DEPARTMENT OF
PSYCHIATRY
Learning Objectives
PGY1 Psychiatry Residents
Clinical Rotations & Electives
July 2012 – June 2013
POSTGRADUATE EDUCATION
DEPARTMENT OF PSYCHIATRY
UNIVERSITY OF TORONTO
Overview of Psychiatry Residency Training
Welcome to psychiatry residency training!
This booklet outlines the training objectives for your PGY-1 rotations. The Royal College
of Physicians and Surgeons of Canada mandate the training that you must receive in
order to be recognized as a specialist in psychiatry in Canada.
These objectives are framed in terms of the CanMEDS Roles for physicians:
 medical expert
 communicator
 collaborator
 scholar
 health advocate
 manager
 professional
CanMEDS Roles developed out of a project of the Royal College of Physicians and
Surgeons of Canada in 1996 to provide an educational framework for physician
competencies. It was subsequently revised in 2005. The CanMEDS roles were created by
physicians in response to challenges in contemporary health care and were based on
evidence and oriented to societal needs. Further information about CanMEDS Roles is
located at the end of this document.
What is the Purpose of the PGY1 Year?
The PGY1 year of training is designed to consolidate your knowledge, skills and attitudes
as a physician prior to embarking on specialty training in psychiatry. The medical
knowledge, skills and attitudes you develop during your PGY1 year will inform your
ability to provide excellent care to your psychiatric patients. It will also provide the
medical foundation that you require in order to successfully complete your mandatory
training in geriatric psychiatry, consultation-liaison psychiatry and shared care.
Which Rotations Do I Complete in the PGY1 Year?
PGY1 Psychiatry residents will complete rotations in:
Internal Medicine
Family Medicine OR Pediatrics
Emergency Medicine
Behavioural Neurology
Neurology
Neuroradiology
Palliative Care
Psychiatry
Psych ER
C/L Psych
Addictions
2 months
1 month
1 month
1 month
1 month
1 week intensive
1 month
3 months
1
Elective 1 mo & Selective 1 mo
2 months
(Elective & Selective months to be determined in discussion with Dr. Abbey.
These months should be tailored in order to meet your individual learning needs
and career goals. CSS residents must do two months of research with their
supervisor other residents tailor their elective experience based on their personal
learning needs)
How do I organize my elective and selective? You will meet in the summer or early fall
with the PGY1 Coordinator, Dr. Susan Abbey, who will help you to sort out
opportunities that will meet your individual learning needs.
How much time can I spend doing research? Research can be the focus of up to 2 months
of training. You will need to complete an application form to spend your time doing
research. The form is available on the Department web site and also from Dr. Abbey.
PGY1s in the Clinician Scientist Stream are expected to spend two months of elective
time doing research with their supervisor.
Why Are There Objectives for Training?
We have provided you with objectives that will help you to direct your learning and to
make choices amongst the many educational opportunities that will be available to you.
Please review the rotation specific objectives at the start of each rotation in order to
orient you to the goals of training for that rotation.
At the end of each rotation, your supervisor(s) will complete an ITER (In-Training
Evaluation Report) that evaluates your performance on the rotation and that is based on
these objectives.
Who Can I Get Help From In Sorting This All Out?
Dr. Mark Fefergrad, Director of Post-graduate Education for the Department of
Psychiatry will meet with you during the course of the year to ensure that your
educational needs are being met. He is very helpful and approachable and you should feel
free to contact him if you need anything before your scheduled meeting.
Dr. Susan Abbey, PGY-1 Coordinator for the Department of Psychiatry, will meet with
you during the summer or early fall to help you sort out electives and to assist you in
tailoring your training experiences to your individual needs. She will be happy to
organize additional support or mentorship if that would be helpful to you.
PGY1 Coordinators at each of the base hospitals are available to help you with site based
issues. They are another important source of mentorship and support.
2
The PGY1 Coordinators at the base hospital are as follows:
Mt. Sinai
Dr. Ellen Margolese - EMargolese@mtsinai.on.ca
St. Michael’s Dr. Mark Halman -
Halmanm@smh.ca
Sunnybrook
Dr. Justin Weissglas – justin.weissglas@sunnybrook.ca
UHN
Dr. Susan Abbey -
susan.abbey@uhn.ca
Questions
If you have any comments or questions about these training objectives, please contact the
PGY-1 coordinator, Dr. Susan Abbey at susan.abbey@uhn.on.ca or 416-340-4447.
What if My Attending Physician/Supervisor has a Question?
If your attending physician/supervisor has any questions about these training objectives,
please give them Dr. Abbey’s contact information (susan.abbey@uhn.on.ca or 416-3404447) or send her an email with their contact information and she will follow up with
them.
3
CORE MEDICAL ROTATIONS
4
GENERAL INTERNAL MEDICINE
Rotation offered at: MSH, SHSC, SMH, UHN
Description:
General internal medicine is a two-month core rotation for all PGY1 residents in
psychiatry that occurs on clinical teaching units (CTUs). PGY1s are assigned to their
base hospital whenever possible. The general internal medicine team provides care for
patients with a wide spectrum of medical conditions. Each team consists of one senior
resident (PGY2-3), two junior residents (PGY1-2), and a maximum of four clinical clerks
under the supervision of an attending physician.
The general internal medicine rotation provides an opportunity for the PGY1 psychiatry
resident to develop knowledge and skills in the assessment and management of patients
with a variety of medical illnesses.
PGY1s will receive their general internal medicine training through care of inpatients on
the clinical teaching units, consultation to the emergency room and through participation
in educational opportunities including morning report, noon hour lecture series and
medical grand rounds.
Rotation Specific Objectives:
Medical Expert

Develop an approach to the diagnosis and management of a wide variety of
clinical problems including patients presenting with the following clinical
problems:
o Cardiovascular – heart failure, coronary artery disease, atrial fibrillation,
hypertensive emergencies, syncope, shock, valvular heart disease
o Respiratory – obstructive airway disease, pleural effusion,
thromboembolic disease, malignant disease, lower respiratory tract
infections, interstitial lung disease
o Gastrointestinal – GI bleeding, peptic ulcer disease, acute and chronic
liver diseases and their complications, diarrhoea, pancreatitis,
undifferentiated abdominal pain
o Infectious – fever of unknown origin, complications of HIV infection,
appropriate use of antibiotics, acute infectious illness (meningitis,
encephalitis, pneumonia, endocarditis, gastroenteritis, sepsis, septic
arthritis, cellulitus, pyelonephritis)
o Endocrinologic – diabetes and its complications, adrenal disorders, thyroid
disorders, complications of steroid use, calcium disorders, osteoporosis
o General – weight loss, overdose, drug reactions, fatigue
o Ethics – end of life care, informed consent, capacity assessment
o Geriatric – frequent falls, incontinence, polypharmacy, failure to cope, the
“social admission”
5

