What is PGY-4 like?

PGY-4 could be very different for everyone. This is because of the specialty you choose. I chose Geriatric Medicine, which is an extension of medicine... if you though Internal Medicine residency was difficult, then GM is half the hours, but just as much work. This is because the nature of diagnosing, treating, and preventing illness and complex medical conditions in the elderly population.

Nonetheless, I believe this fellowship will allow me to become a robust internal medicine physician in the near future. As our population is aging, we need to identify geriatric complex issues within healthcare for our patients. GM is not only a vital field in IM, but any other subspecialty. It is a foundation to great and optimal patient care in the near future, and yet, we do not get much of it in residency. 

Artificial Intelligence summarized GM fellowship to me in a nutshell, and I would like to share it with you --

Geriatric medicine curricula focus on comprehensive, person-centered care for older adults across various settings, typically emphasizing the 4Ms: What Matters, Medication, Mentation, and Mobility. Training includes acute care, ambulatory clinics, long-term care, and palliative care, covering topics like dementia, falls, and polypharmacy to prepare trainees for multi-complex, age-friendly care.


Core Curriculum Components --

  • Clinical Rotations:

- Inpatient Geriatrics/Consultation: Management of hospitalized older adults
- Ambulatory Care/Outpatient Clinic: Geriatric assessment and primary care
- Long-Term/Post-Acute Care: Skilled nursing facilities and nursing home management
- Home Care/House Calls: Assessing patients in their homes 
- Subspecialty Experience: Neurology (Alzheimer’s/memory care), Psychiatry, Rehabilitation Medicine, and Wound Care

- Hospice and Palliative Care: Focus on end-of-life care and pain management (however, I did not receive much of this, so I will be doing a fellowship in H&PM)

  • Didactic Curriculum (Core Topics)
    - Geriatric Syndromes: Delirium, dementia, falls, gait disorders, incontinence, and frailty
    - Pharmacology: Polypharmacy management and Beers Criteria
    - Ethical/Legal Issues: Medical direction, decision-making capacity, and guardianship
    - Quality Improvement (QI): Designing and implementing projects to improve care quality
    - Key Learning Objectives (5Ms Framework) Modern curricula often integrate the "5Ms" approach: Mind: Mentation (dementia, delirium, depression). Mobility: Gait and balance maintenance. Medications: Deprescribing and avoiding adverse effects. Multicomplexity: Managing multiple comorbidities and frailty. What Matters Most: Aligning care with patient goals and values

  • Educational Experience: 
    - Interprofessional Collaboration: Working with nurses, social workers, pharmacists, and physical therapists
I highly encourage getting training in this field.

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