GERIATRICS FELLOWSHIP

Advanced Fellowship

...take it a step further

 

University of Texas Health Science Center at San Antonio

Audi Murphy Veterans Health Administration

 

The Geriatric Fellowship Program at San Antonio is a Hartford Center of Excellence in Geriatrics which includes four specialized tracks to build the individuals strengths with the needs of the field and the Institution. The four tracks are:

 

- Clinical Research
- Health Outcomes Research
- Clinician Educator
- Basic Science Research

 

Overall the tracks have an extensive individual mentoring along with experiential research training matching each tracks goals, complemented by didactic activities. A personalized training plan is developed for each trainee early in the course of the Fellowship. The Writing skills enhancement, guidance on balancing personal life and professional career, exposure to inter-disciplinary mentors and the option to do a Masters In Clinical Investigation are some of the features of our program. Over the next 5 years, we will increase our focus on physician scientists, translational researchers (with both types of translation - from bench to bedside and from bedside to community), and strong clinician educators and diversity of trainees.

 

Overall thematic areas and competencies will be share by all the tracks. These are base in our CTSA ( Clinical and Translational Science Award Center). The following are the thematic areas and competencies.

 

1. Clinical and translational research questions
2. Literature critique
3. Study Design
4. Research Implementation
5. Sources of error
6. Statistical approaches
7. Biomedical Informatics and innovation
8. Responsible conduct of research
9. Scientific communication
10. Cultural diversity
11. Translational teamwork
12. Leadership
13. Cross disciplinary training
14. Community engagement

 

 

Description of the Tracks

 

Health Research Outcomes:

 

What is clinical research?

 

Clinical Research – NIH defines clinical research as: (1) Patient-oriented research. Research conducted with human subjects (or on material of human origin such as tissues, specimens and cognitive phenomena) for which an investigator directly interacts with human subjects. Excluded from this definition are in vitro studies that utilize human tissues that cannot be linked to a living individual. Patient-oriented research includes: (a) mechanisms of human disease, (b) therapeutic interventions, (c) clinical trials, or (d) development of new technologies. (2) Epidemiologic and behavioral studies. (3) Outcomes research and health.

This track is dedicated to developing fellows interested in the clinical research but with focus in geriatrics. Fellows and junior faculty who are recognized locally—and eventually nationally—for their expertise in a specific areas of geriatrics clinical research outcomes and related academic and teaching activities. San Antonio is proud to have the partnership with the TARC (Texas Alzheimer’s Research Consortium;
http://www.txalzresearch.org/) that specializes in Dementia research also with the VERDIC (Veterans Evidence Based Research Dissemination and Implementation Center; http://www.verdict.research.va.gov/) as the main resource for the track.


Trainees are encouraged to select a specific clinical research area of expertise on which they will focus their career development. Through this approach, clinical research fellows and junior faculty become known about their research expertise and innovative teaching in their defined areas. With this expertise, they help take the lead on developing new research projects, courses, publish and make a difference in our community.

 

 

Program development


Each fellow interested in clinical research meets with the core Hartford geriatric committee and/or VERDIC and or TARC mentor and develops a strategic career plan for the second year. A quarterly overview of faculty interests enables trainees to select an area of clinical focus and to identify mentors with expertise in that area. Mentees identify mentors through discussions with the Section Chief and the Fellowship Director, as well as at a transitions gathering at the beginning of the academic year. Mentors meet with mentees at least quarterly.


Areas of focus in our fellowship in clinical research includes dementia, infection diseases, health literacy, VA; VERDICT projects plus TARC (Texas Alzheimer’s Research Consortium) among many others.


A research portfolio is mandatory for the fellows where they manage and follow their progress with supervision of the core fellowship faculty and mentors. This portfolio will help to apply to get future local and national a completion of the fellowship. The e-portfolio is review quarterly and our educator will coach the fellows in how to develop them.


The amount of time committee to work in the track is close to 70%. This includes faculty development activities, teaching sessions, research development and clinical experiences where the fellow will interact with different faculty and community leaders.

 

 

Funding Sources

 

The health research outcome program is supported by the Hartford Center of Excellence, both through salary support for fellows directly upon a competitive application. A stipend cover salary enhancement and also research support thought funding. We also have support locally by the VA hospital, and our HRSA grant to provide support for these positions.


Health research fellows (junior faculty and fellows) are mentored by senior faculty who are at the Associate Professor and Professor levels. Again the TARC, VERDIC, The Department of Medicine and family medicine supports faculty time through a faculty funding agreement recognizing their efforts.