Develop technical skills related to in-patient care in general internal medicine
including arterial puncture for blood analysis, nasogastric tube insertion, insertion
of peripheral venous lines
Communicator




Obtain a history from patients and family members
Effectively convey a management plan to patients and family members
Communicate effectively with members of the multidisciplinary team in the
general internal medicine setting and to liaise effectively with community
practitioners and agencies involved with general internal medicine patients and
their families
Communicate effectively and efficiently with consulting services
Scholar


Access relevant literature and other resources to guide assessment and
management of general internal medicine patients
Develop skills in the critical appraisal of literature regarding the diagnosis and
treatment of issues in general internal medicine
Manager


Efficiently assess patients and initiate and tailor management plans for patients in
the emergency room or inpatient medical ward setting
Develop time management skills to reflect and balance priorities for patient care,
sustainable practice, and personal life
Collaborator


Describe and understand the role of the physician in the general internal medicine
setting
Describe and understand the roles of allied healthcare professionals, both within
the hospital setting and in the community, with respect to the assessment and
management of general internal medicine patients and their family and friends
Health Advocate



Advocate effectively on behalf of general internal medicine patients for the
services that they require
Identify opportunities for patient counseling and education regarding their
medical conditions
Educate patients regarding lifestyle modifications that may prevent disease
including modification of cardiovascular risk factors
Professional


Demonstrate professional attitudes in interactions with patients, families and other
healthcare professionals
Recognize and appropriately respond to ethical challenges in the general internal
medicine setting
6
FAMILY MEDICINE OR PEDIATRICS
Rotation offered at: Multiple Sites
Description:
The Royal College mandates that PGY1s in psychiatry spend a month in either family
medicine or pediatrics. The U of T offers many different options to fulfill this
requirement so that you can tailor your learning environment to your learning preferences
and career needs.
General objectives for both rotations are show in the pages that follow.
7
FAMILY MEDICINE
Rotation offered at:
Academic health science centre family medicine units
Community family medicine sites including family health teams,
community health centres and family health care providers offices.
CAMH Family Health Team
Rural Ontario Medical Program (ROMP) sites
Description:
The Royal College mandates that PGY1s in psychiatry spend a month in either family
medicine or pediatrics. The U of T offers many different options to fulfill this
requirement so that you can tailor your learning environment to your learning preferences
and career needs. You have the opportunity to undertake family medicine training in the
type of family medicine environment that is most helpful for your leaning needs.
All of the family medicine sites provide primary care for patients with a wide spectrum of
medical conditions. The composition of the teams varies by site.
The family medicine rotation provides an opportunity for the PGY1 psychiatry resident to
develop knowledge and skills in the assessment and management of patients in the
primary care setting presenting with a variety of medical and psychiatric illnesses and
psychosocial dysfunction and distress.
Rotation Specific Objectives:
Medical Expert




Demonstrate a broad, relevant, up-to-date knowledge base in conditions relevant
to primary care
Demonstrate ability to conduct a focused, accurate and complete history and
physical exam
Develop an approach to the diagnosis and management to common symptoms in
primary care:
o Headache
o Fatigue
o Abdominal pain
o Dizziness
o Back Pain
o Chest Pain
Develop an approach to the management of common clinical problems including:
8
o
o
o
o
o
o
o
o
o

Infections
Hypertension
Diabetes
GERD
Fatigue
Abdominal pain
Dizziness
Back Pain
Chest Pain
Demonstrate counseling and psychotherapy skills related to lifestyle issues and
psychosocial problems
Communicator





Obtain a focused history from patients +/or family members
Uses a patient centred approach and demonstrating understanding of the patient
agenda and illness experience
Effectively convey a management plan to patients and family members
Effectively communicates and collaborates with the multidisciplinary team in the
family medicine setting
Effectively communicates and collaborates with community health care providers.
Scholar


Access relevant literature and other resources to guide assessment and
management of primary care patients
Develop skills in the critical appraisal of literature regarding the diagnosis and
treatment of issues in primary care
Manager

Develop time management skills related to handling multiple clinical demands
and responsibilities
Collaborator


Describe and understand the role of the physician in the primary care setting
Describe and understand the roles of allied healthcare professionals, both within
the primary care setting and in the community, with respect to the assessment and
management of primary care patients and their family and friends
Health Advocate



Advocate effectively on behalf of primary care patients for the services that they
require
Identify opportunities for patient counseling and education regarding their
medical conditions
Educate patients regarding lifestyle modifications that may prevent disease
including modification of cardiovascular risk factors
9
Professional


Demonstrate professional attitudes in interactions with patients, families and other
healthcare professionals
Recognize and appropriately respond to ethical challenges in the primary care
setting
10
PEDIATRICS
Rotation offered at:
Hospital for Sick Children – Emergency room or inpatient ward
Community hospitals including North York General Hospital and
Toronto East General Hospital
Community pediatricians
Pediatric programs with a specific focus – e.g. developmental
pediatrics, adolescent medicine,
Rural Ontario Medical Program (ROMP) sites
Description:
The Royal College mandates that PGY1s in psychiatry spend a month in either family
medicine or pediatrics. The U of T offers many different options to fulfill this
requirement so that you can tailor your learning environment to your learning preferences
and career needs. You have the opportunity to undertake pediatric training in the type of
environment that is most helpful for your leaning needs.
All of the pediatric sites provide pediatric care with a wide spectrum of medical
conditions. The composition of the teams varies by site.
The pediatric rotation provides an opportunity for the PGY1 psychiatry resident to
develop knowledge and skills in the assessment and management of pediatric patients in
the primary care setting presenting with a variety of medical and psychiatric illnesses and
psychosocial dysfunction and distress.
Rotation Specific Objectives:
Medical Expert




To assess pediatric patients and recognize both common illnesses that can be
managed at home and those with critical illnesses that require in-patient care
Demonstrate ability to conduct a focused, accurate and complete history and
physical exam
Develop an approach to the pediatric patient with multiple disabilities or multisystem problems
Demonstrate counseling and psychotherapy skills related to lifestyle issues and
psychosocial problems
Communicator

Obtain a focused history from patients +/or family members
11



Communicate effectively and empathetically with parents and children and
involve families in decision-making
Effectively communicate with other physicians as well as members of the
multidisciplinary team in the pediatric setting
Effectively communicates and collaborates with community health care providers.
Scholar


