Geriatrics Track

Why Geriatrics?

As our population ages, we will need a workforce that is well-equipped to provide patient-centered, goal-focused care for older adults. Nationally, older adults comprise 15-25% of the adult population but account for 50-60% of the hospitalized adult population. The six-county region surrounding Pittsburgh is disproportionately old, with 24% over the age of 65.

The consequences of an aging patient base are multifaceted. Physiologic, pharmacologic, and pathologic changes of aging affect disease presentation, natural history, differential diagnosis, response to treatment, and decisions regarding screening and preventive care. The multiplicity of care settings, regulations, and payment mechanisms also affect decision making and outcomes. Knowledge of these issues can help physicians differentiate normal aging from disease, juggle the challenge of multimorbidity, avoid iatrogenesis, and optimize older adults’ independence and quality of life. Such knowledge can also position physicians to help identify system-based problems and devise ways to make healthcare safer and more responsive to the needs of the oldest, chronically ill and frail. We need a workforce that is expert in providing geriatric-friendly care.

What are the core Geriatrics rotations?

To this end, all internal medicine residents spend at least 6 weeks in geriatrics rotations. Our PGY1s work with the consulting geriatricians at UPMC Presbyterian Hospital to assess and provide recommendations for geriatric syndromes arising in hospitalized patients. PGY2s spend two-weeks on the outpatient service providing both consultation and geriatric primary care, and two-weeks on the inpatient geriatric service learning to manage acute on chronic illness and emerging geriatric syndromes, and to optimize the transition to diverse forms of post-acute care.

What is the Geriatrics Track?

In addition to the above experiences, we are proud to offer one of the very few “geriatrics track” programs in the country. This is an opportunity for interested residents to enhance their knowledge of aging science and develop skills in providing care for older adults. We offer many varied clinical experiences to our residents who want to understand the healthcare continuum, work more intentionally with interprofessional teams, or explore innovative models of care and/or aging research. Track components include:

  • Geriatric medicine continuity clinic during outpatient blocks (splitting time with Gen Med Clinic)
  • Geriatrics track weekly conferences, including journal club with fellows and faculty. Topics emphasize core geriatrics competencies, new knowledge, and new care models.
  • Advanced electives in geriatrics:

      – Syndromes and Synthesis – Consultation skills for geriatric syndromes
      – Rehab and Recovery – Interprofessional team-based care in postacute care
      – Aging Brain – Diagnosis and management of dementias and mood disorders
      – End of Life in Geriatrics – Settings and systems of care in life-limiting illness

  • Mentorship in clinical, health services, and education research

We offer the geriatrics track to all interested residents, including those who may be considering a career in academic geriatrics.  Generalists and subspecialists alike will benefit from understanding principles of geriatric medicine; in fact many subspecialty organizations are embracing the need for geriatric training (e.g., emergency medicine, cardiology, hospital medicine, critical care).  Our division includes faculty who are dually trained in cardiology, pulmonary and critical care, endocrinology, rheumatology, urology, and palliative care, and we conduct cross-disciplinary research in all of these fields as well as with infectious disease, neurology, sleep medicine, and urogynecology, and orthopedics. We collaborate clinically with the trauma service, the geriatric psychiatry service, and the cardiology service.

What do graduates do?

We work with our track residents to find an appropriate mentor, and we provide resources and support to help each resident define and pursue their own individualized career goals.

Over the last five years, our geriatrics track graduates have pursued a variety of opportunities:

  • Fellowships: cardiology, critical care medicine, geriatrics, hematology/oncology, nephrology, palliative care, and rheumatology
  • Hospitalist practice
  • Private practice primary care, pursuing organizational leadership roles.

The Department of Medicine offers several positions in the Geriatrics Track each year. For additional information about this track, please contact Dr. Karen Scandrett. For more information about general application procedures, visit our How to Apply page.

