MOUNT SINAI HOSPITAL 600 University Avenue Toronto, ON M5G 1X8 TEL FAX Dr. Lesley Wiesenfeld, Site Coordinator

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1 MOUNT SINAI HOSPITAL 600 University Avenue Toronto, ON M5G 1X8 TEL FAX Dr. Lesley Wiesenfeld, Site Coordinator Ext: 5351 HOSPITAL OVERVIEW The Mount Sinai Hospital is pleased to offer training in the following areas: Mandatory core training is provided to residents in: General Psychiatry CL Psychiatry Collaborative Care Geriatric Psychiatry Senior selective rotations are available in: Psychotherapy CL Psychiatry Perinatal Mental Health General Psychiatry Collaborative Care Geriatric Psychiatry Culture and Community Health (Ethnic Minority Focused Assertive Community Treatment Team; Cultural Consultation) Trauma HIV-Psychiatry MANDATORY CORE ROTATIONS General Psychiatry Rotations - Whole Year Positions: These positions fulfill mandatory training requirements in general psychiatry. These positions focus on comprehensive training in general psychiatry, consisting sequentially of six months of inpatient psychiatry and six months of outpatient psychiatry. Dr. Greg Chandler is the Head of Inpatient Psychiatry. Supervision of the inpatient training experience is provided by Drs. Greg Chandler, Marina Golts and Chris Ulic. The patients treated in the Inpatient Unit reflect an acute care, diagnostically broad based, general hospital population. The full range of contemporary psychiatric treatments is employed in an integrated fashion, recognizing the interplay of biological and psychological factors in the etiology and treatment of psychiatric disorders. Treatment is provided within the context of an interprofessional team approach. Residents have the opportunity to work with all three in-patient supervisors. Dr. Sian Rawkins is the Head of Ambulatory Psychiatry. The multi-disciplinary ambulatory team includes: Drs. Rodney Slonim (Head of Crisis Intervention Services), Mark Halman Jared Peck (Associate Head), Ms. Rebecca Esrock (M.SW), and Ms. Allison Hughes (M.SW)/Edward McAnanama (M.SW). The PGY2 Out-Patient General Psychiatry training experience consists of 3 main components: (1) Assessment Clinic: Residents have an average of 2 supervised patient assessments per week; residents rotate supervisors in order to maximize their exposure to different styles and approaches, (2) Crisis Clinic: Residents are supervised in providing short-term psychotherapeutic intervention to patients in crisis, (3) Medication Clinic:

2 Residents are supervised in providing short-term medication follow-up (opportunity to gain experience initiating new agents and optimizing existing treatment regimes). In addition, there is a very well received weekly interviewing/ formulation seminar. Ambulatory patients are referred from the community or through the Emergency Department, and reflect a broad range of psychiatric presentations and diagnoses. The Ambulatory Program also provides consultation to several community agencies. Additional training opportunities are available in IPT, Group Therapy, and other psychotherapeutic modalities. Within the PGY 2 Whole Year program, residents will also have the opportunity to fulfill the new Royal College requirements for exposure to longitudinal provision of care to a patient with severe and persisting mental illness, under the supervision of Dr. Andrea Berntson. In keeping with central requirements for psychotherapy training, residents will have the opportunity to begin clinical treatment and supervision in dynamic psychotherapy and cognitive behavioural psychotherapy. Each resident will be assigned one dynamic therapy supervisor in addition to a CBT supervisor, with additional seminar and observation opportunities in brief, group and couple psychotherapy modalities. Finally, there will be an opportunity for exposure to the ACT team and related community psychiatry and ethnocultural psychiatry issues during the out-patient and in-patient general psychiatry portions of the rotation. Supervisors for this opportunity include Drs. Sam Law and Lisa Andermann. Geriatric Psychiatry: (6 Month Positions) The geriatric psychiatry program provides experience in ambulatory and consultation-liaison geriatric psychiatry to elderly patients, within the hospital and community. There are also opportunities to participate in telehealth and outreach consultation as well as home visits if necessary. The range of treatments offered provides residents experience in psychopharmacological and psychotherapeutic modalities. There is also the unique opportunity for geriatric psychotherapy supervision for residents in this rotation. A centralized seminar series comprehensively addresses the Rotation-Specific Objectives of the Division of Geriatric Psychiatry. There is also a weekly