Access relevant literature and other resources to guide assessment and
management of pediatric patients
Develop skills in the critical appraisal of literature regarding the diagnosis and
treatment of issues in pediatrics
Manager


Develop appropriate and cost-effective use of diagnostic and consulting services
Develop an understanding of the principles of quality improvement by attending
morbidity and mortality rounds
Collaborator

Develop the attitude of cooperative and collaborative team work and the ability to
work with and share responsibilities with other medical and health care
professionals including nurses, social workers, dieticians, physiotherapists and
occupational therapists, and respiratory therapists.
Health Advocate



Demonstrates and promotes active involvement of the family in medical decision
making and comprehensive care of the child.
Identifies the psychosocial, economic and societal factors that may affect a child’s
health and ability to receive care
Recognizes and responds appropriately to advocacy situations.
Professional


Demonstrate professional attitudes in interactions with patients, families and other
healthcare professionals
Recognize and appropriately respond to ethical challenges in the pediatric setting
12
EMERGENCY MEDICINE
Rotation offered at: MSH, SHSC, SMH, UHN
Description:
Emergency medicine is a one-month core rotation for all PGY1 residents in psychiatry
that occurs in the emergency departments of their base hospitals whenever possible. This
is a busy rotation during which residents participate in all aspects of patient care in the
emergency department including initial stabilization, decision making regarding
investigations, treatment and admission/discharge disposition.
Rotation Specific Objectives:
Medical Expert




Perform an accurate and concise history and physical examination in the
undifferentiated patient presenting to the emergency department
Demonstrate the ability to formulate an appropriate plan for the investigation,
treatment, and disposition of the undifferentiated patient presenting to the
emergency department
Utilize a systematic approach to issues of resuscitation in the patient:
o with a compromised airway including indications for intubation of a
patient and an understanding of the possible complications of this
procedure, understand the various airway adjuncts, ventilation devices and
oxygen administration devices
o with common cardiac dysrhythmias including ventricular fibrillation,
ventricular tachycardia, asystole, bradycardia, supraventricular
tachycardias,
o in shock including classification of the causes of shock
Demonstrate an approach to the emergency diagnosis and management of:
o substance abuse and toxic exposures – the poisoned patient including
recognition of toxidrome decontamination procedures, laboratory
investigations, use of antidotes, utilization of the Regional Poison-Control
Centre as a resource; recognition and management of alcohol-related
disease including alcohol withdrawal, alcohol withdrawal seizures and
delirium tremens
o environmental exposures – heat-related illnesses; hypothermia; bite wound
(human or animal) including a knowledge of tetanus immunization
o central nervous system disorders – coma including classification of the
causes of coma, demonstration of a knowledge of the Glasgow Coma
Scale; seizure including the use of various anticonvulsant agents;
suspected TIA or stroke
o cardiovascular diseases – chest pain including acute ischemic syndromes,
pericarditis, aortic dissection; indications and contraindications for
thrombolytic therapy; hypertensive emergencies and urgencies; acute
pulmonary edema
13


o respiratory diseases – acute respiratory distress; acute exacerbation of
asthma or COPD and differentiate between mild, moderate and severe
exacerbations of asthma; suspected pulmonary embolism; community
acquired pneumonia and the indications for admission
o genitourinary disease – urinary tract infections; renal colic; urethritis,
epididymitis, testicular torsion; vaginal bleeding in the pregnant and nonpregnant patient, management of pelvic inflammatory disease; risk factors
for ectopic pregnancy
o gastrointestinal diseases – upper and lower gastrointestinal bleeding
o domestic violence
o behavioural and psychiatric disorders – suicidal behaviour; legal criteria
for holding patients in the emergency department against their will,
differentiate between functional and organic causes of psychosis,
indications and contraindications for using physical and chemical
restraints
Develop technical skills related to the practice of emergency medicine including:
maneuvers used to help maintain a patent airway in the compromised patient;
proper technique for infiltration of local anesthetic, technique for performing a
digital nerve block, ability to suture a simple skin laceration including wound
preparation, anaesthesia, suture material selection, wound closure, dressing, and
appropriate follow-up care
Demonstrate awareness of and appropriate referral to community resources
available to emergency medicine patients and their families
Communicator


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


Demonstrate the ability to gather history from patients and their families in the
emergency room context
Demonstrate the ability to gather collateral information from patients’ families
and from community agencies and practitioners
Effectively communicate information regarding medications to patients
Effectively communicate treatment and follow-up plans to the patient
Communicate effectively with members of the multidisciplinary team in the
emergency medicine setting and liaise effectively with community practitioners
and agencies involved with emergency medicine patients and their families
Communicate effectively and efficiently with consulting services
Scholar


Access relevant literature and other resources to guide assessment and
management of emergency medicine patients
Develop skills in the critical appraisal of literature regarding the diagnosis and
treatment of issues in emergency medicine
Manager


Develop the ability to perform focused histories and physical examination in the
time-limited environment of the emergency room
Describe and understand the central role of the physician in overall emergency
department management
14

Develop time management skills to reflect and balance priorities for patient care,
sustainable practice, and personal life
Collaborator


Describe and understand the roles of allied healthcare professionals, both within
the hospital setting and in the community, with respect to the assessment and
management of emergency medicine patients
Demonstrate appropriate initiation of specialty consultation
Health Advocate



Demonstrate the capacity to advocate effectively on behalf of emergency
medicine patients for the services that they require
Identify opportunities for patient counseling and education regarding their
medical conditions
Educate patients regarding lifestyle modifications that may prevent emergency
room visits for certain medical conditions
Professional


Demonstrate professional attitudes in interactions with patients, families and other
healthcare professionals
Recognize and appropriately respond to ethical challenges in the emergency
medicine setting
15
BEHAVIOURAL NEUROLOGY
(COGNITIVE NEUROLOGY)
Rotation offered at: SHSC
Description:
The behavioural neurology rotation provides an opportunity for the PGY1 psychiatry
resident to develop knowledge and skills in the assessment and management of patients
with cognitive and behavioural disturbances secondary to neurological disease.
PGY1 psychiatry residents will develop an organized approach to undertaking a
behavioural neurology assessment including detailed cognitive assessment strategies that
they can use at the bedside and in the clinic as well as general neurological assessments.
They will learn about dementia and other common neurobehavioural disorders.
PGY1s will receive their behavioural neurology training at Sunnybrook Health Sciences
Centre where they will participate in outpatient clinics, consultation to psychiatric and
geriatric inpatients, and on call duties to general neurology.
Rotation Specific Objectives:
Medical Expert






