Fellowship: Important Information

INFORMATION AND APPLICATION PACKAGE
FOR FELLOWSHIP CANDIDATES:

Tel: (808) 523-8461
Fax: (808) 528-1897

The following information is provided for candidates considering the Geriatric Medicine Fellowship Program in the Department of Medicine of the John A. Burns School of Medicine of the University of Hawaii. Geriatric Medicine is a new and growing field of Medicine. As such, the fellowship program is expected to grow and to change as new accreditation guidelines and opportunities for training emerge. Therefore, the information contained in this document should not be construed as a contract, but rather as a description of the program as of the revision date above.

PROGRAM DIRECTOR:
Patricia Lanoie Blanchette, M.D., MPH
Professor of Medicine and Public Health
347 N. Kuakini Street, HPM 9
Honolulu, Hawaii 96817

ASSOCIATE PROGRAM DIRECTOR:
Kamal Masaki, M.D.
Associate Professor of Medicine
347 No. Kuakini St, HPM 9
Honolulu, HI 96817
khmasaki@phrihawaii.org

ASSISTANT PROGRAM DIRECTORS:
Michael Carethers, M.D.
Clinical Associate Professor of Medicine
Dept. of Veterans Affairs
VAMROC
P.O. Box 50188
Honolulu, HI 96850

Warren Wong, M.D.
Clinical Assistant Professor of Medicine
Kaiser Foundation Hospital
3288 Moanalua Road
Honolulu, HI 96819

DIRECTOR OF RESEARCH:
J. David Curb, M.D., MPH
Professor of Medicine
347 N. Kuakini Street, HPM 9
Honolulu, Hawaii 96817

PROGRAM SECRETARY:
Danielle Kamalani-Patoc 347 N. Kuakini Street, HPM 9 Honolulu, Hawaii 96817

ACCREDITATION STATUS: Fully Accredited

DURATION OF FELLOWSHIP: 1 or 2 years. Fellows are usually accepted into a first year position and most remain with the program for two years.

CLINICAL TRACK: 1 year; eligible for CAQ in Geriatrics after 12 clinical months.
ACADEMIC/CONSULTING TRACK: 2 years; additional years possible depending on availability of funding. Second year individually tailored for each fellow, depending on interests and future directions. Options include research, clinical, advance degree (MPH, Ph.D.), medical education, and long-term care administration.

NUMBER OF FELLOWS: The program is accredited for 12 positions and has funding for 11. For the academic year 1999-2000, there were 7 first-year and 4 second-year positions available. All positions are filled. The program is now reviewing candidates for entry July 1, 2005.

ELIGIBILITY REQUIREMENTS: All qualified candidates are invited to apply, regard- less of age, ethnicity, sex, or religious beliefs. Hawaii is a multicultural, multiethnic community. The age of the applicant is not a factor in selection.

  • successful completion of a residency and board eligibility or certification in Internal Medicine or Family Practice.
  • a career interest in clinical practice, teaching, and/or research in Geriatric Medicine.
  • a Hawaii medical license must be obtained prior to beginning the fellowship.

SPECIAL FEATURES OF THE FELLOWSHIP PROGRAM:

