ADOLESCENT MEDICINE SUBSPECIALTY RESIDENTS AND CLINICAL FELLOWS
CLINICAL EXPERIENCE IN CHILD AND ADOLESCENT PSYCHIATRY
HOSPITAL FOR SICK CHILDREN
ROTATION OBJECTIVES
This rotation supports the learning of the Adolescent Medicine subspecialty trainee in the area of
adolescent psychiatry, with the goal of preparing the trainee to function competently as a consultant in
independent practice. This is a longitudinal clinical experience for second year Adolescent Medicine
trainees in the Department of Psychiatry at the Hospital for Sick Children.
While this rotation focuses on the CanMEDS roles of Medical Expert, Communicator and Collaborator, it
is expected that trainees will demonstrate proficiency in all spheres.
On completion of the rotation, the trainee will be able to:
MEDICAL EXPERT
1. Demonstrate an appropriate level of knowledge relating to the assessment and
management of common mental health issues in adolescents, including:
a. Anxiety disorders
i. Accurately diagnose based on DSM-5 criteria, including differentiating between
disorder and normal states:
1. Separation Anxiety Disorder
2. Social Anxiety Disorder
3. Selective Mutism
4. Generalized Anxiety Disorder
5. Panic Disorder +/- Agoraphobia
ii. Demonstrate an understanding of the indications for treatment, and first line
treatments for anxiety disorders, and initiate treatments as appropriate.
b. Obsessive compulsive disorder (OCD)
i. Differentiate typical obsessive compulsive behaviour in normal children and
adolescents from the disorder including timing, severity and content of
obsessive-compulsive behaviours
ii. Demonstrate an appreciation of, and recognize, common comorbidities of OCD:
ADHD, Tourette’s syndrome, Learning Disability
iii. List the common obsessions and compulsions, as well as criteria for diagnosis of
OCD.
iv. Demonstrate knowledge of the evidence for efficacy and adverse effects of
pharmacotherapy for OCD and prescribe medications in the appropriate order.
c. Disruptive behavioural disorders
i. Accurately diagnose based on DSM-5 criteria :
1. Attention Deficit Hyperactivity Disorder
2. Oppositional Defiant Disorder
3. Conduct Disorder
Revised August 2015
ii. Demonstrate knowledge of medications used for treating ADHD and prescribe
when appropriate
iii. Demonstrate knowledge of behavioural interventions for ADHD
d. Psychotic disorders
i. Describe the spectrum of symptoms from hallucinations to strong beliefs to
frank psychosis
ii. Demonstrate an appreciation of the common atypical antipsychotics and know
their mechanism of action, the indication for use, common adverse effects and
approach to medication initiation and monitoring, including monitoring
protocols.
e. Mood disorders
i. Accurately diagnose a Major Depressive Episode in adolescents based on DSM-5
criteria recognising the difference between normal sadness, Adjustment
Disorder and Major Depressive Disorder.
ii. Recognize and elicit symptoms of common comorbidities in mood disorders
including eating disorders, substance use disorders, anxiety disorders and
conduct disorder.
iii. Describe an evidence-based approach to treatment of depressive disorders
including non-specific and depression specific treatments, psychotherapies and
the appropriate use of pharmacological treatment.
iv. Select, initiate and monitor antidepressant medication use.
v. Discuss the literature regarding suicidal risk in the use of SSRI medications in
adolescent depression.
vi. Conduct an empathic and effective suicide risk assessment of an adolescent,
integrating information from the patient and the family.
vii. Appreciate and explain the limits of confidentiality in the presence of acute
suicidal risk
viii. Distinguish between non-suicidal self-injury and suicidal behaviour and the
management approaches in each.
ix. Demonstrate an appreciation for the symptoms of hypomania and mania,
recognize their presentation and implications for treatment, and distinguish
between treatment approaches for MDD and Bipolar Disorder.
2. Use diagnostic instruments such as the MASC, the CDI or CES-D, and the Conners as appropriate,
to contribute to the assessment of the adolescent.
COMMUNICATOR
1. Conduct an effective interview of adolescent patients, and caregivers where appropriate,
presenting for psychiatric assessment, eliciting a history that is concise, accurate and relevant,
using voice, body language, translators to good effect.
2. Integrate information from the medical, developmental, psychiatric and family history, as well
as mental status examination, to generate a formulation of the patient.
3. Trial appropriate Cognitive Behavioural Therapy strategies with the patient and family, where
appropriate.
4. Provide feedback to patients and families with respect to assessment findings, psychoeducation
and options for treatment, and encourage patients and families to participate in shared decision
making
Revised August 2015
5. Discuss the patient’s and family’s (where appropriate) beliefs, concerns, illness experience and
expectations.
6. Demonstrate skill in working with patients to recognize and manage potential challenges to the
therapeutic alliance, including anger, confusion, socio-economic or ethno-cultural differences.
7. Compose complete and accurate written reports in a timely manner, considering what
information should be included and excluded from dictations and the medical record.
COLLABORATOR
1. Describe the roles of the Child and Adolescent Psychiatrist and allied health team members (e.g.
Psychologist, Social Worker, Child and Youth Counsellor) involved in assessing and caring for
adolescents with psychiatric concerns.
2. Refer to a Child and Adolescent Psychiatrist when appropriate.
3. Establish good relationships with peers and other health professionals, allowing them to
function effectively within a team structure, and contribute medical expertise to the team
assessment when appropriate.
4. Gather and report patient related information in a clear and concise manner when working with
allied health professionals on the team.
5. Effectively and clearly communicate comprehensive or complex management plans to other
medical staff, allied health care professionals, community resources, the patient and his or her
family.
6. Work well with other team members to prevent misunderstanding, manage differences and
resolve conflict.
MANAGER
1. Effectively use personal and system resources, including technology, to balance clinical care and
learning needs.
2. Prioritize tasks effectively and efficiently.
ADVOCATE
1. Demonstrate knowledge of key community resources pertaining to adolescents with mental
health issues and families/caregivers where appropriate, and direct them to those resources.
2. Demonstrate an awareness of the determinants of adolescent mental health and wellbeing.
3. Demonstrate an awareness of system-based care services available to adolescents with mental
health issues (e.g. child protection services, adoption, foster care and rehabilitation services)
and support the adolescent patient and family where appropriate in accessing such services.
SCHOLAR
1. Effectively retrieve information from the literature regarding the diagnosis and treatment of
common psychiatric disorders affecting adolescents.
2. Critically evaluate medical information and its sources, and apply this appropriately to the
management of the adolescent patient.
Revised August 2015
PROFESSIONAL
1. Demonstrate an understanding of the issue of confidentiality and its limits, and the assessment
of capacity and consent to treatment in the adolescent patient.
2. Demonstrate a commitment to providing high quality care with integrity, honesty, compassion
and respect for diversity.
3. Demonstrate an awareness of, and maintain, appropriate professional boundaries in the
therapeutic relationship with adolescents and families.
4. Demonstrate an awareness of personal limitations and seek guidance and/or feedback when
necessary.
Revised August 2015