 

 

Process and Outcomes Data

 

The program is designed to assist fellows and junior faculty in meeting the criteria for promotion as Researchers. Each participant is expected to write up their experiences for presentation at national meetings and for publication.

 

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Health Outcomes Research

 

What is health outcomes research?

 

Outcomes research seeks to understand the end results of particular health care practices and interventions. End results include effects that people experience and care about, such as change in the ability to function. In particular, for individuals with chronic conditions—where cure is not always possible—end results include quality of life as well as mortality. By linking the care people get to the outcomes they experience, outcomes research has become the key to developing better ways to monitor and improve the quality of care.

 

This track is dedicated to developing fellows interested in the outcomes research with a focus in geriatrics. The VERDICT (Veterans Evidence Based Research, Dissemination and Implementation Center; http://www.verdict.research.va.gov/) is a key resource for fellows in health outcomes research. It has an interdisciplinary team of clinician investigators and social scientists and over 20 administrative support and technical staff. Current areas of focus include:

    • organizational effectiveness and change in health care settings, relational coordination and communication among health care teams (especially those in primary care and in ICU settings)
    • chronic care management, coordination of care, perioperative risk management, and genomic health services for complex patients
    • quality of care improvement and outcomes for patients with diabetes, obesity, pneumonia, epilepsy, serious mental illness, PTSD, and post-deployment health

Trainees are encouraged to select a specific clinical and community area of expertise on which they will focus their health outcomes research. Through this approach, health research aging fellows and junior faculty become known about their research expertise and innovative teaching in their defined areas. With this expertise, they help take the lead on developing new projects, courses, publish and make a difference in our community.

 

 

Overview

 

Each fellow interested in health research meets with the core Hartford geriatric committee and VERDIC mentor and develops a strategic career plan for the second year. A quarterly overview of faculty interests enables trainees to select an area of clinical focus and to identify mentors with expertise in that area. Mentees identify mentors through discussions with the Section Chief and the Fellowship Director, as well as at a transitions gathering at the beginning of the academic year. Mentors meet with mentees at least quarterly.

 

Areas of focus in our fellowship in health research include, all verdict projects plus and Practice Base Networks, and ASPRI.

 

The amount of time committed to work on the health outcomes research track is 70%. This includes faculty development activities, teaching sessions, curricular development and clinical experiences where the fellow will interact with different levels of learners. We work closely with the Institution’s the Academic Center in Education and Teaching (ACET), intended to enhance fellow teaching skills and to provide direct feedback and support in preparation of teaching materials.

 

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Clinician Educator Track

 

What is a Clinician Educator?

 

A clinician educator specialized in teaching, both in the clinic and in the classroom. Research and publishing focus on new ways to teach, curriculum design, and evaluation.

 

This track is dedicated to developing geriatric clinician-educator fellows and junior faculty who are recognized locally—and eventually nationally—for their expertise in a specific area of clinical geriatrics and related academic and teaching activities.

 

Clinician-educator trainees are encouraged to select a specific clinical area of expertise on which they will focus their teaching career, similar to an area of concentration for clinician-researchers. Through this approach, clinician-educator fellows and junior faculty become known for their clinical expertise and innovative teaching in their defined areas. With this expertise, they help take the lead on developing new lectures, courses, and electives in their topic area.

 

 

Overview

 

Each clinician-educator fellow meets with the core Hartford geriatric committee for clinician educator track and develops a strategic career plan for the second year. A quarterly overview of faculty interests enables trainees to select an area of clinical focus and to identify mentors with expertise in that area. Mentees identify mentors through discussions with the Section Chief and the Fellowship Director, as well as at a transitions gathering at the beginning of the academic year. Mentors meet with mentees at least quarterly.

 

Areas of focus in our fellowship include dementia with the TARC(Texas Alzheimer’s Research Consortium: http://www.txalzresearch.org/) ; pain management in collaboration with Palliative care and Hospice Program; polypharmacy; ethnogeriatrics; systems of care; acute care of elderly in the ACE (Acute Care of the Elderly unit) w/o walls at the NIX hospital; interdisciplinary teaching; transitions of care; geriatric oncology; specific geriatric care settings such as long- term care, care of veterans, and quality improvement.