  • Hawaii and the Pacific Basin: The medical school and the Geriatric Education Center are involved with interdisciplinary teaching and research in several Pacific Basin nations and territories. These currently include American Samoa, Guam, Saipan, Okinawa, Taiwan, and several locations in Micronesia. In addition, an elective in Bangkok is possible. Several fellows have been provided with the opportunity to travel to these areas to participate in educational or research activities.
  • Cross-cultural or minority aging: The people of Hawaii are of many different ethnic and cultural backgrounds, with no group comprising a majority. Currently, mixed marriages are the norm, and the majority of babies born in Hawaii are of mixed ethnicity. The geriatrics faculty and fellows are also ethnically diverse, with Black, Chinese, French, German, Hawaiian, Indian, Japanese, Korean, Polish and Portuguese cultures or languages currently represented. There is excellent opportunity for cross-cultural studies.
  • Epidemiologic Studies: Dr. J. David Curb, the director of research for the fellowship program is an internationally recognized epidemiologist who is the principal investigator of several large epidemiologic studies. Several of the other research scientists associated with these studies regularly interact with fellows for research training. A few of the ongoing studies include: - The Honolulu Heart Program, a longitudinal prospective study of cardiovascular disease in elderly Japanese-American men - The Honolulu-Asia Aging Study of dementia and healthy aging - The Hawaii center for the Women's Health Initiative, a multi-center study of post-menopausal women in the US - Intermap, a multi-center international study of nutritional determinants of blood pressure - Sapphire, a multi-center study of the genetic determinants of hypertension Affiliated with these studies are NIH scientists on-site who are available for collaboration with the fellows in the design and implementation of their research projects.

PROGRAM LOCATION: The medical school of the University of Hawaii bases its clinical instruction in closely-affiliated community hospitals located in close proximity to the main campus. The fellowship program is based at Kuakini Medical Center, the home of the medical school's Geriatric Medicine Program and the internationally-recognized Honolulu Heart Program and Honolulu-Asia Aging Study. It is also the home of the John A. Hartford Center of Excellence in Geriatric Medicine and the Pacific Islands Geriatric Education Center. Kuakini Medical Center includes a modern 250-bed Acute Care Hospital, and a broad range of Geriatric services, including: Skilled Nursing Facility; Intermediate Care Facility; SNF-Rehab; Care Home; Adult Social Day Care Program; Day Health Program; Audiology Center, and licensed Home Care Program. The Rehabilitation Hospital of the Pacific is located across the street and available for electives. The fellows share office space on the top floor of Kuakini's Hale Pulama Mau, a modern academic facility with offices, classrooms, study carrels, library, examining rooms, audio-visual studio, and computer system. Fellows also rotate through the Honolulu VA Outpatient Clinic, VA Center for Aging, and the Kaiser Permanente Medical Center .

FELLOWSHIP PROGRAM YEAR 1 CLINICAL ROTATIONS:

  • GERIATRIC & FAMILY CONSULTATION SERVICE (GFCS) (2 months): This is a comprehensive outpatient interdisciplinary team evaluation service, under the direct supervision of Dr. Linda Tom. The GFCS provides consultation and short-term case management to patients and their families. The fellow serves on a team consisting of a Geriatrician, fellow, Medical Social Worker and medical resident. The service is located at Kuakini Medical Center, the home of the fellowship program.
  • AMBULATORY CARE AND NURSING HOME CONSULTS (2 months): This rotation is an ambulatory care experience at Kuakini Medical Center, under the direct supervision of Drs. Marianne Tanabe and Shari Kogan. The fellow sees patients for ambulatory care and also performs nursing home consults with the faculty during this rotation.
  • PROGRAM DIRECTOR'S ROUNDS (PDR) (2 months): During this rotation the fellow is directly supervised by the program director, Dr. Patricia Blanchette. The PDR rotation provides in-patient consults at Queens Medical Center, as well as instruction in medical directorship of nursing homes.
  • KAISER HMO ROTATION (2 months): At Kaiser the fellow is directly supervised by Drs. Warren Wong and Joy Murakami. The rotation is designed to thoroughly familiarize the fellow with health care delivery to the elderly in an HMO setting. It includes a range of experiences from acute care to home visits.
  • VA OUTPATIENT ROTATION (2 months): While at the VA the fellow is supervised by Drs. Carethers, Joseph, Epure and China. During this rotation, the fellow provides outpatient services in both an interdisciplinary team and primary care format.
  • VA-CFA ROTATION (2 months): The VA Center for Aging (CFA) is a facility that provides short-term post-acute hospital care and respite care for eligible veterans. Fellows provide care to patients in an interdisciplinary team setting. At the VA-CFA, the fellow is supervised by Drs. Joseph, Epure and China.

