Dr. Ian Dawe, Postgraduate Co-ordinator
Tel:
416-416-864-5137x 4544 
Fax:
416-??
Email:
dawei@smh.toronto.on.ca
Ms. Nithya Ravi, Program Coordinator
Tel:
416-416-535-8501 x 4969
Email: nithya_ravi@camh.net
General Psychiatry - Clinical Senior Selective
Supervisors:
Psychiatric Emergency Service:
Dr. I. Dawe dawei@smh.toronto.on.ca
Acute Inpatient Care:
Dr. K Balderson baldersonk@smh.toronto.on.ca
General & CommunityPsychiatry:
Dr. L.Tugg ltugg@smh.toronto.on.ca
Position: Two six-month or one year Senior Selective rotations. The rotations may be taken in Psychiatric
Emergency Services, Acute Care (Inpatient), or General and Community Psychiatry (Outpatient).
A blended rotation of these areas is also possible.
Psychiatric Emergency Service : Emergency Psychiatry is a particular strength at St. Michael’s Hospital. A psychiatric emergency is any disturbance in thoughts, feelings, or actions, for which immediate therapeutic intervention is necessary. For a variety of reasons – such as the increased appreciation of the role of medical disease in altered mental status, the epidemic of alcohol dependence and other substance-related disorders, and the increasing reliance of the serious and persistently mentally ill on psychiatric emergency services for primary levels of care and treatment– the number of psychiatric emergency patients is on the rise. Along with the increased numbers of patients being seen, the complexity and service requirements of these patients have increased considerably. The deinstitutionalization movements of the recent past, along with growing concerns over inappropriate, costly hospitalizations, have accentuated the role of emergency psychiatrists and ensured the continued importance of the psychiatric emergency service.
This career track position will offer training in the following: a) Emergency and crisis management of adult psychiatric disorders, including individuals with suicidal thoughts and behaviours, b) Management of selected outpatients with complex acute mental health care needs, using up-to-date treatment approaches, c) Working as a consultant to a joint Police/Mental Health Service mobile crisis Intervention Team, d) Participation and leadership on a multidisciplinary team, e) Working as a consultant to community agencies, f) Supervision of medical students and junior residents assessing patients presenting to the Crisis Team, and g) Participation in the educational/research experiences as part of the Arthur Sommer Rotenberg Chair in Suicide Studies
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h) Inpatient Psychiatry : St. Michael’s Mental Health Service has a 33 bed psychiatric inpatient unit which includes a 6 bed Acute Care Unit. The unit is divided into four multidisciplinary teams which each include a staff psychiatrist, a resident, nurses, a social worker and medical students. Residents participate in the assessment and treatment of patients with acute psychiatric disorders and psychiatric emergencies as well as substance-related and neuropsychiatric conditions. The position offers residents the opportunity to learn and refine team management skills as they will be expected to take a leadership role in inpatient management and coordinating the multidisciplinary team. The rotation may be arranged on a half- or full-time basis, and is ideally suited for residents considering working on an inpatient mental health unit.
General and Community Psychiatry: Residents have an opportunity to assess patients referred to the
Mental Health Clinic from general practitioners located in the community. These referrals represent patients with a diversity of psychopathology and varying socio-economic/cultural backgrounds. Residents act as consultants to the referring physicians, and assist in diagnosis and management of patients. A thorough knowledge of community resources and different treatment modalities will be gained. Residents may also rotate through community placements working with psychiatrists in a family practice clinic, substance abuse program, hostel, etc. Residents will be expected to develop a liaison with a community agency of their choice. Training within the Clinic’s Group Psychotherapy Program is also provided, as well as participation in our programs for individuals with long-term severe psychiatric disorders. Interested residents may also undertake training in cognitive behaviour therapy.
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Assertive Community Treatment (Mental Health Systems and Schizophrenia Programs) - Clinical Senior Selective
Supervisors:
Dr. L. Tugg ltugg@smh.toronto.on.ca
Dr. S. Law laws@smh.toronto.on.ca
Position: One six-month or one year Senior Selective rotation
Description: This rotation will emphasize the development of leadership skills relevant to working in the assertive community treatment model. The resident will work with the CONTACT Mental Health Outreach
Service, an innovative assertive community treatment team affiliated with the St. Michael’s Mental Health
Service. It will provide a unique opportunity to be part of a comprehensive program, which provides continuity of care to individuals with serious and persistent mental illnesses, many of whom also have concurrent substance use disorders.
The Ontario Ministry of Health has designated assertive community treatment as a priority model of care for this patient population. There are currently more than 50 new teams in the province. This rotation will provide a unique hands-on exposure to all aspects of assertive community treatment. It will enable the resident to assume future leadership roles in this exciting model of service delivery. There will be opportunities to develop an individualized research project or to join one of the already established projects in the community psychiatry program.
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Supervisors:
Dr. H. Spivak spivakh@smh.toronto.on.ca
Dr. J. Novick
NovickJ@smh.toronto.on.ca
Position: One six-month or one year Senior Selective rotation
