuring safe transitions to inpatient, post-acute, or community-based care settings.

Inpatient Palliative Medicine: Fellows develop foundational skills in the assessment and management of pain, dyspnea, and other burdensome symptoms in seriously ill older adults across a range of advanced and life-limiting conditions. The rotation emphasizes structured approaches to goals-of-care conversations, advance care planning, and shared decision-making with patients, families, and surrogate decision-makers in the inpatient setting. Fellows work alongside an interdisciplinary palliative care team to gain expertise in aligning medical care with patient values and preferences, supporting transitions to hospice when appropriate, and addressing the physical, emotional, and spiritual dimensions of serious illness.

Electives:

Electives are primarily in the outpatient setting and designed to broaden the fellow’s clinical experiences and support learning in key areas of care for older adults. Electives can vary based on a fellow’s interests and elective availability. The electives fall into two categories. The first is exposure experiences where the fellow may only spend 1-3 days to gain exposure to an area of interest. For example, these experiences could include: home visits with Sacramento County Adult Protective Services, Caregiver Consultation clinic or Neuropsychology clinic for evaluation of neurocognitive disorder. The second type of elective can occur for 1-2 weeks and, for example, could include Program for All-inclusive Care of the Elderly (PACE) or Movement Disorders clinic.

Didactics:

Our academic curriculum has multiple components to assure a rich learning experience. Fellows have protected time for didactics and other learning activities every other Wednesday afternoon which include:

·       Lectures from a broad range of geriatricians and specialty faculty

·       Fellow led journal club, case conference and grand rounds

·       Board preparation

Scholarship:

Each fellow engages in a scholarly project. Projects are developed and structured for the fellow to be successful and specifically designed to be accomplished in one year. The fellow is provided mentorship and the necessary resources to produce an academic poster to be presented by the end of their fellowship. There are multiple opportunities at UC Davis and nationally to present scholarly work.

Our fellows are encouraged and supported to participate in national initiatives and learning opportunities. They are supported and encouraged to join the Futures program with the Society for Post Acute and Long Term Care Medicine and participate and share projects at the annual American Geriatrics Society meeting and the California Academic Geriatrics Institutions meeting.

Teaching:

Geriatrics fellows have the opportunity to teach medical students and residents. The fellows support the medical student geriatrics elective and teach them once a month. The fellows supervise and teach the residents on inpatient rotations. Fellows are encouraged to engage with the community and provided the opportunity to give educational talks to community groups if interested. 

Rotation Sites:

UC Davis Health

The UC Davis site has core experiences for the fellows in the multidisciplinary Healthy Aging Clinic (HAC), the Inpatient Consult Service, and the Geriatric Emergency Department. With the HAC the fellow will work with a multidisciplinary team comprehensive geriatrics program including geriatricians, physical therapist, pharmacist, social worker, and dietician. The clinic also includes a Dementia Care Program and, Caregiver Consultation Service. 

Mercy Medical Group

Fellows gain community care practice experience by working closely with the community. The geriatrics clinical group make home and nursing home visits with physicians and APPs.

VA Northern California

• Sacramento
  Fellows rotate in geriatric outpatient clinics, on the inpatient psychiatry ward, and with the palliative care inpatient and outpatient services, and in the home-based geriatric primary care and coordination of care services. Fellows have their weekly geriatric continuity clinic based at this site.
• Martinez
  Fellows learn principles of post-acute and rehabilitative care as well as inpatient hospice at Center for Rehabilitation and Extended Care (CREC) and the Community Living Center (CLC) on the Martinez VA Campus. The CLC/CRC is a 120-bed extended care facility that offers subacute, rehabilitation, restorative, palliative, respite and transitional care. It also operates a neurocognitive unit, subacute unit, and a 23-hour bed program in support of post-procedural ambulatory care services.

University Post-Acute Rehab

Fellows have their long-term care continuity experience at this community-based nursing home.

Healthy Aging Clinic in Midtown

Click here to learn more about the Healthy Aging Clinic