Postgraduate psychiatry education

PGY2 - General Hospital Psychiatry Core Rotation

Inpatient Supervisors: Dr. A. Feinstein, Dr. S. Castel, Dr. J. Weissglas, Dr. A Schaffer
Outpatient Supervisors: Dr. E. LaCroix, Dr. N. Grujich, Dr. M. Sinyor

This rotation seeks to introduce residents to the multiple facets of general psychiatry practice in a hospital setting. The year long experience consists of six months of inpatient training and six months of outpatient training. Learning occurs in a hospital setting replete with an extensive array of compelling patients with varying illnesses. Residents will be closely supervised and taught by a variety of excellent supervisors. An exposure to Cognitive Behavioural Therapy is built into the experience through observed assessments and treatment of patients with supervision.

Residents will also meet the Royal College requirement for longitudinal treatment of a patient with persistent and severe mental illness through supervised treatment of an ACT team patient or a similar chronic psychotic patient

This rotation meets Royal College requirements of general hospital psychiatry (inpatients and outpatients).

Consultation Liaison Psychiatry Core Rotation (this rotation meets Royal College requirements for C-L psychiatry)

Supervisors: Dr. R. Jaunkalns, Dr. N. Grujich, Dr. J. Ellis, Dr. G. Tennen, Dr. S. Grigoriadis, Dr. A. Scalco

This rotation involves supervision on the consultation liaison (C-L) team that provides psychiatric assessment and care to the medical and surgical services, as well as a chronic veteran’s facility at Sunnybrook Health Sciences Centre. Residents receive daily supervision of C-L cases with opportunity for experience in liaison with oncology, cardiology, long-term care and our regional burn unit, regional trauma unit and moms and babies unit. Residents may also receive training in neuropsychiatric assessment and treatment of selected patients. Besides one and a half hours of supervision a day, the residents also participate in weekly case conferences/seminars with a C-L focus. Residents on this rotation may also arrange supervision in outpatient consultations in medical psychiatry.

Collaborative Care Core Rotation & Telepsychiatry

Primary Supervisor: Dr. Nik Grujich
Secondary Supervisors: Dr. J. Moss, Dr. M. Sinyor, Dr. J. Ellis, Dr. S. Grigoriadis, Dr. E. LaCroix, Dr. A. Scalco

This relatively new and dynamic rotation has been developed to provide exposure to the growing practice of Collaborative Care. Residents will be working autonomously in the Sunnybrook Family Practice Clinic providing education and support to our family practice colleagues. In this capacity, there will be opportunities to engage in scholarly work and quality improvement projects being conducted by our department. In addition, there are opportunities to work with teams at U of T, Scarborough Campus and York University, Glendon Campus to collaborate with their student mental health services. As well, there are opportunities to work in C-L related clinics including psychosocial oncology and the DAN Women and Babies Program. Lastly, the rotation will provide exposure to telepsychiatry through consults and novel collaborative care programs with remote family health teams. This rotation is malleable and can be tailored to support the students’ interests.

Chronic Care Core Rotation

Primary Supervisor: Dr. Cliff Posel
Secondary Supervisor: Dr. Jay Moss

The primary assignment will be with SunPACT, an assertive Community Treatment Team. On the average day, 3-4 patients will be seen, mostly in the community. Access to a car is recommended, but mileage expense will be reimbursed by the program. In addition to SunPACT, the resident will assess 2-4 new consults per month on patients with Primary Psychotic disorders. They would follow up to 5 of these patients at once during the rotation. Supervision for SunPACT work would be provided directly or by cell phone by the primary supervisor on Mondays, Wednesdays, and Fridays, and by the Secondary Supervisor on Tuesdays. Supervision for the general consults and follow-up will be provided by the primary supervisor.

