3) Psycho-Oncology: University Health Network (Princess Margaret Hospital), Mount Sinai Hospital, Hospital for Sick Children

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1 SENIOR SELECTIVES - DIVISION OF CONSULTATION/LIAISON PSYCHIATRY Dr. Jon Hunter, MD Tel: ext Fax: jhunter@mtsinai.on.ca Jeanette Villapando Tel: ext Fax: JVillapando@mtsinai.on.ca 1. Essential components of a senior selective rotation in this program/division must include The career track rotations in the Consultation-Liaison Division are focused on the psychiatric and psychosocial aspects of medical illness and somatizing and medically unexplained somatic syndromes and on mind-body relationships in health and disease. There is flexibility in the structure of these rotations, but all include an academic and clinical component with supervision in clinical work, teaching, and research. The elective properties of these components may vary depending upon the position. In each rotation, there will be a primary full-time supervisor who will coordinate the training experience with the resident. 2. Experiences in senior elective rotations in this program/division could include Elective experiences of an academic or clinical nature can be arranged as appropriate to the rotations. Most often this consists of a specific clinical assignment or research project. Supervision will be provided to residents who wish to develop research expertise or to start projects which may continue into or lead to fellowship training. Supervision is also available on a wide variety of modalities as appropriate to patients with medical or somatizing conditions. 3. Hospital/training sites where selective rotation is offered 1) General Consultation-Liaison Psychiatry: The University Health Network (Toronto General Hospital and Toronto Western Hospital, St. Michael's Hospital, Mount Sinai Hospital, Women s College Hospital 2) HIV Psychiatry: St. Michael's Hospital, Mount Sinai Hospital 3) Psycho-Oncology: University Health Network (Princess Margaret Hospital), Mount Sinai Hospital, Hospital for Sick Children 4) Psychiatry of Acute Medical-Surgical Illness & Treatment: The University Health Network (Toronto General Hospital), Cardiovascular Disease, Multi-organ Transplantation Critical Care Unit 5) Neuropsychiatry: The University Health Network (Toronto Western Hospital), Sunnybrook Health Science Centre/Baycrest 6) Sleep and Chronobiology: The University Health Network (Toronto Western Hospital)

2 7) Somatizing Disorders and Medically Unexplained Syndromes: The University Health Network (Toronto General Hospital) 8) Psychotherapy and Psychosomatic Medicine: The University Health Network (Toronto General Hospital & Princess Margaret Hospital), Mount Sinai Hospital 9) Eating Disorders Program: The University Health Network (Toronto General Hospital, Hospital for Sick Children 10) Endocrinology and Psychiatry: Women s College Hospital 11) Maternal-Infant Mental Health: Mount Sinai Hospital Title Contact Info Description Comprehensive Care of Acquired Brain Injury (Outpatient) Supervisor: Dr. C. Seyone Tel: Fax: chanth.seyone@uhn.ca Place: Toronto Western Hospital; Department of Neuropsychiatry; ABI Clinic Time: 3-6 months Residents: 1 to 2 The Acquired Brain Injury Clinic in the Department of Neuropsychiatry provides comprehensive management of behavioral and psychiatric problems in the brain injured person, both adult and children. The emphasis is on the management of the subacute and chronic stages. Consultations and various therapies are provided. Patients are referred by community family physicians, specialists, community agencies, rehabilitation teams and for medicolegal purposes. Unique opportunities include an opportunity to observe medico-legal assessments, community based treatments, psychotherapy in the brain injured population as well as Quantitative EEG diagnostic and EEG based biofeedback treatment methods. Residents actively participate in consultations, assessments, and ongoing treatment. They receive individual, weekly or biweekly supervision of their cases, including psychotherapy supervision, from one of the staff psychiatrists. They learn about the psychosocial, neuropsychiatric and psychotherapeutic aspects of ABI. They will also gain first-hand knowledge of community resources available to people affected by ABI. A 3-6 month selective is offered for senior residents wishing to learn about the ABI. Residents will initially observe and then increasingly participate in this process until they can work on their own. The resident will be supervised by Dr. Seyone and Dr. de Souza and will be given the opportunity to work in areas of their interests.

