Dartmouth-Hitchcock Medical Center
Dartmouth-Hitchcock Medical Center (DHMC) is a 400 bed, tertiary medical center set in Lebanon, New Hampshire, that draws patients from multiple states throughout New England. It is home to two psychiatry inpatient units, psychotherapy and psychopharmacology outpatient clinics, ECT, TMS, CL and multiple psychiatric subspecialty clinics. These include sleep medicine, neuropsychiatry, embedded primary care, women’s mental health, treatment resistant depression, child psychiatry, transgender mental health and geriatric psychiatry. It serves patients with a full range of psychiatric disorders, from all sociodemographic backgrounds, throughout the life span.
DHMC is our flagship, and geriatric psychiatry fellows participate in many activities there. These include the Geriatric Psychiatry Teaching Clinic, where fellows supervise psychiatry residents, precept internal medicine residents, and participate in didactic teaching; the primary care geriatrics clinic, where fellows split their time between providing geriatric primary care services under the supervision of faculty geriatricians, providing psychiatric consultation to the geriatricians, under the supervision of faculty geriatric psychiatrists; the Dementia Clinic in the Department of Neurology, where fellows hone skills in dementia evaluation and diagnosis.
DHMC is also the home to many formal teaching activities. Fellows have an opportunity to deliver several core curriculum sessions for the Psychiatry Residency Program, and to present a grand rounds style lecture to the geriatric medicine group.
VAMC White River Junction
The Veterans Affairs Medical Center is a 60-bed, acute care hospital, set in White River Junction, Vermont, only a short drive from DHMC. It is a clinical affiliate of DHMC a teaching and training site for Geisel Medical School, and home to inpatient psychiatry, residential treatment for substance and trauma related disorders, outpatient psychiatry, CL, TMS and ECT. It also has community and geriatric psychiatry clinics.
The VAMC sees patients with a full spectrum of psychiatric diagnoses, with an emphasis on PTSD and substance use disorders. It is also the home for the National Center for PTSD, and a robust research program of the Department of Psychiatry. Beginning in 2021, geriatric psychiatry fellows will spend time there for a geriatric psychiatry substance use disorders rotation. There is also the possibility of participating in a palliative care rotation, based on the fellow’s interest.
New Hampshire Hospital
New Hampshire Hospital, established in 1842, is the state psychiatric facility for New Hampshire. It is a 184-bed, JCAHO-accredited and CMS-certified facility that offers state-of-the art acute and long-term care to adult patients with serious and persistent mental illness. Our geriatric psychiatry inpatient rotation is based in the 38-bed Older Adult Unit at NHH. There fellows see a challenging mix of geriatric patients with early-onset, and late-life psychiatric disorders, co-morbid, chronic medical illness, and functional impairment. During this rotation, fellows assume management of a treatment team, functioning semi-autonomously under the supervision of faculty members. The experience exposes fellows to the challenges of complex geriatric care and the forensic and medical-legal issues in geriatrics that often go with it, and it is an excellent setting in which to sharpen geriatric team leadership skills.
NHH also is main a teaching and training site for the Geisel Medical School, and this is another strength. While at NHH, fellows will supervise psychiatry residents and medical students, and deliver a lecture in the NHH Grand Rounds Series, a DHMC continuing education activity.
Genesis of Lebanon
Genesis of Lebanon is a general nursing facility that provides subacute, long-term, and dementia care services. It is affiliated with Dartmouth-Hitchcock Medical Center, and just a five-minute drive away. The attending physicians and nurse practitioners come from the geriatric medicine program at DHMC, providing another opportunity to work collaboratively with faculty geriatricians and other members of the DHMC Geriatric Medicine Program. At Genesis, fellows learn the nuances of psychiatric consultation in nursing homes while also developing skills supervising psychiatry residents.
The Glencliff Home is New Hampshire’s specialized, psychiatric nursing home. Fellows spend one day per week for six months at Glencliff, located in a bucolic, picturesque setting in New Hampshire’s White Mountains. The experience provides an excellent contrast to Genesis of Lebanon, and a unique opportunity to master team leadership in long-term care. Under the supervision of faculty, fellows gradually assume responsibility for managing one unit in the facility. This provides an immersive chance to see what types of behavioral and environmental approaches can be effective for managing severe behavioral and psychiatric symptoms in nursing homes, and to appreciate why such approaches are more difficult to implement in conventional nursing homes.
Wheelock Terrace is a conventional assisted living facility located adjacent to the DHMC campus. Fellows spend time at Wheelock Terrace during monthly rounds there with residents and faculty. At Wheelock Terrace, fellows gain more nuanced appreciation of assisted living facilities and the nature of the psychiatric disorders that affect their residents. This setting also provides an opportunity for fellows to supervise psychiatry residents.
Kendal at Hanover
Kendal at Hanover is an independent-living, retirement community just a few minutes away between Dartmouth-Hitchcock Medical Center and Dartmouth College. It serves retirees from the Dartmouth-Hanover-Upper Valley community, and gives fellows exposure to working longitudinally with more robust, healthier older adults, and to gain a greater understanding of late-life developmental tasks and crises they face.