OHSU

Clinical Rotations

VA TRAINING FACILITIES

Professional Settings

Portland VAMC is one of the best equipped academic general hospitals in the VA system. Wards, clinics, offices, conference rooms, laboratories and equipment are first rate. Outstanding clinical and research staff in psychiatry, medicine and neurology are closely allied with their counterparts at OHSU, phsyically located just one-quarter mile away. The two institutions are joined by an enclosed sky bridge, making the trip between the two institutions even more convenient. The hospital's catchment area includes metropolitan Portland (population 1.5 million and growing rapidly) and a large rural area with another 1 million.

Clinical Program

(1) VA Mental Health Division

Mental Health Division at Portland VAMC is a major academic service, with 27 staff psychiatrists, all with faculty appointments at OHSU. There are 18 General Psychiatry Residency positions (fully integrated within a total OHSU-VA program of 32 positions), 20 acute beds, clinics totaling over 40,000 visits annually and active inpatient and outpatient consultation programs.

The following geriatric services are in place:

  • Geriatric Psychiatry Clinic (cases selected for teaching)
  • Liaison to Dementia Clinic and Geriatric Medicine Assessment Clinic
  • Consultation programs for the older patients in the 80-bed teaching Nursing Skilled Care Unit (NSCU)
  • Consultation to a 300-bed General Medicine and Surgery Acute Inpatient Service
  • A special geriatric alcoholism and drug dependence rehabilitation program (GSAP)

(2) Geriatric Medicine

This program includes the Geriatric Assessment Clinic (GAC)

(3) Neurology Service

We have a close, congenial relationship with Neurology, which has a strong orientation to Geriatric Central Nervous System Disorders. Dr. Jeffrey Kaye leads Geriatric Neurology activities. A Geooneurology Fellowship also exists.

(4) Dementia Program

This is a multidisciplinary program led by Dr. Kaye that also includes Geriatric Psychiatry (Dr. Douglas) and Neurology (Dr. Joe Quinn). The Dementia program is part of the Oregon Aging and Alzheimer's Disease Center (AADC), along with OHSU, Oregon AADC is supported in part by a legislative Oregon State income tax refund check-off program.

(5) General

The full range of academically oriented medical and surgical specialty services is well represented within the hospital.

Teaching Opportunities

(1) Geriatric Medicine Residents

Reciprocal teaching opportunities occur durin the GAC and consultation rotations, in the NSCU and in seminars. Opportunities for teaching diverse groups of health professionals exist through the Oregon Geriatric Education Center and VAMC-based consortium programs (VA, OHSU and Portland State University) supported by the USPHS Bureau of Health Professionals to develop faculty and train health professionals throughout the state.

(2) Medical Students

Opportunities exist to teach medical students in small groups and on the VA consult liaison service.

Basic Resources

Fellows are provided with:

  • Office space
  • Telephone
  • Free parking
  • Administrative and computer support
  • Laboratories for psychiatry research, and time and tuition support
  • Local training in university, private and other healthcare settings, in addition to the VA.

OHSU TRAINING FACILITIES - OREGON HEALTH & SCIENCE UNIVERSITY

(1) Psychiatry Department

This large and active department houses several nationally prominent academic research and training programs. Most notable are programs on the Biology of Affective Disorders, Psychopharmacology, Psychiatric Epidemiology, and community and social psychiatry (transcultural, forensice and public psychiatry). Geriatric Psychiatry faculty at OHSU who teach residents include Dr. Bentson McFarland, former Milibank Scholoar in Psychiatry Epidemiology and Burroughs-Wellcome Scholar in Pharmacoepidemiology.

(2) Research, including the Vollum Institute

(3) Biomedical Information Communication Center

This program combines traditional library and computing services, biomedical communications, and medical informatics research, and is supervised by Dr. Douglas, Chief of Informatics at the Portland VAMC.

(4) Center for the Ethics in Health Care

The center is funded by grants from several private foundations and has an interdisciplinary faculty (OHSU and VA). The program currently focuses on four areas: education, research, patient consultation, and health policy development. Dr. Ganzini, a Senior Scholar at the Ethics Center, supervises educational and research opportunities in ethics and end-of-life care.

Affiliated Training Facilities and Community Resources

Tuality Hospital: Inpatient rotation at a small private Geropsychiatry unit is supervised by Dr. Scott Armstrong.

Multnomah County Aging Services Division: Our program has ties to this large local Area Agency on Aging Program.

Academic Components

Faculty Preceptors: All faculties are listed in the Appendix, Section 3.

Meaningful research Opportunities

Currently there are two tracks available, which differ predominantly in their research focus. Residents starting in the PGY-5 year will have a predominantly clinical experience, will meet the requirements set by the ACGME for completing an accredited Geriatric Psychiatry Program, and will be prepared for the added-qualification examination. Research opportunities may include participating in the established research study or the scholarly review of a topic. As an alternative, elective time may be non-research. Residents in training in the adult program at OHSU may start on a research track with progressively more research time during their residency and this will extent into their fellowship where they may have approximately 30% research time. There is a comprehensive, sequential, faculty-supported and supervised approach to research training.

Outstanding research programs exist in the areas of:

  • Dementias
  • Psychiatric aspects of movement disorders
  • Ethics
  • Psychiatric Aspects of End-of-Life Care
  • Health Services Research

 

The following groups can accommodate Fellows for special projects.

(1) Dementias and healthy brain aging

Under the general direction of Dr. Jeffrey Kaye, ADCO Clinical Director, studies on the genetics and epidemiology of Alzheimer's disease are in progress, as well as projects on the development of assessment instruments, clinical drug trials, and a study of motor vehicle driving in Dementia, using the resources of the ADCO Consortium (VAMC, OHSU, Good Samaritan). Dr. Kaye also heads the Oregon Brain Aging Study, a clinical-morphological (clinical, neuropsychological, imaging and postmortem brain analysis) longitudinal study of healthy brain aging in the old.

(2) Affective and sleep disorders

Dr. Alfred Lewy at OHSU also heads an internationally recognized group studying, pineal physiology in the elderly and effects of bright light in chronobiologic and mood disorders. This lab also includes Dr. Robert Sack (circadian rhythm and disorders in the blind and treatment of sleep disorders) and Dr. Jonathan Emens.

(3) End-of-life care

Dr. Linda Ganzini currently conducts research on the effects of depression on patient desire for life-sustaining interventions in medically ill elderly, physician-assisted suicide, prevalence of mental disorders in hospice patients, and patient decision-making capacity. Clinical experiences in Palliative Care are available.

(4) Epidemiology and advanced biostatistics

Dr. McFarland leads several projects. Using a large automated database at Kaiser Permanente HMO (which has over 300,000 enrollees locally), he is studying risk for automobile accidents among elderly users of different benzodiazepines, and risk of fall in older users of low versus high potency neuroleptic agents. His other projects, within the State Mental Health Division, include a study of the consequences of Congressionally mandated regulation of access of mentally-ill persons to nursing homes, and a study of the efficacy of Sodium Valproate for mania in persons over age 60.

(5) Vollum Institute for Advance Biomedical Research

Based at OHSU, this is a premier center for molecular neurobiology. For scientifically qualified fellows, access to the Vollum Institute as a setting for a basic science project can be arranged through Dr. Lewy.

For more information about components of the fellowship, please visit the Geriatric Psychiatry Fellowship Appendix.