OTHER FIRST-YEAR FELLOWSHIP ACTIVITIES:
  • PRIMARY CARE PANEL: This is a longitudinal experience that continues over the two years of the fellowship program. Fellows acquire a panel of approximately 10-20 outpatients for whom they function as the primary care Geriatrician under the direct supervision of faculty. For primary care panel, fellows are assigned for the duration of the fellowship either to Kuakini (supervised by Drs. Blanchette, Masaki, Wergowske, Tom, Tanabe, Kogan), or to the VA (supervised by Dr. Carethers). For these patients the fellow functions as the "attending" and is on-call for admissions or urgent care (except for VA patients).
  • UNIVERSITY LONG-TERM CARE SERVICE (ULTCS): This is a longitudinal experience over two years of the fellowship, under the direct supervision of Drs. Blanchette, Masaki, Wergowske, Tom, Tanabe, and Kogan. Most fellows will have patients assigned at Kuakini (Hale Pulama Mau), Maunalani, Pearl City, or the VA-CFA. The fellow provides primary care to a panel of patients selected from every level of long-term care, including SNF, ICF, Care Home, Adult Social Day Care, and Day Health. The fellow also participates in the inter-disciplinary team meetings held at each level of care. This rotation is designed to completely familiarize the fellow with the physician's role in long-term care.
  • DIDACTIC SESSIONS: Several different types of regularly scheduled seminars are included in the training program. These include: daily Chapter Review or Problem-Based Learning sessions; weekly "core curriculum" lectures; weekly Epidemiology and Research Methods course; Law, Medicine and Ethics seminar; and twice monthly Journal Club.
  • VA NEIGHBOR ISLAND VISITS: Each fellow has many opportunities to travel to the neighbor islands (Maui, Hawaii, Kauai, Molokai, Kona and Hilo) with VA faculty for consulting visits to the VA outpatient clinics and for other Geriatric Education Center Activities.
  • TEACHING ACTIVITIES: Fellows participate in teaching activities and directly supervise medical students and residents assigned to the Geriatrics service. They also prepare and deliver several lectures on topics in Geriatrics, participate in rounds, case conferences and continuing education conferences. Fellows are also afforded the opportunity to have their travel expenses paid to the neighbor islands for teaching and case conferences.
  • NATIONAL MEETINGS: Fellows are provided with $1,600 per year to help defray the cost of attending the annual meeting of the American Geriatrics Society and/or the Gerontological Society of America.
SUMMARY OF FIRST YEAR ACTIVITIES:
  • VA clinical rotation 2 MONTHS
  • VA-CFA clinical rotation 2 MONTHS
  • Ambul care + NH Consults 2 MONTHS
  • Clinical rotation 2 MONTHS
  • Kaiser clinical rotation 2 MONTHS
  • GFCS clinical rotation 2 MONTHS
  • PDR clinical rotation 2 MONTHS

  • VA neighbor island clinics as assigned
  • University Long-term care service
  • Primary care panel
  • Didactics (core lecture, chapter review, journal club, research methods course, etc)
  • Planning 2nd year research project (for those planning to stay for a second year)