This rotation meets Royal College requirements for Chronic Care

Geriatric Psychiatry Core Rotation (this rotation meets Royal College requirements for Geriatric Psychiatry)

Supervisors: Dr. M. Rapoport, Dr. C. Cohen, Dr. G. Tennen, Dr K. Shulman, Dr. N. Herrmann, Dr. D. Gallagher

This rotation involves supervision in a variety of settings focusing on the assessment and management of mental health issues pertaining to the elderly. Available opportunities for supervision include a specialized Psychogeriatric inpatient unit, a multi-professional community home-visiting service, acute care and long-term care consultation-liaison services, busy out-patient services, and a multi-disciplinary memory clinic.

This rotation meets Royal College requirements for Geriatric Psychiatry.

Neuropsychiatry Career Track Rotation

Supervisor: Dr. A. Feinstein

This rotation involves a mix of clinical and research opportunities. Residents will be supervised in the detection and management of the psychiatric sequelae of neurological disease. Particular emphasis falls on multiple sclerosis, traumatic brain injury and conversion disorder. The rotation involves a close association with neuropsychology and neuroradiology.

Psychosocial Oncology

Supervisor: Dr. Janet Ellis

Place: Sunnybrook Health Sciences Centre

Time: Negotiable

Inquiries: Dr. J. Ellis 416-480-4073 or janet.ellis@sunnybrook.ca

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

Mood Disorders

Supervisor(s): Drs. A. Schaffer / M. Sinyor / A. Levitt

Place: Sunnybrook Health Sciences Centre

Time: Negotiable

Inquiries: Dr. A. Schaffer 416-480-4070 or ayal.schaffer@sunnybrook.ca

The Mood & Anxiety Disorders Program offers a clinical and/or research elective in Mood Disorders. The aim of the elective is to enhance clinical experience with patients suffering from major depression and bipolar disorder. The elective is also designed to allow the resident to participate in a research project that will lead to the opportunity to analyse and present data in written and/or oral format (optional). The areas of clinical and academic interest include: diagnosis and management approaches to bipolar disorder and treatment-resistant depression, population health / epidemiology of mood disorders or suicide, the role of novel treatment approaches for depression, and the principals of outpatient pharmacologically-based treatment for mood disorders with comorbid medical or psychiatric conditions.

Mood and Anxiety Disorders in Women

Supervisor(s): Drs. S. Grigoriadis / J. Mansfield / A. Sullovey / C. Brown

Place: Sunnybrook Health Sciences Centre

Time: Negotiable

Inquiries: Dr. S. Grigoriadis 416-480-5677 or Sophie.Grigoriadis@sunnybrook.ca

The Women’s Mood and Anxiety Disorders Clinic: Reproductive Transitions is part of the Mood & Anxiety Disorders Program at Sunnybrook and staff work closely with the DAN Women’s and Babies program of the hospital. The aim of the selective is to enhance clinical experience with women suffering from mood or anxiety disorders across the reproductive life cycle. Assessment and treatment of perinatal mood and anxiety disorders is currently the focus of the clinic but exposure to other stages such as perimenopause is also an option. Both outpatient and inpatient experiences are available, including shared care. Consultation, assessment and short-term follow-up are provided. Our staff have expertise in both psychotropic medication and psychotherapies as potential treatment options. Elective experiences will be catered to resident’s interests and ongoing educational needs / goals and can be designed to allow for the participation in a research project.

OCD & Related Disorders

Supervisor: Dr. Peggy Richter

Place: Sunnybrook Health Sciences Centre

Time: Negotiable

Inquiries: Dr. Peggy Richter 416-480-6832 or peggy.richter@sunnybrook.ca

This rotation will provide residents with the opportunity to gain expertise with obsessive compulsive disorder, as well as related OCD-spectrum disorders such as hoarding, trichotillomania, and body dysmorphic disorder. The resident will develop skills pertinent to the assessment and treatment of outpatients with these conditions, covering provision of consultations to community physicians, and hands on delivery of treatment to a selected cohort of appropriate outpatients. Expertise will be developed in delivery of both pharmacological and psychological treatments, focusing on specific CBT skills for this population. The interested resident will also have the opportunity to co-lead group CBT for OCD and trichotillomania. Regular supervised interviews will be provided, as well as close supervision with Dr. Richter. Opportunity to assess the broader range of anxiety disorders may also be arranged.