Description: This rotation offers an intensive experience in learning about the theories and clinical practice regarding a variety of psychotherapies. These include psychodynamic psychotherapy (time-limited and timeunlimited), group psychotherapy, and cognitive-behavioral therapy. The resident will study brain/mind interaction and how various therapeutic approaches borrow concepts and techniques from each other, either explicitly or implicitly. Residents will be expected to be involved in three psychotherapy experiences of their choice.
A through knowledge of community resources and different treatment modalities will be gained while acting as a consultant to family practitioners and community agencies. Residents may also rotate through community placements working with psychiatrists in a substance abuse program, a hostel, etc. Residents will be expected to develop a liaison with a community agency of their choice.
Academic Content: All residents at St. Michael’s Hospital participate in ongoing seminars. Dr. H.
Golombek organizes a theoretical seminar where residents present papers dealing with various types of psychotherapy, e.g. individual dynamic, cognitive and brief, and a clinically focussed psychotherapy seminar. Other seminars are available in the various program areas mentioned above. All residents doing a career track rotation are expected to develop an academic project or to participate in ongoing research.
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Supervisors:
Dr. John Langley
416-864-6060 x6410 john.langley@utoronto.ca
Position: One six-month Senior Selective rotation
1.
Essential components of an elective rotation in this program
This Elective will provide a community psychiatry experience with an emphasis on transitional age individuals (ages 16-23).
These youth are generally not well served by mental health services, either child and adolescent agencies or general adult services. They often fall through the cracks. However, they are a unique and rewarding population to work with and the possibilities for hope and real change are great.
Residents will work with the STEPS for Youth Program, an intensive case management team for youth with first episode psychosis. A wide variety of additional settings are available. These include Covenant House, the Youth Hostel Outreach Program, the Children’s Aid Society.
There will also be the opportunity to participate in the group therapy program for transitional age clients who self-harm. The therapy uses a psychoeducational/psychosocial rehabilitation model with elements of dialectical behaviour therapy.
Residents will work with the supervising psychiatrist and a variety of mental health professionals. They will be given ample opportunity to refine their interview, diagnostic, and treatment skills. They will also gain an appreciation for the mental health issues unique to this population. Supervision for the group work is provided through the Arthur Sommer Rotenberg Chair in Suicide Studies.
2.
Additional experiences of an elective rotation in this program could include
Residents will also have the opportunity to work autonomously in a community setting. This may involve developing a consultation service to a community partner, such as the Shout Clinic, Evergreen Services for
Street Youth, or Street Outreach Services.
Depending on scheduling and funding issues, there may also be an opportunity during the elective for a three day outreach experience in Wawa, Ontario.
Educational opportunities are available and encouraged. There are usually senior medical students participating in electives on the service.
Several research projects are ongoing and residents will be encouraged to participate in research activities.
3. Hospital/training sites where elective rotation is offered:
St. Michael's Hospital and community partner organizations.
Person for interviews with senior residents seeking this elective rotation: Dr. John Langley
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Supervisors:
Dr. Paul Links
416-864-6099 paul.links@utoronto.ca
The Suicide Studies Unit (SSU) at St. Michael's Hospital is offering a position to a PGY 5 who is interested in a final year elective experience in the diagnosis and management of patients at high risk for suicide, many of whom have co-morbid personality pathology.
There will be an opportunity to participate in a weekly multidisciplinary assessment clinic, for complex patients with axis I and axis II diagnoses. The SSU is also actively involved in studies of individuals who suffer from a borderline personality disorder, and the resident would be able to follow some of these patients for both pharmacotherapy and psychotherapy. This unit has a group intervention arm for patients who have made multiple suicide attempts (named PISA) and the resident would be encouraged to participate in this as well.
These clinical responsibilities would be accompanied by a strong focus on education and research. The resident would be invited to participate in ongoing educational events such as CMEs. As well, interest in research would be strongly fostered.
It is assumed that the resident would spend at least four days per week throughout the PGY 5 year, and if desired, it would be easy to ultimately blend this experience into a fellowship.
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Supervisors:
Dr. Vicky Stergiopoulos
416-864-6060 x 6415 stergiopoulosv@smh.toronto.on.ca
Position: One six month or one year long Senior Selective rotation.
This rotation will provide a community psychiatry experience with an emphasis on homelessness and mental illness, collaborative mental health care and health systems. A wide variety of settings are available, including Seaton House, The Salvation Army Maxwell Meighan Centre, 416 Drop-In, and shelters and other agencies serving the homeless in Southeast Toronto. Residents will work with the supervising psychiatrist and a variety of other community based health providers. They will have the opportunity to work autonomously, and if desired, to develop a new consultation service, gaining valuable insights into the challenges of starting a new practice.
Training may be offered in the following:

Interviewing, diagnostic and management skills.

Development and refinement of innovative models of collaborative mental health care (program development and evaluation).

Quality improvement in health care delivery.

Leadership in multidisciplinary teams and collaborative skills development.

Mental health consultation to a community agency and community development.

Educational, and if desired, research opportunities through the Centre for Research on Inner City Health.
2. Additional experiences of an elective rotation in this program could include:
Residents will also have the opportunity to work autonomously in a community setting. This may involve developing a consultation service to a community partner, such as a Drop-In or a case management agency.
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Supervisors:
Dr. Vicky Stergiopoulos
416-864-6060 x 6415 stergiopoulosv@smh.toronto.on.ca
Position: One to two elective part time rotations (1/2 to 2 days per week – flexible according to resident schedule and interests).
Seaton House, first opened in 1931, is Ontario’s largest shelter for homeless men. It is a 780-bed shelter that through four sites and seven programs cares for 4,000-5,000 men per year. More than half of Seaton House beds are dedicated to the care of 1,300 high needs clients per year who require high level of support and mental health care. To meet their complex health needs, Seaton House has undergone major changes since
1993, and is currently developing, in partnership with St. Michael’s Hospital, one of the first Family Health
Teams in the province.
This rotation, offered by the mental health service of St. Michael’s Hospital, will provide a community psychiatry experience with an emphasis on collaborative mental health care, homelessness and mental illness, and health care reform. Training may be offered in the following:
1.
Management of homeless men with severe and persistent mental illness, using evidence based practices.
2.
Development and refinement of innovative models of collaborative mental health care and an introduction to quality improvement in health care delivery.
3.
Participation and leadership in multidisciplinary teams and collaborative skills development.
4.
Mental health consultation to a community agency and community development.
5.
Participation in educational, and if desired, research opportunities through the Centre for Research on
Inner City Health.
This rotation is suitable for residents interested in general psychiatry, health systems, or chronic care.
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Clinical Senior Selective – General
Psychiatry
Dr. Daniela Hlousek
Tel: 905-668-5881 ext. 6290
Dr .Shammi Chekkara, Dr. Christopher
Tam
Ontario Shores is a 300+ bed tertiary psychiatric facility, serving both in and outpatients with severe and persistent mental illness. The Assessment & Reintegration Program includes 5 inpatient wards dealing with a range of acuity in general adult psychiatry chronic care. Electives can be tailored to students’ learning needs. Students will be working in a patient-focused multidisciplinary setting, which follows the recovery model. Students will be exposed to a variety of diagnoses for clients refractory to treatment.
Selectives can be of varying lengths and foci. Some examples, ranging from 1 to 6 months include:
1.
Rapid Assessment Service: on the 5-bed Rapid Assessment Unit, students will have the opportunity to assess patients with chronic mental illness presenting in crisis. The focus on this ward is formulation and assessment, addressing bio-psycho-social factors as they contribute to the decompensation of illness and readmission to hospital. Students will participate in developing targeted treatment and management plans to assist clients in returning successfully to the community in a timely way. Students will have regular opportunities to involve outpatient treatment teams and family members to assist with a transition back to the community.
2.
Assessment and Stabilization Unit: this is a 27-bed inpatient ward for clients with a wide range of psychiatric presentations requiring diagnostic clarification and medication reviews. Students will have the opportunity to review various modalities of treatment for individuals with complex presentations, predominantly with schizophrenia, bipolar disorder, and schizoaffective disorder, who are refractory to treatment.
3.
The Skills, Training, and Education Program, is an inpatient setting for young adults suffering from psychotic disorders, requiring both stabilization and development of various life skills to assist with recovery. Students will assist clients in learning to recognize and manage symptoms, address confounding factors such as substance use, and provide assistance with education and employment. There will be a focus on assessment and diagnosis of psychotic disorders, and developing multifactorial treatment plans.
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Clinical Senior Selective – General
Psychiatry
Dr. Cliff Posel
Tel : 480-6100 x7173
Email: cliff.posel@sunnybrook.ca
The purpose of this rotation is to prepare the resident for a career in a general hospital setting that integrates the multitude of clinical and theoretical models to provide exemplary patient care, clinical teaching, and scholarly pursuits. The focus will be on learning to manage a diverse practice and on consolidating the relevant CANMED roles applicable to such a practice, such as Communicator, Collaborator, Health
Advocate, and Manager.
Experiences will be in a variety of areas relevant to general hospital practice. This may include a small inpatient load, transitional care for discharged inpatients, participation in general outpatient consultations to primary care physicians, emergency psychiatry, mobile crisis, medical psychiatry liaison, psychooncology,
Assertive Community Treatment or shared mental health care. In addition to having experiences in a variety of settings, there is the opportunity to treat people with various psychotherapeutic modalities.
Diversity in clinical settings is offered through community-based hospitals, community organizations, and university academic programs. The specific experiences will be tailored to the resident’s interests and needs.
Clinical supervision will be provided from within the services or programs in which the resident chooses to participate. The primary supervisor will oversee the rotation and provide one hour of individual supervision per week.
At the end of the rotation, the resident should feel competent to practice as a general hospital psychiatrist.
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