FELLOWSHIP PROGRAM YEAR 2

  • KUAKINI HOSPITAL INPATIENT CONSULTS (3-4 months): The fellow is assigned to Kuakini Medical Center to learn the role of the Geriatrician as a consultant. The fellow responds to requests for inpatient consultations, often with a medical resident on rotation in Geriatrics, at the request of attending physicians. The case is then staffed by a faculty Geriatrician. This is not a full-time experience as consultations usually average one or two requests per week, allowing the fellows most of their time for elective work or research.
  • RESEARCH: The fellows are provided with ample time to participate in research. Hawaii is the home of several important research projects in dementia, heart disease, cancer, and osteoporosis. Additionally, there are usually one or more clinical trials providing an optional experience for fellows with medications in the developmental stages. The fellow will have the opportunity to work with nationally-recognized senior investigators.
  • ELECTIVES: Fellows may participate in a number of electives (up to 3 months total) including: rehabilitation medicine; geriatric psychiatry; neurology; neurobehavioral medicine; cardiology; health policy; and others. They may also take a 6-week elective away. The program provides unique opportunities for electives in Okinawa, Bangkok, or in other Pacific Islands by special arrangement.
  • PAPERS: During the second year the fellow prepares at least one paper for presentation at national conference on Geriatrics or the regional meeting of the American College of Physicians and at least one paper for publication. The faculty advise and assist the fellows, both with the paper(s) and with preparation for oral presentation.
  • ADVANCED DEGREES: Fellows are encouraged to attend University classes and work towards related advanced degrees (such as an MPH or Ph.D.). Application to the graduate program must be made separately by the fellow, but will be guided and assisted by the geriatrics faculty. Fellows are responsible for their own tuition. However, with the assistance of the Hartford Center of Excellence grant, tuition reimbursement may be possible as funding permits.

SUMMARY OF SECOND YEAR ACTIVITIES: In-patient consults 3 MONTHS Clinical electives (up to 6 weeks away) 3 MONTHS Individually planned 6 MONTHS

  • Primary care panel
  • VA urgent care clinics - 2 half days a month
  • University Long-term care service
  • Didactics (core lecture, chapter review, journal club, etc)
  • Research methods course
  • Honolulu Heart Program M&M conferences
  • 2nd year research project and/or advanced degree work
NIGHT AND WEEK-END CALL: First and Second Years:
  • On weekdays, fellows are expected to take beeper call from home for their own primary care and nursing home patients.
  • On weekends and most holidays, fellows are on a rotating call schedule to cover all the primary care and nursing home patients, this is also by beeper call from home.

SALARY AND BENEFITS:

  • For fiscal year 2004-2005 the annual salary is $50,916. Fellows may earn other income in addition to their fellowship salary by special arrangement. Interested candidates are invited to inquire.
  • The fellow also receives several fringe benefits, including: health insurance; temporary disability and worker's compensation; group life insurance; four weeks (20 days, Monday through Friday, exclusive of holidays) paid annual vacation; and 12 days annual sick leave.
  • The program provides paid non-working holidays according to the University of Hawaii holiday schedule.
  • The fellow receives an annual allowance of $1,600 to help defray the cost of attending either the annual meeting of the American Geriatrics Society or the Gerontological Society of America.
  • A one-time $1,000 moving allowance is available for fellows who must relocate to Oahu for the fellowship.
  • The program allows for certain paid absences from duties, such as for educational leave, temporary military duty, or a death in the family.
  • The program allows for certain unpaid absences for compelling, urgent or unusual circumstances as well as for maternity/paternity/adoption leave. The fellow may qualify for temporary disability benefits and/or sick leave during the maternity/paternity/adoption leave.
  • The combination of paid or unpaid leaves of absences from the program which exceeds two months in any program year will not be counted towards completion of required fellowship program time. Approved elective time or approved carry over of vacation time from year one to year two are not included in the two month limit.
  • The program does not provide or arrange for living quarters. However, the faculty are pleased to give advice and to assist fellows to find suitable housing.
  • The program offers a tax-deferred annuity plan which allows deductions from income on a before-tax basis. Participation is voluntary and contributions can be made only through payroll deductions. The program does not contribute to the plan.
  • MOONLIGHTING: All moonlighting has to be approved in writing by the fellowship program director. You must provide your own malpractice coverage for moonlighting. This activity should ONLY take place after usual work hours or weekends/holidays, and cannot interfere with regularly scheduled fellowship activities.
  • VACATION: The fellow may take up to 20 working days of vacation each year. In the first year, no more than two weeks may be taken off during a two-month rotation. However, four consecutive weeks are possible if the last two weeks of a rotation are combined with the first two weeks of the next. Requests for vacation time should be made in writing at least 3 months in advance, except for emergencies. You are responsible for informing all relevant attendings (rotation attending, PCP attendings, ULTCS attendings, research attending).


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