Develop an organized approach to doing a neurobehavioural examination
through:
o history taking
o neurological physical examination
o detailed mental status examination
o physician administered cognitive testing including the assessment of
memory, aphasia, neglect, and apraxia
o completion of structured assessment questionnaires
o record-keeping on a structured consultation feedback form
Develop skills in eliciting and interpreting abnormal neurobehavioural signs
Assess and initiate diagnostic and management plans for neurobehavioural
disorders including dementia
Interpret the reports of EEG and neuroimaging investigations including CT, MRI,
and SPECT scanning
Review knowledge of neuroanatomy and neurophysiology that is required to
localize lesions and recognize abnormalities of function
Refine general neurology skills in assessment, diagnosis and management
planning with respect to the evaluation of the emergency room patient presenting
with neurological symptoms including:
o unexplained coma
o status epilepticus
o acute bacterial and viral infections of the CNS
16

o acute stroke syndromes
o acute paralytic disorders
Appropriately utilize community resources available to behavioural neurology
patients and families
Communicator



Deliver understandable information to patients and families regarding common
issues in behavioural neurology
Identify and appropriately address ethical issues with behavioural neurology
patients and their families
Communicate effectively with members of the multidisciplinary team in the
behavioural neurology setting and liaise effectively with community practitioners
and agencies involved with behavioural neurology patients and their families
Scholar

Access relevant literature and other resources to guide assessment and
management of behavioural neurology patients
Manager


Develop the ability to perform appropriately focused histories, mental status and
physical examinations in behavioural neurology patients
Develop the ability to prioritize and make appropriate allocation of time in the
face of competing clinical priorities
Collaborator



Describe and understand the role of the physician in the behavioural neurology
setting
Describe and understand the roles of allied healthcare professionals, both within
the hospital setting and in the community, with respect to the assessment and
management of behavioural neurology patients and their family and friends
Collaborate effectively with other members of the behavioural neurology team
and community agencies
Health Advocate

Demonstrate the capacity to advocate effectively on behalf of behavioural
neurology patients for the services that they require
Professional


Demonstrate professional attitudes in interactions with patients, families and other
healthcare professionals
Recognize and appropriately respond to ethical challenges in the behavioural
neurology setting
17
NEUROLOGY
Rotation offered at: MSH, SHSC, SMH, UHN
Description:
The neurology rotation provides an opportunity for the PGY1 psychiatry resident to
develop knowledge and skills in the assessment and management of patients with
neurological disease. Most rotations include some combination of inpatient and
ambulatory experiences.
PGY1 psychiatry residents will develop an organized approach to undertaking a
neurology assessment. They will learn about common neurological conditions and the
management of common neurological emergencies.
Rotation Specific Objectives:
Medical Expert






Develop an organized approach to assessing a patient with neurological
complaints through:
o history taking – obtaining a complete neurologic history from adults
including a collateral history where necessary
o an appropriate physical examination
o neurological examination – identify if there is unifocal, multifocal or
diffuse involvement of the nervous system and, where possible,
appropriately localize the lesion(s) based on neurophysiology and
neuroanatomy
o mental status examination
Formulate an appropriate provisional diagnosis and differential diagnoses
Outline an appropriate plan for laboratory investigation
Outline an appropriate therapeutic plan
Develop the necessary technical skills in neurology
o Perform a lumbar puncture
o Evaluate the relevance of a specific report of common investigative
procedures used in neurology including: CSF analysis,
electroencephalogram, evoked responses, angiograms, CT and MRI of the
neuraxis
Be familiar with and able to recognize, assess and treat patients with the following
neurological problems:
o Neurological emergencies
 Acute paralysis
 Bacterial infections of the CNS
 Status epilepticus
 Unexplained coma
 Subarachnoid hemorrhage
18


 Myasthenic crises
 AIDP/Guillain-Barre syndrome
o Acute myelopathy
o Acute and chronic neuropathies
o Ataxia and gain disorders
o CNS infections
o Cancer & the CNS including metastatic & nonmetastatic neurologic
complications of cancer, tumors of the nervous system
o Cervical and lumbosacral radiculopathies
o Coma and acute encephalopathies
o Dementia
o Headache syndromes and craniofacial pain
o Neuromuscular disorder including neuromuscular junction syndromes
(e.g. myasthenia gravis) and myopathies
o Neuro-opthalmological disorder (e.g. optic neuritis)
o Cranial neuropathies
o Movement disorders: parkinsonism, hypokinetic & hyperkinetic disorders
o Epilepsy and seizures
o Cerebrovascular diseases
o Vertigo and dizziness
Describe the indications for, side effects and dosages of the major agents used in
neurologic therapeutics
Describe the major bacteria causing nervous system infections including
classification and antibiotic sensitivities
Communicator


Establish therapeutic relationships with patients/families including being able to
obtain and synthesize relevant history from patients/families, listen effectively
and discuss appropriate information with patients/families patients and their
families
Communicate effectively with members of the multidisciplinary team in the
neurology setting and to liaise effectively with community practitioners and
agencies involved with neurology patients and their families
Scholar

Access relevant literature and other resources to guide assessment and
management of neurology patients
Manager


Develop the ability to prioritize and make appropriate allocation of time in the
face of competing clinical priorities
Develop time management skills to reflect and balance priorities for patient care,
education, sustainable practice and personal life
Collaborator

Describe and understand the role of the physician in the neurology setting
19


Describe and understand the roles of allied healthcare professionals, both within
the hospital setting and in the community, with respect to the assessment and
management of neurology patients and their family and friends
Collaborate effectively with other members of the neurology team and community
agencies
Health Advocate



Demonstrate the capacity to advocate effectively on behalf of neurology patients
for the services that they require
Know about community resources helpful to neurology patients
Counsel patients on the importance of taking responsibility for their own wellbeing and recognize the important determinants predisposing to neurological
disorders (e.g. risk factors for TIA and stroke, teratogenic effects of anti-epileptic
drugs)
Professional



