One of the specific goals of the geriatric emergency medicine (GEM) fellowship at the University of California, Davis Department of Emergency Medicine is to spread the word about what works for older patients and their families while they are in our emergency departments. The fellowship provides clinical training in GEM, with additional experience in education, research, operations, and policy.

The GEM fellowship is appropriate for a candidate with a strong interest in operations and quality improvement. Clinical experience in the management of geriatric patients is gained through geriatric clinics, home-based primary care, outpatient and residential services, and subspecialty surgery experience such as vascular surgery and orthopedics. There is a strong palliative care component, including some hospice involvement.

UC Davis has a newly established multidisciplinary geriatric fracture program for coordinated management of hip fracture patients. A large multidisciplinary team of educators supplements the EM geriatrics faculty. The GEM fellowship places a strong emphasis on improving the care of the elderly patient in the emergency department, safe discharge practices, care transitions, multidisciplinary teams, and perioperative management. The graduating fellow will use this experience to further develop GEM in the academic or community setting. The fellow will work part time as clinical faculty in the ED at UC Davis and VA Mather to provide funding support for the fellowship.

The GEM fellowship at UC Davis is available as a one- or two-year option for emergency medicine graduates, and the fellows work about six ED clinical shifts per month, with some adjustments made for when they are on heavier clinical rotations. GEM fellows are compensated in the neighborhood of $85,000 annually.

One of the advantages of not being ACGME accredited (no GEM fellowships are currently accredited) is that there is fluidity to the schedule and curriculum. For example, if a candidate is very interested in the operations and leadership side of things, then the educational experience could be tailored to that interest, including an away rotation to a department with a geriatric observation unit. Another candidate may be more interested in the actual medical components of geriatrics, and the experience could be more focused on clinical geriatrics.

The key components of the geriatric curriculum include a mix of short-term (one to two months) and longitudinal (three to six months) clinical experiences.

Short-term clinical exposures include:

• Neurology clinic
• Hospice program
• Home-based primary care
• General medical consultation service
• Preoperative evaluation and postoperative management

Longitudinal experiences include:

• Geriatric outpatient clinic
• Palliative care medicine
• Long-term care facility
• Geriatric pharmacology management

Dr. Tyler is geriatric emergency medicine fellowship program director, associate residency director, and associate professor in the Department of Emergency Medicine at the University of California, Davis.