Geriatric Psychiatry Fellowship
Program History
The Geriatric Psychiatry Fellowship Program was funded by the Department of Veterans Affairs in 1991 and is currently directed by Linda Ganzini, M.D., M.P.H.
The program has received full accreditation by the Accreditation Council for Graduate Medical Education (ACGME) since its inception. Several program graduates, who are staff geropsychiatrists at OHSU and Portland VAMC, participate as principal faculty in this Fellowship program.
Graduates include
- Dr. Ganzini (1989)
- David Douglas, M.D. (1993)
- Kevin Smith, M.D. (1998)
- Sahana Misra, M.D. (1998)
- Kristen Snyder, M.D. (2003)
- Molly Davis, M.D. (2006)
- David Mansoor (2009)
Members of the combined OHSU/VA Psychiatry faculty have American Board of Psychiatry and Neurology subspecialty certification (Added-Qualification in Geriatric Psychiatry).
Overall Goals and Plan of the Geriatric Psychiatry Fellowship
Goal 1.
Balance and breadth of experience.
We provide a balanced experience in geriatric psychiatry, with opportunities for the development of the Fellow's clinical, teaching and research skills. Clinical skills are developed in acute care settings and in long-term, continuous care of outpatients. The design of the residency includes a continuous Geropsychiatry Clinic. There is a significant participation in geriatric medical and neurological settings, with emphasis on the interaction between psychiatric and medical problems in the elderly and collaboration among the specialties. We complement the Fellow's predominantly male VA patient exposure with the addition of female patients in university, county and private systems of care. By the end of the Fellowship, each resident will be prepared for the Added-Qualification Examination in Geriatric Psychiatry.
Goal 2.
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 an established research study or the scholarly review of a topic. As an alternative, elective time may be non-research. Residents starting the Fellowship during the PGY-4 year are allowed substantial research time the first year (50%) and more research time in the PGY-5 (30%). There is a comprehensive, sequential, faculty-supported and supervised approach to research training.
Outstanding research programs exist in the areas of:
- Dementias Affective Disorders
- Schizophrenia Psychiatric Epidemiology
- Ethics
- Substance Abuse
- Psychiatric Aspects of End-of-Life Care
- Other Themes Relevant to Geriatrics
VA Training Facilities
Professional Settings
Portland VAMCis one of the best-equipped academic general hospitals in the VA system. Wards, clinics, offices, conferences 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, physically 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 a 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 Geroneurology 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. OHSU and Oregon AADC are recipients of an Alzheimer’s Disease Center Research Grant from the National Institute on Aging.
(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 during 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 Professions 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, forensic and public psychiatry). Geriatric Psychiatry faculty at OHSU who teach residents includes Dr. Kevin Smith, and Dr. Bentson McFarland, former Milbank Scholar in Psychiatric Epidemiology and Burroughs-Wellcome Scholar in Pharmacoepidemiology.
Geriatric Psychiatry Clinic, conducted by Dr. Smith, evaluates and treats a broad range of demented and nondemented elderly women and men. An ECT (electroconvulsive therapy) service administers between 60 and 80 treatments per month. The Public Psychiatry Program is a unique program which links the Department with the State Mental Health Division in a variety of teaching, research and administrative enterprises. The Aging and Dementia Clinic at OHSU is the clinical component of OHSU’s NIH funded Alzheimer’s Disease Research Center.
(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.
Research opportunities. Research resources here are excellent.
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.
Applications
Applicants entering at the PGY-5 level must have completed an approved U.S. general psychiatry residency (PGY-1 through PGY-4), and have an unrestricted Oregon medical license. Submit applications to: linda.ganzini@va.gov
An interview with Fellowship faculty may be required at the applicant's expense. For more information on academic and student educational programs and a graduate medicine link, visit OHSU Graduate Medical Education.
Linda Ganzini, MD MPH
Mental Health, R&D 66
Portland VA Medical Center
3710 SW U.S. Veterans Hospital Road
Portland, OR 97239
Those interested in entering at the PGY-4 level need to contact Dr. Ganzini at linda.ganzini@va.gov before completing an application.
Application on the Web
Applicants are required to submit the following documentation:
- Two signed copies of the OHSU residency application
- Two letters of recommendation
- Letter of recommendation from the Dean of Medical School, including dates attended
- Letters of recommendation from the Program Director(s) of prior residency training, including dates and location
- Verification of previous staff positions(s)
- Application Form
Fellowship Completion
Certification of Fellowship completion will be awarded at the end of the PGY-5 year. Psychiatrists completing the Fellowship will have met requirements for the Geriatric Psychiatry Added-Qualification Examination offered by the American Board of Psychiatry and Neurology, Inc.
