The Geriatric Psychiatry Fellowship Program at Dartmouth Health trains excellent clinical geriatric psychiatrists, preparing them to practice geriatric psychiatry wherever older adults receive healthcare services, and to become leaders in the field, as clinicians, educators, researchers, and advocates. To accomplish this, clinical rotations span a broad range of inpatient, outpatient, and long-term care settings.
In addition to the longitudinal experience in the program’s geriatric psychiatry outpatient clinics at Dartmouth Hitchcock Medical Center and the White River Junction VA Medical Center, fellowship rotations include: a primary care geriatric medicine clinic, a behavioral neurology clinic, a neuromodulation service including ECT, TMS, and esketamine, a palliative care service, a consultation-liaison service, several longitudinal care facilities, a state hospital, and neuroradiology.
In the primary care geriatric medicine clinic, the fellows provide psychiatric consultations to geriatricians and other primary care providers as well as working with geriatricians to delivery geriatric primary care services personally to reinforce general medical knowledge.
In the behavioral neurology clinic, the fellows evaluate patients under the supervision of a behavioral neurologist to gain experience with common and uncommon neurodegenerative disorders including Alzheimer’s disease and variants, vascular dementia, Parkinson’s disease dementia and Parkinson’s plus syndromes, bvFTD, PPA, and rapidly progressive dementias with exposure to cutting edge diagnostic techniques including liquid and tissue biomarkers, novel imaging biomarkers, and bedside neuropsychological assessments. Dartmouth Health is offering monoclonal antibody treatment for Alzheimer’s disease and fellows are actively involved in screening and managing patients receiving these treatments.
On the neuromodulation service, fellows supervise the provision of electro-convulsive therapy, transcranial magnetic stimulation, and esketamine treatment with a goal of becoming proficient in prescribing and providing these treatments to older adults. A structure reading curriculum is provided to accompany this rotation to ensure that fellows acquire an expert level of knowledge in neuromodulation.
On the palliative care service, fellows rotation with palliative medicine specialists in both the inpatient and outpatient setting to gain experience in navigating goals of care conversations and in employing palliative care interventions with a focus on older adults.
On the consultation-liaison service, fellows are embedded with the general C/L team at Dartmouth-Hitchcock Medical Center to provide expert consultations on older adults admitted to medical and surgical services at a tertiary referral center.
On the longitudinal care rotations, fellows see patients independently under the supervision of geriatric psychiatry faculty at a community assisted living/memory care facility, a continuing care retirement community, and a state psychiatric nursing home.
On the New Hampshire State Hospital rotation, fellows lead a teaching team providing care to a geriatric psychiatry inpatient unit for patients who are admitted to the hospital involuntarily with serious mental illness and severe behavioral disturbances related to neuropsychiatric disorders.
On the neuroradiology rotation, fellows work with neuroradiology faculty to gain experience interpreting imaging studies in cases of suspected neurodegenerative disorders. A compendium of education imaging cases is also provided for review to familiarize fellows with imaging findings in neurodegenerative disorders in older adults.
Sample of rotations completed throughout the course of the year-long fellowship:
| Placement | Length |
| Dartmouth Hitchcock Medical Center (Includes: Neurology, Memory Clinic, Geriatric Mood Disorders Clinic, Falls Clinic, Psychotherapy, and ECT) |
6 months |
| Nursing Home / Assisted Living / Continued Care Retirement Community (Sites may include: Wheelock Terrace and Kendal at Hanover) |
1 month |
| Glencliff Home | 1.5 months |
| New Hampshire Hospital/Specialty Inpatient | 2 months |
| Veterans Affairs Medical Center (White River Junction, Vermont) | 1.5 months |
This full range of geriatric care settings affords our program two strengths. First, we have a great deal of flexibility to mix and match, based on individual fellow’s career goals and interests. Second, fellows gain experience with a clinically, demographically, and socially diverse population of older adults.
Despite the wealth of clinical opportunities our program offers, our focus is on quality, not quantity. We strive to ensure that clinical responsibilities leave plenty of time for fellows to delve into the conceptual, methodological, evidentiary, and philosophical underpinnings of geriatric psychiatry, especially with respect to the unique mechanisms by which mental disorders present in late life, and the barriers (patient, provider, system, and societal) to delivery of quality care to older adults.
Didactic teaching centers on a directed reading syllabus of curated, original source references, covering the gamut from seminal articles in the field to cutting-edge research. All have been selected to stay up to date and to stimulate discussion about what makes both geriatric patients and our sub-specialty’s approach to evaluating and treating them differently. We want you to feel fully prepared to step into the new and evolving roles geriatric psychiatrists will fill in the future healthcare delivery system.
At all levels: local, regional, national, and international, geriatric psychiatry comprises an exceptionally collegial, close-knit, supportive, and welcoming sub-specialty niche. You will find this to be the case here. We’re fortunate to be in a spectacular region of Northern New England that promotes wellness and wellbeing, complementing perfectly our program’s overall focus on high quality education and training. Fellows feel welcome as junior colleagues here. You’ll find that as soon as you sign up for geriatric psychiatry, you’re one of the family.