Geriatric Medicine: Residency Program

This 2-year subspecialty program in Geriatric Medicine follows 3 years of core Internal Medicine training, and is approved by the Royal College of Physicians & Surgeons of Canada. Successful completion of the residency training program entails progressing through all transitional stages and completing all Entrustable Professional Activities (EPAs) as outlined by the Royal College. Though the program is no longer strictly time-based, the following describes the traditional 2-year program of years past.

Whilst working closely with the interdisciplinary team, subspecialty trainees spend their 1st year learning the basics of geriatric medicine. This includes completing comprehensive geriatric assessments, assessing and managing acute and chronic illness and common geriatric syndromes, in addition to learning about the medico-legal aspects of geriatric practice. To attain these skills, 2 months are spent on inpatient Acute Care of the Elderly (ACE) units at two tertiary hospital sites, one month in consultative work in a hospital setting, and one month on an inpatient senior's rehab unit at a tertiary rehabilitation hospital and in outpatient care. Experience in consultation with rural communities through outreach ambulatory clinics and telehealth is also available. In addition, in their 1st year, subspecialty residents spend 2 months in geriatric psychiatry at two different sites with different patient populations and participate in a weekly longitudinal geriatric medicine outpatient clinic. A workshop on decision-making capacity assessment is also provided.

The 2nd year is geared to the resident's interests and career goals with 5 elective blocks provided. Residents have the option of selecting from a wide variety of elective opportunities including but not limited to: geriatric emergency room, community geriatric medicine, movement disorder clinics, continence clinics, wound care clinics, rheumatology, physiatry, osteoporosis/fracture liaison services, rural geriatric medicine experiences, neurology/stroke, neuroradiology, oncology, etc. Out-of-province electives will also be considered.

During their 2nd year, the resident will have further exposure to the acutely ill older adults on the ACE units and on inpatient consultations where a more independent role is expected, such that the resident functions as a junior consultant. The resident spends a month with the palliative care service in acute care and the community. Home visits and consultations in supportive living occur during an outreach exposure in which the resident may also visit day programs in the city, the Alzheimer's society, the Multicultural Health Centre, the Elder Abuse team, the Public Guardian's office and a driving assessment centre. The resident spends a further 4 weeks on ambulatory care with different geriatrician preceptors.

The internist geriatricians have a wide variety of research interests, including continence, osteoporosis, falls, frailty, dementia, postural hypotension, geriatric cardiology, community engagement and quality improvement.  Under supervision, the resident is expected to take a significant role in a scholarly project during their training. A dedicated research block is provided in both the 1st and 2nd year of residency. A quality improvement curriculum has been implemented in the 1st year of training. Residents are encouraged to present their research findings at Resident Research Day & Geriatric Grand Rounds.

An academic half day is organized every Tuesday afternoon to provide structured educational activities, and it is currently being conducted virtually. This includes Geriatric Grand Rounds and interactive sessions on selected geriatric syndromes, journal club, and presentations by staff, the Geriatric Medicine residents, and the Care of the Elderly residents.