3 Comprehensive Care of Acquired Brain Injury (Outpatient) Neuropsychiatric Electrophysiology Clinic (Outpatient) Supervisors: Dr. Chanth Seyone Dr. Minella de Souza Inquiries: Place: Toronto Western Hospital; Department of Neuropsychiatry; ABI Clinic Time: one ½ day per week for 2 months Supervisor: Dr. Minella de Souza Inquiries: Place: Toronto Western Hospital; Department of Neuropsychiatry; Time: one ½ day per week for 2 months The Acquired Brain Injury Clinic in the Department of Neuropsychiatry provides comprehensive management of behavioural and psychiatric problems in the brain injured person, both adult and children. The emphasis is on the management of the subacute and chronic stages. Consultations and various therapies are provided. Patients are referred by community family physicians, specialists, community agencies, and rehabilitation teams and for medicolegal purposes. Unique opportunities include an opportunity to observe medico-legal assessments, community based treatments, psychotherapy in the brain injured population as well as Quantitative EEG diagnostic and EEG based biofeedback treatment methods. Residents actively participate in consultations, assessments, and ongoing treatment from both staff psychiatrists. They learn about the psychosocial, neuropsychiatric and psychotherapeutic aspects of ABI. They will also gain firsthand knowledge of community resources available to people affected by ABI. The Neuropsychiatric Electrophysiology Clinic at TWH provides diagnosis as well as treatment to Neuropsychiatric patients. Patients at the clinic have conditions that include Traumatic Brain Injury, Conversion Disorders (including Psychogenic Movement Disorders and Non Epileptic Seizures) as well as psychiatric issues related to seizures and other movement disorders. Patients are referred by community family physicians, specialists and community agencies. This selective rotation focuses on the understanding and application of objective measures for understanding of the physiology through Quantitative Electroencephalography the treatment of neuropsychiatric conditions. It also includes the benefits and limitations of these techniques. A one-half day per week selective is offered for two months to a PGY2 wishing to learn about the electrophysiological underpinnings of these disorders. This will include basics of Electroencephalography, Quantitative EEG and EEG based biofeedback. Residents will initially observe and then increasingly participate in this process.

4 Psychiatric Neuroelectrophysiology (Outpatient) Supervisor: Dr. Minella de Souza Inquiries: Place: Toronto Western Hospital; Department of Neuropsychiatry; Time: Senior Residents: from a minimum of one day a week for 12 weeks to 3 months. The elective is a clinically focused one and designed primarily for senior residents. The resident is expected to participate in assessments as well as treatments, which include pharmacotherapy, psychotherapy as well as EEG based biofeedback. Objective: To provide the resident an objective framework of conceptualizing neuropsychiatric conditions and to understand the underlying physiology of various operations and functions, such as attention and memory in the brain through Quantitative methods of analyzing EEG. On completion of this elective the resident will have Knowledge: Enhanced knowledge of the physiology of the brain and the value and potential of EEG in neuropsychiatry through the various metrics that constitute the EEG such as frequency, spectral power, coherence, phase measures, etc, Skills: to be able to link clinical history and symptom and create hypothesis regarding localization of function in the brain. Attitudes and/or awareness of the Neurophysiological underpinnings of psychiatric disorders This elective is being offered at the department of Neuropsychiatry at TWH; diagnosis (both clinically and through QEEG analysis) as well as treatment (which includes EEG guided biofeedback) is provided to both children and adults. Patients have conditions that include Traumatic Brain Injury, Conversion Disorders (including Psychogenic Movement Disorders and Non Epileptic Seizures), movement disorders, and developmental challenges including autism and learning challenges. Depending on the interest of the resident the following topics can be covered: 1. Review of literature regarding the use of EEG in neuropsychiatry. (TBI, Conversion Disorders (motor subtype), Seizures, Learning disability, Autism spectrum disorders, OCD, anxiety, psychosis) 2. Going beyond conventional visual analysis. Reliability measures of visual versus quantitative EEG.