Demonstrate professional attitudes in interactions with patients, families and other
healthcare professionals
Recognize and appropriately respond to ethical challenges in the neurology
setting
To be punctual when attending clinics, consults, rounds, teaching sessions. If
unable to attend for legitimate reasons, to notify the attending staff or the senior
neurology resident ahead of time.
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NEUROIMAGING & NEURORADIOLOGY
Centralized Teaching
Description:
Neuroimaging week is a one-week introduction to neuroimaging for the PGY1
psychiatric resident that includes a day in neuroanatomy.
The week provides an opportunity to develop knowledge and skills with respect to the
appropriate role of neuroimaging in the investigation and follow-up of patients with
psychiatric, neuropsychiatric and neurobehavioural disorders. PGY1 psychiatry residents
will review fundamental neuroanatomy relevant to neuroimaging and psychiatry, develop
an understanding of the basic principles underlying common neuroimaging techniques,
increase their ability to understand neuroradiology reports and develop basic skills in
reading CT and MRI scans.
21
PALLIATIVE CARE
Rotation offered at: MSH, SHSC, SMH, UHN
Description:
The palliative care rotation provides an opportunity for the PGY1 psychiatry resident to
develop knowledge and skills in the provision of end-of-life care that can be applied in
other PGY1 rotations and which are applicable to later training in and the practice of
psychiatry.
PGY1 psychiatry residents will develop an approach to the assessment and management
of common medical issues in palliative care patients including the optimal use of opiate
and nonopiate analgesic medications, symptom control strategies for common distressing
symptoms in palliative patients, and breaking bad news and working with emotionally
distressed patients and their families.
PGY1s will receive their palliative care training in palliative care inpatient units and
consultation services. While the rotation is a part of core medical training, PGY1s will
have the opportunity to participate in educational activities related to the psychosocial
aspects of palliative care.
The University of Toronto Post-Graduate Medical Education Program has developed a
web-based learning module on End-of-Life Care that all PGY1s are required to complete
at some point during their PGY1 year. If you have not already completed the module,
your palliative care rotation is a good time to do the module and the unit tests. You are
required to achieve a minimum score of 70% on all of the unit tests and the post-module
test in order to successfully complete the module.
Rotation Specific Objectives:
Medical Expert





Assess pain and symptoms effectively via a pain history, appropriate physical
exam and relevant investigations
Prescribe opioids effectively including initiating dosage, titration, breakthrough
dosing and prevention of side-effects.
Prescribe adjuvant modalities and medications for pain.
Participate in the development of interdisciplinary management plans for other
symptoms including fatigue, anorexia, cachexia, constipation, dyspnea, nausea
and vomiting, delirium, anxiety and depression
Monitor the efficacy of symptom management plans
22





Develop a management plan that appropriately balances disease-specific
treatment and symptom management according to the individual needs of the
patient and family
Document a holistic management plan
Identify and assess psychosocial and spiritual issues in end-of-life care and
develop and implement a care plan to address these issues in collaboration with
other disciplines
Describe the elements of the ESAS tool and the Palliative Performance Scale in
relation to ongoing assessment of both the management plan and disease
trajectory
Self-assess one’s own attitudes and beliefs in caring for the dying and how they
impact the care provided
Communicator




Communicate comprehensive information about the common issues of an
advanced illness compassionately and effectively including delivering bad news
Initiate and participate in effective patient and family meetings
Educate patients and family about end-of-life care issues and pain and symptom
management
Effectively communicate with the interprofessional team and community
resources regarding end of life care issues for patient and family
Scholar


Access relevant literature and other resources to guide assessment and
management of palliative care patients
Develop skills in the critical appraisal of literature regarding palliative care
Manager


Develop the ability to perform appropriately focused histories, mental status and
physical examinations in palliative care patients
Develop time management skills to reflect and balance priorities for patient care,
education, sustainable practice and personal life
Collaborator


Demonstrate effective consultation skills as part of the interprofessional care in
formal and informal teams
Effectively arrange and coordinate the care of dying patients with the help of an
interprofessional team, including the multiple modalities of care available in the
hospital and the community
Health Advocate

Demonstrate the ability to advocate for palliative care patients and their families
23
Professional



Demonstrate professional attitudes in interactions with patients, families and other
healthcare professionals
Recognize and appropriately respond to ethical challenges in the palliative care
setting
Be aware of emotional reactions to palliative care patients and families including
countertransference and counter-reactions in the palliative care setting, and
appropriately use available supports including the clinical supervisor and team
debriefings to deal with the emotional challenges of palliative care
24
CORE PSYCHIATRY ROTATIONS
25
ADDICTION PSYCHIATRY
Rotation offered at:
sites
CAMH for base rotation with clinical experiences at a variety of
Description:
The addiction psychiatry elective rotation provides an opportunity for the PGY1
psychiatry resident to develop an understanding of important areas in addiction medicine
and addiction psychiatry that will serve as a basis for their further psychiatric training.
The rotation is based at CAMH with clinical experiences at a variety of sites. The focus
of the PGY1 addiction psychiatry rotation is on creating a foundation for further training
by focusing on addiction assessment and treatment in a variety of modalities and settings
with a large focus on addiction medicine.
Rotation Specific Objectives:
Medical Expert




Competency in managing acute intoxication and withdrawal conditions
Knowledge of the different levels of care and treatment modalities for substance
use conditions with and without concurrent disorders
Basic assessment of the addiction patient with and without concurrent disorders
Basic understanding of the techniques of Motivational Enhancement
Communicator




Establish effective relationships with patient and their families
Interact with community caregivers and other health resources to obtain and
synthesize relevant information about the patient
Develop a discharge plan for hospitalized patients and learn to involve the family
physician, home care and other caregivers in the development of long-term
community health planning
Learn to communicate effectively and efficiently with colleagues both verbally
and through written records (i.e. the medical record, discharge summaries,
consultation notes)
Collaborator

Know when to consult other caregivers appropriately (Addiction and Concurrent
Disorder).
Manager

Develop the understanding of how to effectively balance patient care and health
care resources.
26


Develop a knowledge base for understanding the interplay between governments
and the health care sector in allocating finite health care resources as well as
understand navigating patients between systems (addiction, mental health, justice
etc).
When the opportunity arises, to help develop effective and efficient patient
management strategies.
Health Advocate


Ability to adopt a preventive approach in clinical practice
Identify important determinants of patients' (and public) health.
Scholar


Development of reflection and self-assessment skills via reflection journal and
reflection paper
Opportunity to join the Resident Addiction Curriculum Education committee
Professional



Development of appropriate professional attitudes toward individuals with
addiction and concurrent disorders
Understand professional obligations to patients and colleagues
Exhibit appropriate personal and interpersonal professional behaviours
27
EMERGENCY PSYCHIATRY
Rotation offered at:
CAMH, SHSC, SMH, UHN
Description:
The emergency psychiatry rotation provides an opportunity for the PGY1 psychiatry
resident to develop an approach to the assessment of patients with common psychiatric
emergencies. There is a strong focus on interviewing skills. Knowledge and skills related
to the psychopharmacological and psychotherapeutic management of emergency
psychiatric patients are developed and enhanced. Special attention is focused on the legal
and ethical aspects of emergency psychiatry.
Rotation Specific Objectives:
Medical Expert