case conference to review outpatient assessments. On this service, supervision is provided by Drs. Adrian Grek (outpatient geriatric services) Joel Sadavoy (head of geriatric psychiatry program), Virginia Wesson (outpatient geriatric services/caregiver support) and Lesley Wiesenfeld (Consultation Liaison Geriatric Psychiatry Service). Residents on this rotation also participate in the weekly Interview Course, for PGY 3-5 residents. Consultation/Liaison Psychiatry: (6 Month Positions July-Dec & Jan-Jun) The CL psychiatry resident positions provide broad and intensive training in psychosomatics and consultation/liaison psychiatry. There are 2 main components to the rotation. There is a full range of general hospital training opportunities, encompassing assessment, consultation and liaison with a number of different clinical teams, crisis intervention, short-term and longer-term individual and family treatments. An outpatient CL brief follow-up clinic provides an opportunity for the resident to appreciate outcomes beyond discharge. Additionally, core residents will augment their training with an outpatient CL- based experience. This will likely be within the areas of Palliative care, HIV psychiatry and OB/GYN psychiatry. The specific patient areas and the supervisors associated with them are: psycho-oncology - breast; sarcoma - Dr. Jon Hunter; G.I. - inflammatory bowel disease; irritable bowel syndrome - Dr. Ellen Margolese; ICU- Dr. Mary Preisman, HIV-Dr. Peter DeRoche, Palliative medicine Dr. Bill Mah; OBS/GYN and maternal-infant mental health - Drs. Ariel Dalfen, Sharon Szmuilowicz, Mary Preisman and Beverly Young. Dr. Peter Moran also consults to the Wasser Pain Clinic and an opportunity is afforded for resident training in this area, including supervised interviews. Dr. Bob Maunder provides an opportunity for an observed interview focusing on the assessment of psychiatric aspects of the medically ill and provides supervision of the psychotherapy of ambulatory medically ill patients. Residents on this rotation also participate in the weekly Interview Course for PGY 3-5 residents. Overall, this rotation will provide residents with the opportunity to address the psychological aspects of a range of patients with medical/surgical illnesses utilizing a full range of pharmacological and psychotherapeutic treatments. Regular daily clinical rounds are augmented by monthly day long CL core curriculum teaching, created by the University Of Toronto Division of CL Psychiatry. This position is suitable for mandatory CL Psychiatry training, or it can be specifically tailored for senior selective psychosomatic medicine rotations.

3 Core Hospital-Based Opportunities PGY 3-5 Residents at Mount Sinai Hospital also participate in the weekly Senior Interview/STACER Prep Course, taught by Drs. Halman and Wiesenfeld Psychotherapy training opportunities for residents include Psychodynamic Psychotherapy, CBT, IPT, Brief Psychodynamic, Couple/Family Psychotherapy, or Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Our Psychodynamic Psychotherapy Supervisors include Drs. L. Chagoya, C. Dunbar, S. Horodezky, R. Kay, P. Keefe, A. Peterkin, C. Pain, R. Ruskin, J. Sadavoy, R. Slonim, A. Tarnopolsky, Dr. Madhu Vallabhaneni, M. Leszcz and G. Taylor. Couple and family therapy supervision is available from Mrs. C. Chagoya, Drs. L. Chagoya, Jeff Genik, and Kalam Sutandar. Group psychotherapy supervision is available with Drs. M. Leszcz and Greg Chandler. Supervision of crisis intervention is provided by Dr. R. Slonim. Cognitivebehaviour therapy supervision is provided by Drs. Greg Chandler and Jared Peck. Interpersonal psychotherapy supervision, including Group IPT, is provided by Dr. P. Ravitz, Dr. S. Rawkins and Dr. P. Westlind. Brief Psychodynamic Psychotherapy supervision is provided by Drs. Peter DeRoche, Christine Dunbar, Clare Pain and Allan Peterkin. CBASP supervision is provided by Dr. Sian Rawkins. All levels of residents are expected to participate in the teaching of medical students as well. In addition, each resident is expected to make one presentation at Departmental Grand Rounds, during their rotation. Grand Rounds are the central academic event of the department and are held weekly. Presenters are both departmental staff and trainees, and visiting lecturers. Seminars: Beyond the centralized seminars offered for core training, MSH offers a year-long interview skills/stacer preparation course, additional psychotherapy seminars in Brief (Dr. Christine Dunbar), Couple (Dr. Leo Chagoya and Ms. Charlotte Chagoya), and Group Psychotherapy (Dr. Molyn Leszcz), and an Advanced Formulation Course and a supplementary PGY-2 psychotherapy seminar. MSH also offers a challenging patient case conference on a monthly basis, led by Dr. Edred Flak. Certain