Â鶹AV

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Location: Montreal General Hospital, Room D6 237.F

Program Information:

Number of fellowship positions requested: 2

Duration of fellowship: 1 year

Academic affiliation: Division of Geriatric Medicine

Hospitals involved in training and percentage time spent in each institution:

1. 1. Jewish General Hospital 20%
   2. Â鶹AV Health Centre (Montreal General Hospital and Royal Victoria Hospital) 40%
   3. Douglas Mental Health University Institute 15%
   4. Montreal Neurologic Institute 15%
   5. St. Mary’s Hospital 10%

Background: With the aging population, the incidence and prevalence of cognitive disorders, including dementia and delirium, and their complications will increase. Basic science and clinical research in cognition is an active field, while memory clinics, although increasing in number, remain relatively rare.

Established in 1991 and considered a pioneer in the field, the Anna & Louis Goldfarb Jewish General Hospital/Â鶹AV Memory offers internationally recognized expertise in the early diagnosis and treatment of memory disorders and dementia and is well positioned, in conjunction with the other memory clinics in existence at Â鶹AV, to provide specialized training in the field of cognition, the translation of research into clinical practice and increase the number of clinician experts in the field.

Furthermore, the behavior management unit at the Montreal General Hospital Acute Geriatric Unit and the division’s geriatrics clinic can provide state of the art training in the behavioral complications that arise during the evolution of cognitive disorders. Further experience in psychogeriatrics, behavioral neurology and neuropsychiatry will be acquired at the Douglas Mental Health University Institute and the Montreal Neurological Institute.

Research Activity: A research project during the fellowship is encouraged. There exist adequate supervisors from members in the division as well as access to Solidage Research Group of the Lady Davis Institute of the Jewish General Hospital, which together can provide supervision and guidance for a research project.

Mission: Provide fellows with clinical experience in the early detection and management of cognitive disorders and in the management of their complications during their evolution.

The fellowship curriculum will be tailored based on the clinical background of the fellow. For example, a neurology resident will have more training in clinical geriatric management of cognitive disorders such as delirium in addition to further training in geriatric psychiatry than would a fellow applying from geriatric medicine. A fellow from geriatric medicine would therefore have more training in neurology.

Name of the Fellowship Program Director: Dr. Elise Levinoff

Names of the teaching faculty: Division of Geriatric Medicine

Geriatricians:
Dr. Yves Bacher
Dr. Susan Gold
Dr. Gary Inglis
Dr. Elise Levinoff
Dr. Susan Vaitekunas

Neuropsychologists :
Dr. Leonard Babins
Dr. Nora Kelner
Dr. Lisa Koski

Department of Neurology:
Dr. Howard Chertkow
Dr. Étienne DeVillers-Sidani
Dr. Lesley Fellows

Department of Psychiatry:
Dr. René Desautels
Dr. Monique Desjardins
Dr. Michel Elie
Dr. Theodore Kolivakis
Dr. Ghislaine Savard (Psychology dept., MNI)

Department of Radiology:
Dr. Jean-Paul Soucy

Academic Facilities: The facilities will include the Â鶹AV teaching hospitals listed above. More specifically, the inpatient and outpatient units, along with the administrative support available in each division site will be used. Access to the library and multimedia learning materials will be provided.

Fellow duties and responsibilities:

• Clinical mandatory and non-mandatory rotations, based on the clinical background of the fellow, wherein the fellow will be assessing patients, developing a diagnosis and treatment plans and actively participating in multidisciplinary team meetings as well as meetings integrating the clinical, radiological and pathological presentations of cognitive disorders.
• Attendance in Geriatric Medicine Grand Rounds, journal clubs and other academic activities related to cognition.
• Become familiar with the neurocognitive evaluation of cognition performed by neuropsychologists.
• Become familiar with and be able to perform competency assessments of patients with cognitive disorders
• Supervision and teaching of more junior trainees, depending on the background of the fellow.
• Call duty: 1 of every 6 weeks from home after in-hospital rounds
• Research project (optional)
• Participation in clinical trials for pharmacological and non pharmacological treatment of cognitive disorders

Mandatory rotations:

• Memory clinics in the various sites of the division, along with the multidisciplinary rounds associated with each clinic. Fellows will be expected to evaluate, diagnose and treat cognitive disorder in the outpatient setting. Longitudinal follow-up of patients will also occur. Rounds will include the correlation of clinical, radiological and pathological findings.
• Neuropsychology clinic with neuropsychologists to learn about the purpose and use of the various psychometric tests used.
• Consultations in emergency room and inpatients for issues of cognition and their complications, including behavioral management and disposition planning, including the support of caregivers. Consultations will be screened by an attending physician for appropriateness for the fellow.

Non-mandatory rotations based on the background of the fellow:

• Psychogeriatrics (consult, ward and clinic)/ Neuropsychiatry
• Movement disorders clinic and associated cognition assessment and treatment
• Clinics in Geriatric Medicine
• Geriatric Medicine wards
• Behavior Unit consultations on Acute Geriatrics Ward at the Montreal General Hospital
• Neurology
• Neuroimaging: structural (CT, MRI) and functional (FDG-PET) + or – PIB-PET

Curriculum: Case load: Clinics will involve the assessment of 1-2 new patients and the follow-up of 0-4 patients per half day. Inpatient services will vary depending on where the rotation takes place, but should be no more than 10 patients. There is no maximum on consultation services.

Key articles in cognition will be reviewed.

There will be weekly multidisciplinary meetings associated with outpatient clinics and wards, in which the fellow is expected to participate.

Division of Geriatric Medicine Grand Rounds and site specific journal clubs are mandatory. Attendance at any rounds within the divisions of Geriatric Medicine, Neurology and Psychiatry pertaining to cognition will be strongly encouraged and supported.

Attendance at the annual Canadian Conference on Dementia will be mandatory and supported. Attendance at other conferences pertinent to the fellowship will be also encouraged.

Fellows, under supervision, will be expected to assess patients with cognitive issues, developing a differential diagnosis and investigation and treatment plans. These evaluations will be predominantly in the outpatient clinics, but may involve consultations within the hospital setting depending on the rotation.

The fellow will be asked to prepare presentations on cognition topics for the purpose of teaching attending and junior staff.

Supervision and review with more junior staff in memory clinics will enhance their teaching abilities.

If a research project is undertaken, it will be expected the fellow will prepare a presentation at a scientific meeting which will be supported.

Fellows will be involved in the administrative aspects of memory clinics to provide them with a better understanding of how memory clinics are established and function.

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For further information on application process, please visit the Â鶹AV Faculty of Medicine Post-Graduate Education Office site at /pgme/admissions/apply

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