This selective is most appropriate for residents with a career interest in OCD, anxiety disorders, or CBT, as well as in general psychiatry with a proficiency in these areas of expertise.

There is significant opportunity to participate in research if interested, however this is not a requirement.

Cognitive Behaviour Therapy for the Senior Resident

Supervisor: Dr. Ari Zaretsky

Place: Sunnybrook Health Sciences Centre

Time: 1 day a week

Inquiries: Dr. Ari Zaretsky 416-480-5836 or ari.zaretsky@sunnybrook.ca

This rotation will provide residents with the opportunity to acquire mastery of CBT for both common as well as challenging psychiatric conditions such as bipolar disorder, PTSD and eating disorders. Expertise will be developed in delivery of both pharmacological and CBT, focusing on the acquisition of specific CBT skills for the diagnostic group that the resident is interested in. An immersive supervision experience will involve review of audiotapes and experiential learning through role-playing and self-reflection. Opportunity to observe Dr. Zaretsky’s own CBT treatment and weekly assessments will be built into this senior elective experience.

Collaborative Care

Supervisor: Dr. Nik Grujich

Place: Sunnybrook Health Sciences Centre

Time: Negotiable

Inquiries: Dr. Nik Grujich 416-480-4693 or Nikola.Grujich@sunnybrook.ca

The Collaborative Care opportunities at Sunnybrook are diverse and flexible. I would be happy to work with you to develop a tailored experience to meet your educational/career related needs.

We provide support to our in house academic FHT as well as the U of T Scarborough campus student services. In addition, over the last years, due to our new videoconferencing capacity, we have developed relationships with various FHT across Ontario and into remote regions to provide collaborative care support. These relationships focus on education and capacity building with less emphasis on direct consultation. Due to growing interest in this service, there will be opportunities for residents to engage in program development and take on leadership roles.

Our program is expanding and we are happy to support resident led initiatives. Also, for those interested in quality improvement projects, we are studying our model of collaborative care locally at Sunnybrook with the hopes of optimizing the program and developing metrics to evaluate outcomes.

At Sunnybrook, we have a number of opportunities to get involved with medical student teaching for those residents that may be interested.

Currently, we have clerks rotate through Psychiatry here in 6-week blocks. The two main teaching sessions that we as residents at Sunnybrook lead specifically, are the Personality Disorders Course and the Narrative and Reflective Curriculum course. During the course of the year, the Chief Resident will be asking for volunteers to teach portions of these two courses, and they can both be taught individually or in pairs.

Here is a description of the teaching opportunities currently at Sunnybrook;

The Personality Disorders Course

This course is taught in five separate one-hour sessions on the following topics;

1. Introduction to Personality Disorders (typically taught by the Chief Resident)
2. Borderline Personality Disorder and Antisocial Personality Disorder
3. Managing Difficult Clinical Situations – BPD and ASPD
4. Narcissistic Personality Disorder and Dependent Personality Disorder
5. OCPD, Schizoid, and Shizotypal Personality Disorders

The course is fun to teach, and provides an opportunity to interact with the clerks on their psychiatry rotation. The sessions are fairly straightforward to teach, and are outlined in a teaching manual. The manual guides you through how to complete each of the seminars (but there is always room for improvisation along the way!).

The Narrative and Reflective Competence Curriculum

This course is taught as one session that is one-hour in length, and typically occurs at the beginning of the clerks block, as they have an assignment on reflection that is due at the end of their block (which we are not responsible for looking at or grading). Our role in this curriculum is to teach the companion seminar that introduces and fosters skills of reflection.

Additional Teaching Opportunities

As the below opportunities often have extra time components to them (compared to the Personality Disorders and Narrative Seminars), and they are not mandatory resident based teaching, it is important that you contact your primary supervisor for approval before signing up to teach these sessions. All the additional teaching opportunities below are co-taught with a staff:

1. ASCM 1 and ASCM 2 which are clinical and interviewing skills courses (ASCM 1 is more basic clinical skills, and ASCM 2 has a specific psychiatry interviewing component)
2. PBL
3. Community, Population, and Public Health (formerly known as Determinants of Community Health)
4. Transition to Clerkship (professionalism, and the violent patient teaching sessions)
5. Portfolio: for this teaching seminar, it is limited to only PGY-2 residents and above.