 

A clinician portfolio is mandatory for the fellows. The portfolio is a tool for developing and documenting trainee progress with supervision of the core fellowship faculty and mentors. This portfolio will support efforts to win GACA awards (Geriatric Academic Career Award: http://www.hrsa.gov/grants/gaca/): and local Institutional clinician educator awards after completion of the fellowship. The e-portfolio is reviewed quarterly. our educator will coach the fellows in how to develop them.

 

The amount of time allotted for educational track activities is close to 70%. This includes faculty development activities, teaching sessions, curricular development and clinical experiences. Fellows will interact with many levels of learners and have opportunities to teach individuals, small and large groups. We work closely with the Institution’s the Academic Center in Education and Teaching (ACET : http://www.uthscsa.edu/acet/) is intended to enhance fellow teaching skills and to provide direct feedback and support in preparation of teaching materials.

 

Clinician-educator trainees (junior faculty and fellows) are mentored by senior faculty who are at the Associate Professor and Professor levels. The Departments of Medicine and Family Medicine support faculty time through a funding agreement recognizing their efforts.

 

Currently, four clinician-educator junior and mid career faculty have secured Geriatric Academic Career Awards (GACAs) as well and are active in the clinician educator track.

 

 

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Basic Science/Translational Research Track

 

What are basic science and translational research?

 

Basic science research in aging seeks to understand and examine basic mechanisms of aging, studying processes at the genetic, cellular, organ system and organism levels that are hypothesized to be intrinsic to the aging process. Using the scientific method and primarily using animal models of aging that can be manipulated and intervened upon, basic research in aging seeks to determine what manipulations affect the course of aging.

 

Translational research seeks to translate scientific discoveries from basic science to clinical applications that can improve human health. According to the NIH, “To improve human health, scientific discoveries must be translated into practical applications. Such discoveries typically begin at ‘the bench’ with basic research — in which scientists study disease at a molecular or cellular level — then progress to the clinical level, or the patient's ‘bedside.’”

 

This track is dedicated to developing fellows and junior faculty who have an interest in basic science and/or translational research in the areas of aging and Geriatrics. Individuals who choose this track will work alongside internationally recognized scientists with The Barshop Institute for Longevity and Aging Studies. Led by Dr. Arlan Richardson, this Institute is receives the largest amount of funding from the National Institute on Aging in order to study basic mechanisms of aging as well as to trainresearchers of the future. (http://www.barshop.uthscsa.edu/).

 

Trainees select a specific research topic in aging research with a complementary clinical area of expertise as a focus for their aging research. With this expertise, they will take the lead on developing a core of lectures, courses, and electives in their topic area. Given the vigorous training environment at the Barshop Institute, there are several didactic activities to choose from. These include:

 

• Aging Journal Club (weekly)
• Barshop Institute Seminar Series (weekly)
• Nathan Shock Center Annual Conference on Aging (yearly)
• Number of courses available through the Graduate School of Biomedical Sciences in the Biology of Aging Track.

 

These didactics are complementary to the additional seminars and didactics available through the Department of Medicine and Division of Geriatrics, Gerontology and Palliative Medicine. These include:

 

• Department of Medicine Grand Rounds (weekly)
• Department of Medicine Research Seminar (weekly)
• Geriatrics and Gerontology Grand Rounds (weekly)
• Geriatrics Journal Club (monthly)

 

 

Overview

 

Each fellow interested in basic science and/or translational research meets with the core John A. Hartford geriatric committee and Barshop Faculty mentors to develop a strategic career plan for the second year of fellowship. Mentees identify mentors through discussions with the Section Chief and the Fellowship Director, as well as at a transitions gathering at the beginning of the academic year. Mentors meet with mentees at least monthly.

 

Resources and focus areas of the Barshop Center include the Nathan Shock Center. The San Antonio Nathan Shock Center was one of the original Shock Centers founded by the NIH National Institute on Aging in 1995. The Center is a national resource that provides a state-of-the-art scientific infrastructure and services used in the development and study of rodent models to address questions about the basic biological mechanisms of aging. The Center also promotes the scientific study of aging by sponsoring seminars, conferences, and pilot grant awards focused on the basic biology of aging.

 

The amount of time committed to work on the Basic Science/Translational Research track is 70%. This includes faculty development activities, teaching sessions, curricular development and clinical experiences where the fellow will interact with different levels of learners. We work closely with the Institution’s the Academic Center in Education and Teaching (ACET) ,intended to enhance fellow teaching skills and to provide direct feedback and support in preparation of teaching materials.

 

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