5 Neuropsychiatry Inquiries: Dr. Omar Ghaffar Place: Ontario Shores Centre for Mental Health Sciences Supervisors: Drs. Omar Ghaffar, Anil Srivastava 3. EEG compared to fmri; spatial, temporal resolution; cost 4. Briefly review Conventional EEG visual analysis; review procedures including identification of background features and gross pathology. 5. A history of the controversies that led to the delay in utilization of Quantitative EEG as a diagnostic tool for neuropsychiatric conditions. 6. Quantitative EEG: EEG metrics such as frequency, power, amplitude, and connectivity measures including phase relations and how these inform us about the working of the brain. Visual analysis tools including LORETA time domain, event marking, etc 7. LORETA Hypothesis testing, Source correlation, linking 3D sources to the surface EEG & Localization of Function 8. Discriminant Analysis: Traumatic Brain Injury, Learning Disability 9. Hagemann s modules, Default state network and concepts of the self 10. EEG based biofeedback 11. Review other methods of noninvasive brain stimulation for diagnosis (Evoked potentials) and treatment (TMS, tdc s, caloric stimulation). The Neuropsychiatry Rehabilitation Service (NRS) at Ontario Shores Centre for Mental Health Sciences (formerly Whitby Mental Health Centre) was established to address the need for psychiatric care of neurological patients through inpatient and outreach programs. NRS includes a 25-bed inpatient unit with a 5 bed Intensive Observation and Treatment Unit. Individuals between 18 and 65 years of age with psychiatric, cognitive, and/or behavioral symptoms and a brain disorder (e.g. due to trauma, neurosurgery, infection, stroke, non-progressive tumor, multiple sclerosis, etc) are provided with inpatient services including specialized multidisciplinary assessments; diagnostic clarification; neuropsychological testing and rehabilitation; medication review; behavioral interventions; individualized programming; family support, education and consultation; inclusion of community partners in planning and treatment process; and discharge planning and community integration. Through a minimum four week elective, residents can gain experience in neuropsychiatric evaluation. Integration of clinical data with investigations including brain imaging and neurocognitive assessment is emphasized.

6 HIV Psychiatry Consultation-Liaison / Medical Psychiatry Supervisors: Dr. M. Halman halmanm@smh.toronto.on.ca Position: One six-month or one year Senior Selective rotation. Residents may also wish to do a more limited one-year longitudinal elective focusing on one aspect of this training (i.e. ambulatory clinic only, Casey house liaison only) as an adjunct experience (ie one day or one half day per week). For more information, contact: Dr. Claire De Souza, Head Tel: claire.desouza@sickkids.ca Psychological, family, and cultural issues are given equal weight in the formulation and treatment planning of complex patients. Ample opportunities exist for research in interested, qualified, and motivated residents. This research may involve writing a case report, case series, or review paper, or participating in brain imaging research (MRI, fmri, diffusion tensor imaging). Research projects can also be tailored to accommodate specialized knowledge and skills or unique talents of the resident through endeavors ranging (for example) from computer programming projects relevant to neuropsychiatry to the design of art, music, or recreational therapy programs for neuropsychiatric patients in collaboration with a multi-disciplinary team. Description: Develop skills in the assessment and management of persons with HIV/AIDS, including management of the major neuropsychiatric and mood disorders associated with HIV disease, and development of psychotherapeutic skills with a diverse range of patients including gay men, persons from inner city communities and women from endemic countries. Experience may be gained in any or all of these sites: 1. Ambulatory HIV Psychiatry Clinic: Emphasis on major mood disorders, dementia management, adaptation to illness and psychotherapy. 2. Psychiatric consultation to the Positive Care Clinic: Assessment and management of patients in the HIV medicine clinic using a liaison and comanagement model with the HIV medicine team as the standard of care. 3. Inpatient HIV Psychiatry: designated inpatient psychiatry beds for persons with HIV and severe and persistent mental illness. 4. Community based collaborative care: with Casey House Hospice, both residential and community outreach teams; and primary care at 410 Shelbourne Health Centre. The Consultation-Liaison/Medical Psychiatry program at the Hospital for Sick Children consists of an interdisciplinary team which provides comprehensive outpatient and in-patient care to children and adolescents with complex co-morbid medical and psychiatric conditions, medically unexplained symptoms and/or disability. Children, adolescents and their families are referred for consultation and