Complete a rapid emergency psychiatric assessment interview and appropriate
mental status examination
Enhance skills in eliciting and interpreting abnormal mental status findings in the
emergency psychiatry setting
Assess and initiate diagnostic and management plans for the patient with the
following presentations:
o acute and chronic psychosis
o depression
o anxiety
o potentially explosive situations or violence
o self-harm
o suicidality
o homicidality
o substance intoxication or withdrawal
o acute situational crisis
o developmentally delayed patient presenting with psychiatric emergency,
Enhance foundational skills in risk assessment for self-harm and risk to others
Make a comprehensive diagnosis using DSM-IV including using the diagnostic
criteria for the major psychiatric syndromes of schizophrenia, bipolar I and II
disorders, major depression, anxiety disorders, personality disorders
Construct a psychiatric formulation for crisis intervention with knowledge of
models of crisis intervention and brief therapies.
Develop a foundational knowledge of the pharmacological agents used in the
treatment of psychiatric emergencies including the indications and
contraindications, potential side-effects and common serious drug interactions for
medications with a focus on antipsychotics and benzodiazepines
28





Demonstrate understanding of the Mental Health Act and the appropriate use of
relevant mental health forms for certification of patients and be able to complete
Mental Health Act forms and associated documentation accurately
Assess for competency to consent to treatment under the Consent to Treatment
Act and complete the required forms and documentation accurately
Demonstrate appropriate use of commonly used community resources available
to emergency psychiatric patients including crisis services at the base hospital, the
Gerstein Centre and crisis phone lines
Demonstrate foundational understanding of the concept of institutional
transference
Describe major medical conditions relevant to the differential diagnosis of
behavioural disturbance in the ER and recognize urgent medical problems in
psychiatric patients and make appropriate referrals
Communicator





Develop therapeutic relationships with patients
Deliver understandable information to patients and families regarding common
psychiatric disorders and common psychiatric emergencies
Discuss medicolegal and ethical issues related to psychiatric emergencies with
patients and their families
Communicate effectively with members of the multidisciplinary team in the
emergency setting and liaise effectively with community agencies involved with
patients
Succinctly present relevant information to supervising staff psychiatrists
Scholar



Access relevant literature and other resources to guide assessment and
management of emergency psychiatric patients
Develop skills in the critical appraisal of literature regarding common psychiatric
emergencies
Actively participate in and contribute to educational environment (e.g. attending
and participating in educational rounds, teaching medical students)
Manager

Demonstrate the ability to prioritize amongst competing clinical priorities
Collaborator


Describe and understand the role of the psychiatrist in the emergency setting and
the systemic issues involved in emergency psychiatry including the gatekeeper
function of the emergency department, the consulting role of emergency
physicians and psychiatrists, and the pressures from community and institutional
systems
Demonstrate an understanding of the roles of allied healthcare professionals, both
within the hospital setting and in the community, with respect to the assessment
and management of psychiatric patients and psychiatric emergencies
29


Collaborate effectively with other members of the health care team and
community agencies
Know when and how to initiate specialty consultation
Health Advocate


Demonstrate the capacity to advocate effectively on behalf of psychiatric patients
Identify opportunities for patient education regarding their psychiatric conditions
Professional





Fulfill medical, legal and professional obligations of the psychiatrist
Demonstrate responsibility, dependability, self-direction, and punctuality
Accept and make constructive use of supervision and feedback
Demonstrate collaborative and respectful interactions with patients, families and
other health care staff that demonstrates gender and cultural awareness
Identify and respond to ethical challenges in the care of emergency psychiatric
patients
30
CONSULTATION-LIAISON PSYCHIATRY
Rotation offered at: MSH, SHSC, SMH, UHN
Description:
The consultation-liaison psychiatry rotation provides a one month introduction to the
psychiatric care of the medically ill. It provides the PGY1 Psychiatry Resident with the
opportunity to gain skills in the management of patients with co-morbid medical and
psychiatric illnesses. It allows the trainee the opportunity to reflect on the psychological
experience of medical illness and the group dynamics of the health care system.
Rotation Specific Objectives:
Medical Expert






Develop foundational skills in completing focused psychiatric assessment
interview and appropriate mental status examination in medical patients with comorbid psychiatric disturbances
Develop skills in eliciting and interpreting abnormal mental status findings
Assess and initiate diagnostic work-up and management plans for the medical
patient with the following psychiatric presentations:
o agitation, confusion and delirium
o dementia
o depression
o anxiety
o self-harm and suicidality
o acute situational crises
o behaviour which is difficult for the medical team to manage
o personality disorder
Foundational knowledge of the pharmacological agents used in the management
of psychiatric symptoms in the medically ill with particular emphasis on the
management of delirium, anxiety and depression. There is a particular focus on
the indications for medication use, potential side-effects and relevant drug
interactions and interactions with the co-morbid medical illness(es).
Develop or enhance basic skills in providing supportive psychotherapy
Demonstrate knowledge and skills related to the use of the Mental Health Act
and the Consent to Treatment Act in medically ill patients
Communicator

Deliver understandable information to patients and families regarding common
psychiatric disorders and common psychiatric emergencies in the context of
medical illness
31



Discuss medicolegal and ethical issues with patients and their families related to
psychiatric issues in the medically ill.
Communicate effectively with members of the multidisciplinary team in the
medical setting and liaise effectively with community practitioners and agencies
involved with patients to obtain collateral information or to develop disposition
plans
Develop skills in succinct case presentations in the consultation-liaison context
Scholar


Access relevant literature and other resources to guide assessment and
management of psychiatric patients with medical co-morbidities
Develop skills in the critical appraisal of literature regarding common psychiatric
issues in the medically ill
Manager


Develop the ability to perform focused histories in patients presenting with
psychiatric symptoms in the context of medical illness
Prioritize and appropriately allocate time in the face of competing clinical
priorities
Collaborator




Describe and understand the role of the psychiatrist in the medical setting and the
pressures from community and institutional systems
Describe and understand the roles of allied healthcare professionals, both within
the hospital setting and in the community, with respect to the assessment and
management of patients with co-morbid medical and psychiatric diagnoses
Collaborate effectively with other members of the health care team and
community agencies
Appropriately initiate specialty consultation
Health Advocate


Advocate effectively on behalf of psychiatric patients
Identify opportunities for patient education regarding their psychiatric conditions
Professional