psychotherapy seminars share the same time slot within an alternating fashion, thus providing an opportunity for a broad range of seminars within a compact period of time. Senior General Psychiatry and Psychotherapy Residents also participate in the Crisis Clinic case conference/seminar led by Dr. Rodney Slonim. The Department of Psychiatry also has an active Quality Improvement Committee and Research Group for residents wishing to pursue core or elective projects. Dr. Bob Maunder is the head of Research in the MSH Department of Psychiatry and welcomes researchinterested residents to join or develop projects in any of the focal areas of the department, including but not limited to : C/L Psychiatry, the impact of attachment on illness and disease, the impact of the supervisory relationship on psychotherapy outcomes, perinatal mental health services, clinician resilience, health, arts and the humanities, trauma, caregiver support, and ethno-cultural psychiatry. Senior Selectives (available as individual or combined opportunities) 1) Senior Psychotherapy Selectives can offer clinically supervised immersion into specific approaches or with specific patient populations. An intensive Senior Psychodynamic Psychotherapy opportunity is also available under the supervision of Dr. Rex Kay. This elective emphasizes directed literature reviews, mutual observation of clinical work and supervised teaching of junior trainees. This elective offers twice-weekly supervision and the opportunity to co-teach a PGY2 seminar and to review literature of interest to the resident. Other psychotherapy modality intensive training includes: Cognitive Behavioural Therapy under supervision of Dr. Greg Chandler or Dr. Jared Peck, Group Psychotherapy under supervision of Dr. Molyn Leszcz, Interpersonal Psychotherapy under supervision of Drs. Paula Ravitz, Sian Rawkins or Paul Westlind, Brief Psychodynamic Psychotherapy under supervision of Dr. Christine Dunbar, Narrative Therapy under supervision of Drs. Allen Peterkin, Rex Kay, or Ms. Julie Hann, Couple/Family Therapy under

4 supervision of Drs. Leo Chagoya or Jeffrey Genik or Kalam Sutandar or Charlotte Chagoya and CBASP under supervision of Dr. Sian Rawkins. Advanced Psychotherapy Seminars are also offered. All PGY 5 Residents pursuing Senior Selectives in Psychotherapy are expected to participate in the Dynamically informed Crisis Clinic. Furthermore, there will be opportunities for training in supervision through graduated responsibility for supervision of junior trainees. Dr. Ravitz is the key contact for Psychotherapy Selectives. 2) The Mount Sinai Hospital Perinatal Mental Health Program is offering a senior selective in caring for women with reproductive-related mental health concerns. Residents will develop expertise in doing outpatient assessments of women at risk of mental illness prior to pregnancy, during pregnancy as well as up to one year postpartum. They will also assess and follow patients on the obstetrics floors during pregnancy and the postpartum period. Residents will develop knowledge and expertise in treating women who are pregnant and breastfeeding with psychopharmacology as well as various modalities of psychotherapy. There are options for learning IPT, CBT, group therapy, and mindfulness based interventions for this population. In addition, the resident will have the opportunity to be involved with the Mature Women's Health Clinic at Mount Sinai by providing assessment and treatment for peri-menopausal women. Involvement in outreach to community mental health agencies that serve high risk perinatal populations is another are that the resident can be involved with. This selective will place a strong emphasis on liaising with our obstetrics and gynecology colleagues. Involvement with the team's research projects or new research initiatives may also be part of this selective experience. The resident will have the opportunity to work with various psychiatrists on the team, including Drs. Ariel Dalfen, Bev Young, Eileen Sloan, Mary Preisman, and Sharon Szmuilowicz. The team social worker, Ms. Melissa Goldband also participates in patient care, offering interprofessional opportunities for resident learning. There is also an opportunity for residents to be involved with research projects. Ongoing epidemiological research in the department aims at describing characteristics of this complex population, such as psychiatric, gynecological and medical co-morbidities; treatment outcomes; and psychosocial factors. 3) Drs. Lesley Wiesenfeld, Joel Sadavoy, Adrian Grek and Virginia Wesson in the Geriatric Psychiatry group at Mount Sinai Hospital can offer a Senior Selective Experience to residents seeking additional exposure, learning and supervision in C/L, ambulatory and community settings seeing elderly patients and families with psychiatric issues. Specialized training is also available in caregiver support and collaborative care with geriatric medicine and family medicine colleagues. 