7 Psychosocial Oncology and Palliative Care (POPC) Supervisors: Dr. Kim Miller; Dr. Gary Rodin Time: 6-12 months Residents: 2 treatment by the medical and surgical in-patient wards of the hospital. Consultation-Liaison ranges from care of the patient to team based and program based consultation. The program provides ambulatory consultation to various subspecialists, pediatricians, and family physicians. Telehealth and Telepsychiatry consultation are also available to other hospitals and children s mental health centres. Major foci of this program are consultations to Haematology-Oncology, Rheumatology, Multi-organ transplant, Obesity, Chronic Pain, HIV, Trauma, Orthopedics, Genetics and Metabolics, and Neurology. Collaborative care is emphasized including education and support of the interdisciplinary teams. The rotation will include a mix of in-patients, outpatients, and Telelink. The resident will take part in providing consultation (urgent and semi-urgent) plus follow-up for in-patients and out-patients as timing permits and based on learning needs. The resident will have the opportunity to provide education to teams as part of the liaison work. POPC is located in Canada s largest cancer hospital, primarily an ambulatory setting, with 125 inpatient beds. Exposure to a wide range of patient ages (18 years or older), cancer types, and disease stages is ensured during the rotation. Residents will learn about the psychiatric and psychosocial aspects of cancer for patients and families at diagnosis through all phases of the disease and during survivorship, palliation and end-of-life care. Residents will have the opportunity to observe and perform psychiatric assessments with supervisors to aid in developing diagnostic and formulation skills. Development, coping, attachment, trauma and biologic medicine are all incorporated into a complex understanding of the physical, psychological and existential dilemmas that face individuals with cancer and their families. Weekly educational activities at POPC include: Palliative Psychiatry seminar, Palliative Psychiatry clinic with supervision, Advanced Psychotherapy seminar, Behavioral Sciences and Health Research seminar, Palliative Care Journal Club. Additionally, monthly educational activities include: POPC Grand Rounds, Pain and Symptom Management Rounds, and Interprofessional Complex Care Rounds. Participation and supervision in Mindfulness Based Stress Reduction (MBSR) and short-term supportive-expressive

8 psychotherapy for advanced cancer patients, Managing Cancer and Living Meaningfully (CALM), is also available. Ongoing weekly clinical supervision occurs, with the opportunity to teach more junior residents and medical students, and/or participating in research. For those interested in research, participation in a biweekly Manuscript Review seminar is also available. At the end of the rotation, residents will have acquired knowledge and skills in assessing, responding to, and managing psychosocial distress in the patient with cancer. Psychosocial Oncology Supervisor(s): Drs. J. Ellis / A. Scalco Place: Sunnybrook HSC Time: Negotiable This selective provides the supervised opportunity to become comfortable and proficient in assessing and managing psychiatric and psychological issues in the context of the diagnosis and treatment of cancer. It also includes developing expertise in grief, existential psychotherapy and individual and family support for those living with chronic medical illness as well as those who are dying. There is opportunity to participate in a biweekly seminar as well as research Inquiries: Dr. J. Ellis (416) or janet.ellis@sunnybrook.ca Senior Selective Type/Title: Clinical Research MSH C/L Psychiatry Senior Selective Part-Time (Please indicate Part-Time Version of the Selective) YES Full-Time (Please indicate Full-Time Version of the Selective) Name Tel Ext Inquiries Mary Preisman mpreisman@mtsinai.on.ca