Sample Schedule of a Geriatrics Track Resident

GERIATRICS TRACK

PGY1

5-6 Months of Inpatient Floors

2-3 Months General Medicine
1 Month Geriatrics/Neurology
1 Month Cardiology
1 Month Hematology/Oncology

1 Month Medical ICU

1 Month CCU

2-3 Months Electives

2 Weeks Night Float

Continuity clinic 1 full day per week every other month (outpatient months);
Clinic is split 50:50 between general medicine and geriatrics

PGY2

4 Months of Inpatient Floors

2 Months General Medicine
1 Month Cardiology
1 Month Hematology/Oncology

1-2 Months ICU (Medical ICU or CCU)

1 Month Inpatient + Outpatient Geriatrics

1 Month Ambulatory Block

2-3 Months Electives including Advanced Geriatrics Elective

2 Weeks Night Float/2 Weeks VA Emergent Care Center

Continuity clinic 1 full day per week every other month (outpatient months);
Clinic is split 50:50 between general medicine and geriatrics

PGY3

3 Months of Inpatient Floors

2 Months General Medicine
1 Month Cardiology

1-2 Months ICU (Medical ICU or CCU)

3-4 Months Electives including Advanced Geriatrics Elective

1 Month Special Elective

2 Weeks Night Float/2 Weeks VA Emergent Care Center

Continuity clinic 1 full day per week every other month (outpatient months);
Clinic is split 50:50 between general medicine and geriatrics

Karen Scandrett, MD, MPH

Director, Geriatrics Track

Shachi Tyagi, MD, MS

Associate Track Director, Research Liaison

“The UPMC Geriatrics Track was a tremendous launching pad for me, not only for my geriatric medicine fellowship, but also for my career. The track provided early and significant opportunities to see, learn, and practice compassionate care of the older adult and their family. I received strong mentorship, guidance in a geriatric scholarly project, and opportunities to meet with geriatricians who are now my colleagues.”

Hillary Day Lum, MD, PhD

Assistant Professor of Geriatrics, University of Colorado

“I joined the Geriatrics Track as a second year medicine resident and had a wonderful experience in the Geriatrics division. I had developed an interest in geriatrics during medical school but had not joined the track initially simply because early on I was undecided about my long term career plans. I realized during my intern year that I really enjoyed working with geriatric patients. I found the elderly to be a population with unique challenges for delivering medical care and in optimizing recovery that made patient care all the more rewarding for me. I also developed an interest in pursuing pulmonary and critical care medicine as a career and decided to join the geriatrics track to help enrich my long term clinical and academic interests.”

Faraaz A. Shah, MD

Assistant Professor of Medicine, PACCM

Read more about Faraaz's experience with the geriatric track.

“I joined the Geriatrics Track as a second year medicine resident and had a wonderful experience in the Geriatrics division. I had developed an interest in geriatrics during medical school but had not joined the track initially simply because early on I was undecided about my long term career plans. I realized during my intern year that I really enjoyed working with geriatric patients. I found the elderly to be a population with unique challenges for delivering medical care and in optimizing recovery that made patient care all the more rewarding for me. I also developed an interest in pursuing pulmonary and critical care medicine as a career and decided to join the geriatrics track to help enrich my long term clinical and academic interests. My experience in the Geriatrics track was phenomenal. The attendings within the division are great teachers with a wealth of experience and have been seeing some of their geriatric patients for decades. The didactic sessions prepare you for many diverse aspects of geriatric medicine ranging from minimizing polypharmacy to geriatric syndromes to managing psychiatric disorders in the elderly. Most of all the division has the feel of a close family and I always felt supported in my endeavors. The training in the Geriatrics track has prepared me well for my experience in pulmonary and critical care medicine, much more than I had anticipated. For example, my experiences working in the Benedum Center treating incontinence, malnutrition, and delirium as an outpatient have been invaluable in treating geriatric syndromes in an intensive care unit setting where they are often under-recognized. My experiences working in nursing homes and rehab settings have helped me better inform patients and families about what to expect during the long road to recovery following critical illness. My experiences working alongside palliative care teams have prepared me to discuss goals of care in a sensitive and respectful manner when recovery is not an option. In addition to enhancing my clinical experience, the Geriatrics track also enriched my academic experience. Through my scholarly project, I was able to combine my interests in geriatrics and critical care medicine. I developed a research project with a mentor in the Department of Critical Care, Dr. Sachin Yende, a clinical epidemiologist and translational scientist who studies long term outcomes after critical illness. My project utilized a clinical database to study a bidirectional relationship between cognitive dysfunction and pneumonia, both of which can lead to loss of independence in the elderly. I presented our findings at conferences within the Geriatrics division which prepared me for presenting internationally at the American Thoracic Society Annual Conference and in preparing our study for publication in the American Journal of Respiratory and Critical Care Medicine. I am delighted by the experience I received in the Geriatrics track and look forward to meeting the next generation of Geriatrics track residents in the years to come.”