Demonstrate professional attitudes in interactions with patients, families and other
healthcare professionals
Recognize and appropriately respond to ethical challenges in the consultationliaison psychiatry setting
Display an ability to appraise oneself and to utilize supervision appropriately
Monitor emotional reactions to patients, be aware of countertransference and
counter-reactions in the C/L setting and make use of available supports and
supervision to deal with the emotional challenges of working with seriously ill
and dying patients
32
SELECTIVE
&
ELECTIVE ROTATIONS
33
SELECTIVE & ELECTIVE ROTATIONS
PGY-1 psychiatric residents will choose or develop a one month selective rotation and a
one month elective rotations that meets their self-identified learning needs.
There are a wide range of selective rotations – you will tailor your learning objectives to
meet the rotation that you choose.
Elective rotations may be organized in any area of psychiatry or clinical medicine or may
be used to gain exposure to research or other academic or scholarly pursuits.
34
PSYCHIATRIC RESEARCH
Rotation offered at: site of supervisor identified by resident
Description:
Psychiatric research is a two month elective rotation for PGY1 residents in the CSS
stream. It is arranged with their CSS supervisor. PGY1s who are not in the CSS stream
may request one or two months of research time in their PGY1 year.
Rotation Specific Objectives:
Medical Expert

Gain specialized knowledge in a subspecialty area of psychiatry.
Communicator


Develop academic writing skills related to the design and implementation of a
research project
Effectively communicate with research supervisors
Scholar


Access relevant literature and other resources to guide the development of a
research project and develop skills in the critical appraisal of literature relevant to
the research project
Develop an understanding of and foundational skills for preparing applications to
research ethics boards
Manager


Develop time management skills to reflect and balance priorities for scholarly
work and personal life
Utilize research resources appropriately
Collaborator

Collaborate effectively with other members of the research team or group
Health Advocate

To be specified based on project – may not be relevant for all elective rotations
Professional


