Fall 2014
VA, Renown Health offer rich training grounds for fellowship

synapse: University of Nevada, Reno School of Medicine

Dr. Jonathan McCaleb

Helping veterans

A fifth-generation Nevadan, Jonathan McCaleb, M.D.'07, decided to remain in Reno to treat military veterans. Photo by Edgar Antonio Núñez.

Training doctors to care for older Nevadans

Story by Anne Pershing

With a fellowship devoted to the health care needs of older Nevadans, the School of Medicine's Reno campus is looking to train physicians for the state's burgeoning aging population.

The geriatrics fellowship offers advanced training and mentoring in geriatric medicine with concentrations in rehabilitation, home care, transitional levels of care, patient safety and medical directorship with an interdisciplinary team experience. Training sites for this fellowship are the Veterans Administration Sierra Nevada Health Care System in Reno and Renown Health.

The Department of Internal Medicine provides some salary and administrative support and mandatory oversight and monitoring of the fellowship as required by the Accreditation Council on Graduate Medical Education, which oversees physician training nationally.

Kristen Alexander, program coordinator for the fellowship, said she is fortunate to be supporting a program whose trainees voluntarily extend their education for the sole purpose of caring for society's parents, grandparents and veterans.

In regard to the state's need to train geriatric fellows, Neila Shumaker, M.D., geriatrics fellowship program director, explained that Nevada's physician growth has not kept up with Nevada's population growth, especially in the primary specialties.

"Geriatricians are primary care specialists who can also provide consultation and education to both health care professionals and the public," she said, adding: "The health care of frail elders is about balancing risk and benefit, as well as choice and quality of life in medical care and intervention decisions."

She pointed out that the Reno VA is a consistent statewide leader in terms of quality and patient satisfaction and that education and training, being core missions of the VA, offer many students, residents and other trainees in medicine, psychology, pharmacy, nutrition and social work the opportunity to learn.

Shumaker explained that the variety of problems and diagnoses seen at the VA makes for a strong clinical education environment.

"A well-designed electronic medical record and the ability to access records from other VAs exposes learners to a powerful model of comprehensive, coordinated, patient-centered care. At the VA, our fellows train in our 60-bed skilled nursing facility and in primary and specialty outpatient clinics," she said.

Shumaker added that Renown Health and the VA together provide balanced experience between the public and private models and between male and female patients.

For example, more women veterans are seeking care at the VA, but not necessarily in the geriatric age group.

As for the veteran population seen by the fellows, Shumaker said some are physiologically older than their chronological age due to difficult lives and circumstances of having served in the military.

"In the nursing home, where most of our geriatrics training occurs, we see some veterans under 60, but most are in their 60s, 70s and 80s. Veterans we care for face many of the same diseases and disabilities, namely medical, neurologic, orthopaedic and vascular diseases related to diabetes, heart and lung disease. We also see a lot of cancer and various types of dementia," Shumaker said.

She said a high percentage of Nevada fellows have taken positions with the VA and Renown, thus benefiting those medical care centers and their patients.

Current geriatrics fellow Jonathan McCaleb, M.D. '07, who also completed his family medicine residency and the hospice and palliative care fellowship with the School of Medicine, speaks highly of his learning experiences with the geriatric fellowship.

"Working with older veterans at the VA and Renown has enhanced my ability to help optimize their quality of life and see what a great difference geriatric care provides. In our role as fellows at the VA, we manage patients' chronic health issues, which includes both mental and physical problems. It makes my day when I can help veterans be restored to their baseline level of functioning and healthy living, both mentally and physically," McCaleb explained.

McCaleb, a fifth-generation Nevadan from Reno, chose to come back and do his second fellowship with the School of Medicine so he could work again with his mentors and hone his practice of geriatric medicine to the benefit of veterans.

"Dr. Shumaker is a fantastic leader and a very experienced clinical teacher. I've learned everything I know about the geriatric paradigm from her and Dr. Kelly Conright, program director for the hospice and palliative medicine fellowship. They nurtured my interest in geriatrics and inspired me to want to learn more. They also encouraged me to expand my horizons and were attentive to my educational needs."

He plans to remain in Reno to practice medicine following completion of his fellowship next summer.