9 Hospital(s) Supervisors(s) Time Commitment Mount Sinai Hospital Drs. Mary Preisman, Jon Hunter and Ellen Margolese 3-4 clinical days/week SENIOR SELECTIVE DESCRIPTION (must be in CanMEDS format) Please describe the selective opportunity and objectives using the CanMEDS format. Please describe any specific transition to practice elements of the selective where appropriate (e.g. training in supervision, team leadership, resource management, program development, integrated care, managing multiple clinical roles, practicing continuous quality improvement or change management, participation in hospital/institutional administrative roles). This senior selective is an opportunity to transition to practice with experience as a senior supervisory resident on a consultation liaison service. There are opportunities for supervising and teaching residents, as well as senior medical students. This experience is complimented by some outpatient opportunities leading an outpatient follow-up clinic for patients seen on the consult service, and following some medical patients for psychotherapy. This selective lends itself to broad clinical exposure and preparation for the Royal College examination, educational presentations and scholarship.

10 1. Medical Expert / Clinical Decision Maker Residents will learn to apply evidence based pharmacologic, behavioural and psychotherapeutic techniques to a wide range of medically ill patients. Residents will enhance their experience managing a team and making clinical decisions as a training supervisor. Residents can select areas of particular focus within the hospital and work with challenging patients in those areas. 2. Communicator Residents will practice patient and family-centered care and will learn to manage the often complex needs of people with medical illness. They will learn how to assess, treat, and communicate with an array of diverse patients and families. They will also learn how to communicate effectively as a team leader, and as an independent practitioner. 3. Collaborator Residents will work closely with other medical specialties and interprofessional colleagues to enhance their liaison skills and to provide optimal patient care. Residents will also work closely with more junior colleagues to facilitate a strong team environment. 4. Manager (Leader) Residents will learn how to function as a supervisor and team leader. Skills in managing patients as a supervisor will facilitate transition to practice. Decisions about resource management and provision of follow-up will prepare

11 residents for independent work. 5. Health Advocate Residents will solidify their skills in patient advocacy, and develop advocacy as it relates to medical education and the needs of their learners. 6. Scholar Residents will be encouraged to become familiar with the most up to date literature in the area of medical psychiatry and medical education and to develop a plan to remain abreast of the evolving literature in order to maintain safety standards in practice. There will be opportunities to be involved with research projects. 7. Professional Residents will demonstrate integrity and honesty in all interactions with patients, learners, and other health care providers. Residents will receive support and feedback regarding professional behaviour, interactions, and communication and will learn about maintaining a high standard of professionalism in practice.

12 SAMPLE OF A TENTATIVE SCHEDULE Please provide a TENTATIVE SCHEDULE for your proposed selective rotation (note: this schedule does not need to be finalized and does not need to include details of all psychotherapy supervision, apart from with your primary +/- secondary supervisors). MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY MORNING Rounds with junior house staff, inpatient work 9-12am Rounds with junior housestaff 9-10am CL follow-up clinic 10am-12pm PGY5 CORE CURRICULUM (Sept-May, Mount Sinai, 9-11:30am) ADVANCED PSYCHOTHERAPY SEMINAR SERIES (July-Aug, Mount Sinai, 9-12pm) Senior Interview Seminar Grand Rounds 10:30am-12noon CL Rounds 2-3:15 CL Rounds 2-3:15 ADVANCED PSYCHOTHERAPY SEMINAR SERIES (Sept-Oct, Mount Sinai, 1-2:30pm) CL Rounds 2-3:15 CL Rounds 2-3:15 AFTERNOON SUGGESTED PGY5 STUDY HALF-DAY

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