4) Drs. Clare Pain, Alex Tarnopolsky, and Lisa Andermann lead the Psychological Trauma Program, which provides an in-depth tertiary assessment and mini intervention for patients suffering from trauma spectrum disorders on Tuesday afternoons. Residents are encouraged to participate over a number of clinics and become part of the assessment team. Cases presented are generally complex, often involving treatment failures, impasses or misdiagnosis. Pre-clinic assessment includes the use of semi-structured questionnaires and clinical interviews by the clinic nurse. This material is discussed pre-clinic interview by the team. Supervision and guided readings are a component of the elective experience. Depending on patient availability there is a chance for interested residents to learn and practice a brief trauma desensitizing therapy model. The Affect Regulation Mastery group (ARM) runs for 2 hours a week for a 12 week period, and after a 2 week break it runs again. The ARM group is based on the DBT Emotional regulation module and is best suited to alexithymic but stable trauma patients who benefit from emotional literacy and emotional skills development. The clinic resident is welcome to co-facilitate a 12 week group. 5) A blended psychotherapy and psychosomatics position can be developed, to focus on the application of the psychotherapies and related research to particular patient populations, including the HIV, psychooncology and GI areas. A comprehensive senior training experience in HIV psychiatry can also be provided. Key Supervisors for this selective are Drs. Jon Hunter and Bob Maunder. 6) A blended position combining psychotherapy and general psychiatry is also available, affording opportunities to focus on the integration of the broad range of psychotherapeutic modalities with general adult psychiatry, psychopharmacology and crisis intervention. Dr. Sian Rawkins is the key supervisor for this selective. Full or part-time training in our Day Treatment program is also available under the supervision of Dr. Andrew Berntson.

5 7) A Collaborative Care selective in which residents consult to family physicians is available under the supervision of Dr. Halman (Head, Collaborative Care) (and may be particularly well-combined with outpatient C/L activities for added exposure to Collaborative Care skill development.) Training at the family practice unit includes 1-3 new assessments per week in addition to follow up care at the clinic. Residents work closely with family practice staff and residents as well as allied mental health clinicians. Residents will attend case rounds twice per week. They are paired with a group of family practice residents in the buddy program to answer mental health questions by , phone or in person. Residents can also be involved in assisting with the family practice resident core curriculum seminar. A combined General Psychiatry / Collaborative Care selective offers diverse patient population and level of acuity; working within a cohesive and supportive interprofessional team; opportunities to take on junior staff role and provide supervision to junior residents; supervision time dedicated to professional development. Drs. Sian Rawkins and Mark Halman are contacts for this selective. 8) Training can also be provided in the Assertive Community Treatment Team, offering a unique blend of community approaches in the context of diverse ethno-racial populations. Drs. Lisa Andermann and Sam Law can provide further details. 9) Health, Arts and Humanities Selective: Residents can arrange a humanities elective for one month or more based on the following options: -Becoming involved with editing/producing an issue of ARS MEDICA ( -Working on a piece of creative writing (fiction, memoir, creative non-fiction or poetry) or a scholarly humanities-based paper/article. Book reviews of medical humanities texts for medical journals may also be assigned. -Taking an active role in organizing/presenting at Health, Arts and Humanities seminars/workshops (See for current options in narrative medicine, film, and graphic medicine/illustration, writing workshops, medical history). Supervision of medical students around humanities initiatives may be involved. Residents will be asked to provide their learning goals for the elective and will be assigned to an appropriate supervisor in the Department of Psychiatry based on those goals. For information-contact apeterkin@mtsinai.on.ca For further information about core or selective experiences, please contact the MSH Postgraduate Education Site Coordinator, Dr. Lesley lwiesenfeld@mtsinai.on.ca