Demonstrate professional attitudes in interactions with supervisors and members
of the research team
Recognize and appropriately respond to ethical challenges in the psychiatric
research setting
35
CanMeds 2005
Medical Expert
Definition: As Medical Experts, physicians integrate all of the CanMEDS Roles,
applying medical knowledge, clinical skills, and professional attitudes in their
provision of patient-centered care. Medical Expert is the central physician Role in
the CanMEDS framework.
Description: Physicians possess a defined body of knowledge, clinical skills,
procedural skills and professional attitudes, which are directed to effective
patient-centered care. They apply these competencies to collect and interpret
information, make appropriate clinical decisions, and carry out diagnostic and
therapeutic interventions. They do so within the boundaries of their discipline,
personal expertise, the healthcare setting and the patient’s preferences and
context. Their care is characterized by up-to-date, ethical, and resource efficient
clinical practice as well as with effective communication in partnership with
patients, other health care providers and the community. The Role of Medical
Expert is central to the function of physicians and draws on the competencies
included in the Roles of Communicator, Collaborator, Manager, Health Advocate,
Scholar and Professional.
Elements:
• Integration and application of all CanMEDS Roles for patient care
• Core medical knowledge
• Patient problem identification
• Diagnostic reasoning
• Clinical judgment
• Clinical decision-making
• Application of appropriate therapies
• Procedural skill proficiency
• Humane care
• Application of ethical principles for patient care
• Functioning as a consultant
• Knowing limits of expertise
• Maintenance of competence
• Principles of patient safety and avoiding adverse events
Communicator
Definition: As Communicators, physicians effectively facilitate the doctor-patient
relationship and the dynamic exchanges that occur before, during, and after the
medical encounter.
36
Description: Physicians enable patient-centered therapeutic communication
through shared decision-making and effective dynamic interactions with patients,
families, caregivers, other professionals, and other important individuals. The
competencies of this Role are essential for establishing rapport and trust,
formulating a diagnosis, delivering information, striving for mutual understanding,
and facilitating a shared plan of care. Poor communication can lead to undesired
outcomes, and effective communication is critical for optimal patient outcomes.
The application of these communication competencies and the nature of the
doctor-patient relationship vary for different specialties and forms of medical
practice.
Elements:
• Patient-centered approach to communication
• Rapport, trust and ethics in the doctor-patient relationship
• Therapeutic relationships with patients, families23 and caregivers
• Diverse doctor-patient relationships for different medical practices
• Shared decision-making
• Concordance
• Mutual understanding
• Empathy
• Capacity for compassion, trustworthiness, integrity
• Flexibility in application of skills
• Interactive process
• Relational competence in interactions
• Eliciting and synthesizing information for patient care
• Efficiency
• Accuracy
• Conveying effective oral and written information for patient care
• Effective listening
• Use of expert verbal and non-verbal communication
• Respect for diversity
• Attention to the psychosocial aspects of illness
• Breaking bad news
• Addressing end-of-life issues
• Disclosure of error or adverse event
• Informed consent
• Capacity assessment
• Appropriate documentation
• Public and media communication, where appropriate
Key Competencies: Physicians are able to…
1. Develop rapport, trust and ethical therapeutic relationships with patients and
families;
2. Accurately elicit and synthesize relevant information and perspectives of
patients and families, colleagues and other professionals;
3. Accurately convey relevant information and explanations to patients and
families, colleagues and other professionals;
37
4. Develop a common understanding on issues, problems and plans with patients
and families, colleagues and other professionals to develop a shared plan of
care;
5. Convey effective oral and written information about a medical encounter.
EDS 2005 Physician
Collaborator
Definition: As Collaborators, physicians effectively work within a healthcare
team to achieve optimal patient care.
Description: Physicians work in partnership with others who are appropriately
involved in the care of individuals or specific groups of patients. This is
increasingly important in a modern multi-professional environment, where the
goal of patient-centred care is widely shared.
Modern healthcare teams not only include a group of professionals working
closely together at one site, such as a ward team, but also extended teams with
a variety of perspectives and skills, in multiple locations. It is therefore essential
for physicians to be able to collaborate effectively with patients, families, and an
interprofessional team of expert health professionals for the provision of optimal
care, education and scholarship.
Elements:
• Collaborative care, culture and environment
• Shared decision making
• Sharing of knowledge and information
• Delegation
• Effective teams
• Respect for other physicians and members of the healthcare team
• Respect for diversity
• Team dynamics
• Leadership based on patient needs
• Constructive negotiation
• Conflict resolution, management, and prevention
• Organizational structures that facilitate collaboration
• Understanding roles and responsibilities
• Recognizing one’s own roles and limits
• Effective consultation with respect to collaborative dynamics
• Effective primary care – specialist collaboration
• Collaboration with community agencies
• Communities of practice
• Interprofessional health care
• Multiprofessional health care
• Learning together
• Gender issues
38
Key Competencies: Physicians are able to…
1. Participate effectively and appropriately in an interprofessional healthcare
team;
2. Effectively work with other health professionals to prevent, negotiate, and
resolve interprofessional conflict.
Manager
Definition: As Managers, physicians are integral participants in healthcare
organizations, organizing sustainable practices, making decisions about
allocating resources, and contributing to the effectiveness of the healthcare
system.
Description: Physicians interact with their work environment as individuals, as
members of teams or groups, and as participants in the health system locally,
regionally or nationally. The balance in the emphasis among these three levels
varies depending on the nature of the specialty, but all specialties have explicitly
identified management responsibilities as a core requirement for the practice of
medicine in their discipline. Physicians function as Managers in their everyday
practice activities involving co-workers, resources and organizational tasks, such
as care processes, and policies as well as balancing their personal lives. Thus,
physicians require the ability to prioritize, effectively execute tasks collaboratively
with colleagues, and make systematic choices when allocating scarce healthcare
resources. The CanMEDS Manager Role describes the active engagement of all
physicians as integral participants in decision-making in the operation of the
healthcare system.
Elements:
• Physicians as active participants in the healthcare system
• Physician roles and responsibilities in the healthcare system
• Collaborative decision-making
• Quality assurance and improvement
• Organization, structure and financing of the healthcare system
• Managing change
• Leadership
• Supervising others
• Administration
• Consideration of justice, efficiency and effectiveness in the allocation of finite
healthcare resources for optimal patient care
• Budgeting and finance
• Priority-setting
• Practice management to maintain a sustainable practice and physician health
• Health human resources
• Time management
• Physician remuneration options
• Negotiation
• Career development
• Information technology for healthcare
39
• Effective meetings and committees
Key Competencies: Physicians are able to…
1. Participate in activities that contribute to the effectiveness of their healthcare
organizations and systems;
2. Manage their practice and career effectively;
3. Allocate finite healthcare resources appropriately;
4. Serve in administration and leadership roles, as appropriate.
05 Physi
Health Advocate
Definition: As Health Advocates, physicians responsibly use their expertise and
influence to advance the health and well-being of individual patients,
communities, and populations.
Description: Physicians recognize their duty and ability to improve the overall
health of their patients and the society they serve. Doctors identify advocacy
activities as important for the individual patient, for populations of patients and for
communities. Individual patients need physicians to assist them in navigating the
healthcare system and accessing the appropriate health resources in a timely
manner. Communities and societies need physicians’ special expertise to identify
and collaboratively address broad health issues and the determinants of health.
At this level, health advocacy involves efforts to change specific practices or
policies on behalf of those served. Framed in this multi-level way, health
advocacy is an essential and fundamental component of health promotion.
Health advocacy is appropriately expressed both by individual and collective
actions of physicians in influencing public health and policy.
Elements:
• Advocacy for individual patients, populations and communities
• Health promotion and disease prevention
• Determinants of health, including psychological, biological, social, cultural and
economic
• Fiduciary duty to care
• The medical profession’s role in society
• Responsible use of authority and influence
• Mobilizing resources as needed
• Adapting practice, management and education to the needs of the individual
patient
• Patient safety
• Principles of health policy and its implications
• Interactions of advocacy with other CanMEDS Roles and competencies
Key Competencies: Physicians are able to…
1. Respond to individual patient health needs and issues as part of patient care;
2. Respond to the health needs of the communities that they serve;
40
3. Identify the determinants of health of the populations that they serve;
4. Promote the health of individual patients, communities and populations.
Scholar
Definition: As Scholars, physicians demonstrate a lifelong commitment to
reflective learning, as well as the creation, dissemination, application and
translation of medical knowledge.
Description: Physicians engage in a lifelong pursuit of mastering their domain of
expertise. As learners, they recognize the need to be continually learning and
model this for others.
Through their scholarly activities, they contribute to the creation, dissemination,
application and translation of medical knowledge. As teachers, they facilitate the
education of their students, patients, colleagues, and others.
Elements:
• Lifelong learning
• Moral and professional obligation to maintain competence and be accountable
• Reflection on all aspects of practice
• Self-assessment
• Identifying gaps in knowledge
• Asking effective learning questions
• Accessing information for practice
• Critical appraisal of evidence
• Evidence-based medicine
• Translating knowledge (evidence) into practice
• Translating knowledge into professional competence
• Enhancing professional competence
• Using a variety of learning methodologies
• Principles of learning
• Role modeling
• Assessing learners
• Giving feedback
• Mentoring
• Teacher-student ethics, power issues, confidentiality, boundaries
• Learning together
• Communities of practice
• Research / scientific inquiry
• Research ethics, disclosure, conflicts of interests, human subjects and industry
relations
Key Competencies: Physicians are able to…
1. Maintain and enhance professional activities through ongoing learning;
2. Critically evaluate information and its sources, and apply this appropriately to
practice decisions;
3. Facilitate the learning of patients, families, students, residents, other health
41
professionals, the public, and others, as appropriate;
4. Contribute to the creation, dissemination, application, and translation of new
medical knowledge and practices.
Professional
Definition: As Professionals, physicians are committed to the health and wellbeing of individuals and society through ethical practice, profession-led
regulation, and high personal standards of behaviour.
Description: Physicians have a unique societal role as professionals who are
dedicated to the health and caring of others. Their work requires the mastery of a
complex body of knowledge and skills, as well as the art of medicine. As such,
the Professional Role is guided by codes of ethics and a commitment to clinical
competence, the embracing of appropriate attitudes and behaviors, integrity,
altruism, personal well-being, and to the promotion of the public good within their
domain. These commitments form the basis of a social contract between a
physician and society. Society, in return, grants physicians the privilege of
profession-led regulation with the understanding that they are accountable
to those served.
Elements:
• Altruism
• Integrity and honesty
• Compassion and caring
• Morality and codes of behaviour
• Responsibility to society
• Responsibility to the profession, including obligations of peer review
• Responsibility to self, including personal care in order to serve others
• Commitment to excellence in clinical practice and mastery of the discipline
• Commitment to the promotion of the public good in health care
• Accountability to professional regulatory authorities
• Commitment to professional standards
• Bioethical principles and theories
• Medico-legal frameworks governing practice
• Self-awareness
• Sustainable practice and physician health
• Self-assessment
• Disclosure of error or adverse events
Key Competencies: Physicians are able to…
1. Demonstrate a commitment to their patients, profession, and society through
ethical practice;
2. Demonstrate a commitment to their patients, profession, and society through
participation in profession-led regulation;
3. Demonstrate a commitment to physician health and sustainable practice.
42