Clinical Rotations

Geriatric Psychiatry Inpatient Unit

Duration: Four to six months (87.5% time)

Three board-certified geriatric psychiatrists and one medical psychiatrist staff our 14-bed Geriatric Psychiatry Inpatient Unit. The unit is dedicated to caring for older adults, individuals with early onset dementing illness, and adults with complex medical comorbidity not acute enough to admit to our medical psychiatry unit. Fellows are directly responsible for six to eight patients and take on increasing responsibility for directing the work of other trainees on the unit as the year progresses. Daily rounds are followed by individual patient encounters and emphasize diagnosis and somatic therapies of late-life geriatric illness, including electroconvulsive therapy (ECT). Discharge planning with family and community resources are also emphasized.

Geriatric Psychiatry Outpatient Clinic

Duration: 11 months (usually 10% time - four half days per month)

Fellows in the Geriatric Psychiatry Outpatient Clinic perform diagnostic evaluations on all new geriatric patients. Findings are reviewed and treatment plans are developed by fellows and attending faculty. Fellows will see one new geriatric patient and have two to four follow-up visits during an average a week. Common diagnoses include mood disorders, dementia, and psychotic disorders. Treatment plans often include medication management and individual therapy. Fellows may also see patients after discharge from the inpatient unit, assist with community referrals, and provide second-opinions for the state-wide catchment area.

Windmill Manor

Duration: 11 months (2.5% time - one half day per month)

Windmill Manor is a nursing home located about 5 miles from UI Hospitals and Clinics. During an average half-day visit, fellows perform one diagnostic evaluation and have three to four follow-ups. Common diagnoses for residents of the 120-bed facility include dementia, usually combined with behavior problems, depression, anxiety, or psychoses; anxiety disorders; mood disorders; and behavior problems without any clear psychiatric diagnosis. This rotation allows fellows to practice providing continuity of care in a long-term hospital setting.

Iowa Veterans Home

Duration: One month

Fellows will experience a different system of care during their rotation at the Iowa Veterans Home in Marshalltown, Iowa, which provides care to more than 670 individuals. Duties will include performing evaluations and designing treatment plans with a multidisciplinary team. Diagnoses include anxiety disorders, dementias, mood disorders, personality disorders, psychotic disorders, and substance use disorders. Some patients will have been recently admitted while others are longstanding members of the community who recently developed mental illness. The facility has three CCDI (secured dementia) units with a total of 55 beds, two electronically monitored dementia units with a total of 66 beds, and a domiciliary (residential care facility) with 111 beds. Fellows see approximately ten new patients and 60 to 80 follow-up patients during an average month. Housing is provided on-site and fellows are excused from UI Hospitals and Clinics activities during this time.

Palliative Care Service and Iowa City Hospice

Duration: One month (87.5% time)

The Palliative Care Service at UI Hospitals and Clinics is made up of experts in palliative care and hospice, family medicine, internal medicine, psychiatry, surgery, anesthesiology, cardiology, pastoral care, social work, and music therapy. The service provides team consultations to all adult units in the hospital, usually about 85 new patients each month. Iowa City Hospice has an average daily census of 90 to 100. The majority of patients are over the age of 65 and enrolled for diagnoses that include cancer, dementia, or general decline.

Neurology Outpatient Clinic

Duration: One month (60% time)

The Neurology Outpatient Clinic is staffed by 20 neurologists and four neuropsychologists, and works closely with occupational and physical therapy. In addition to general neurology, fellows gain experience in various subspecialties, including memory disorders, movement disorders, and stroke. Fellows see approximately four patients on an average day. Every patient is also seen by a supervising faculty physician who reviews findings and treatment plans.

Geriatric Medicine Clinic

Duration: One month (87.5% time)

Three to four faculty members from Family Medicine and Internal Medicine staff the Geriatric Medicine Clinic at UI Hospitals and Clinics, which sees 130 patients per month. A wide range of acute and chronic medical problems are seen in this clinic where all of the patients are over the age of 60 and 75 percent are over the age of 75. Fellows see approximately ten patients daily, half of which require diagnostic evaluations. A strong emphasis is placed on interdisciplinary team management, iatrogenic illness, occupational and physical therapy, and community service referral.

General Hospital Medicine

Duration: One month (42.5% time)

Three psychiatrists who are certified in either psychosomatic medicine or internal medicine-psychiatry staff the consultation-liaison service at UI Hospitals and Clinics. The service sees up to 100 patients per month, 10 percent of which are geriatric. The most frequent diagnoses include delirium, dementia, mood disorders, substance use disorders, anxiety disorders, and other organic mental disorders. Fellows see up to four new patients weekly and have 3 to four follow-up patients daily. During this rotation, fellows are required to attend Clinical Problems in Consult Psychiatry, a weekly conference.

Physical Medicine and Rehabilitation

Duration: One month (50% time)

The physical medicine and rehabilitation service at St. Luke's Hospital in Cedar Rapids, Iowa, is staffed by a multidisciplinary team of physicians, nurses, social workers, case managers, psychologists, neuropsychologists, physical therapists, occupational therapists, speech therapists, and recreational therapists. Fellows will observe and participate in all phases of inpatient and outpatient care during this two-week rotation. General rehabilitation as well as specialized rehabilitation for impairments that include stoke, brain injury, spinal cord injury, multiple major trauma, neurological disorders, and orthopedic disorders is emphasized. Fellows see five to six patients on the inpatient unit on an average day and 10 patients in the outpatient clinic on an average week.