In terms of learning more about the teaching opportunities for medical students at Sunnybrook; Dr. Eileen LaCroix is the Undergraduate Coordinator (contact email is eileen.lacroix@sunnybrook.ca) and Tasoula Masina is the Undergraduate Education Assistant (contact email is tasoula.masina@sunnybrook.ca)

Sunnybrook also emphasizes training in psychotherapy, including cognitive behavioural, short and long–term psychodynamic, interpersonal, group, couples and family psychotherapies.

A superlative cadre of supervisors includes: Dr. G. Adler Nevo, Dr. C. Brown, Dr. A. Cheung, Dr. E. Dubo, Dr. J. Ellis, Dr. M. Fefergrad, Dr. L. Gerber, Dr. S. Grigoriadis, Dr. N. Grujich, Dr. S. Hershkop, Dr. M. Korenblum, Dr. D. Leibow, Dr. M. Leith, Dr. Joanna Mansfield, Dr. N. Rector, Dr. S. Reiter, Dr. P. Richter, Dr. M. Rosenbluth, Dr. S. Selchen, Dr. M. Sinyor, Dr. F. Small, Dr. B. Stein, Dr. A. Sullovey, Dr. N. Westreich, Dr. J. Weissglas, Dr. A. Zaretsky

Residents will have an opportunity to participate in both prospective clinical trials and retrospective chart reviews at varying levels of involvement according to their wishes and needs. We have a very active research portfolio in the department run by Dr. Anthony Levitt. Current areas of study include epidemiology of mental illness, genetics of mental illness, mood disorders including a focus on women, suicide, Obsessive Compulsive Disorder, geriatric psychiatry, adolescent psychiatry, psychosocial oncology, post traumatic stress disorder and Cognitive Behavioral Therapy

Sunnybrook provides a rich seminar program experience. While the seminars are designed to meet specific needs of either junior or senior residents, we have found that most residents attend and benefit from the spectrum of teaching activities.

These programs include the following Seminars:

1. Junior Resident Interview
2. Senior Resident Interview
3. Senior Psychotherapy
4. Formulation
5. Geriatric Psychiatry
6. Psychopharmacology
7. Interpersonal Psychotherapy
8. Family Therapy
9. Psychosocial oncology and palliative care
10. Grand Rounds Preparation
11. Department Chief Rounds
12. Journal Club

Geriatric Psychiatry: Drs. Gayla Tennen, Nathan Hermann, Ken Shulman, Mark Rapoport, Carole Cohen

Medical Psychiatry: Drs. Rob Jaunkalns, Gayla Tennen, Nikola Grujich, Janet Ellis

Neuropsychiatry: Drs. Anthony Feinstein, Scott McCullagh, Neal Westreich

Adolescent Psychiatry: Drs. Gili Adler-Nevo, Carolyn Boulos, Elyse Dubo, John Teshima, Neal Westreich, Sharon Reiter, Amy Cheung, David Kreindler, Ben Goldstein, Ralph Lewis

SUNPACT (Assertive Community Treatment Team): Drs. Jay Moss, Cliff Posel

Psychiatric Emergency Services (PES): Drs. Eileen LaCroix, Jay Moss, Nik Grujich, Mark Fefergrad, Cliff Posel

Mood Disorders: Drs. Ben Goldstein, Anthony Levitt, Ayal Schaffer, Sophie Grigoriadis, Mark Sinyor, Amy Cheung, David Kreindler

Obsessive Compulsive Disorder (OCD) and related disorders: Drs. Peggy Richter, Nik Grujich, Neil Rector

Psycho-oncology: Drs. Janet Ellis, Eileen LaCroix

Women’s Mental Health: Drs. Sophie Grigoriadis, Joanna Mansfield, Amanda Sullovey, Cara Brown