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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