Psychiatry

Program Director: Dr. Michael Tseng (michael.tseng@nygh.on.ca) (416) 756-6000 ext 4187

Program Assistant: Faye Verveniotis (faye.verveniotis@nygh.on.ca) (416) 756-6316

Overview

This rotation consists of exposure to many areas of Psychiatry and has been geared to train future family physicians who need to be comfortable with mental health issues. The focus is more on outpatient mental health; emergency psychiatry and consult liaison work versus inpatient work because these are areas more relevant for family physicians. The primary goals of the rotations is to become more confident with interviewing bread and butter and some complex cases, developing richer differential diagnosis and treatment plans using a bio-psycho-social model. We want residents to feel more comfortable assessing difficult areas such as suicide, psychosis and past trauma.

Rotation Components

Consult Liaison Psychiatry

This is an excellent opportunity to practice taking your psychiatric histories and mental status examinations. You will act as a consultant to patients who can benefit from psychiatric intervention while admitted in the hospital and review your consult note with the staff psychiatrist. This is an excellent opportunity to see how medical and psychiatric issues intertwine and learn about issues such as comorbidities and drug interactions.

Staff Preceptors: Drs. Lin, Nathanson, Paupst, and Tseng

Adult Mental Health Out-Patient Program (AMHOP)

You will act as a consultant to community physicians for patients either discharged from the hospital or have been newly referred. You will be observing and conducting these interviews. This gives you an opportunity to diagnose mental health conditions, create treatment plans, and get direct feedback on interviewing skills.

Staff Preceptors: Drs. Gelber, Tugg

Tele-Psychiatry Consults

This is an opportunity to observe and participate in initial psychiatric assessments for complex patients living in under-serviced areas lacking psychiatric care. You will have exposure to trauma cases and many concurrent disorders.

Staff Preceptor: Dr. Gelber

Sub-Specialized Experiences

You may have the opportunity to work in sub-specialized areas of psychiatry including the following:

Addictions [Staff Preceptor: Dr. Fletcher]
Crisis in the Emergency Department
Adolescent Mental Health

Before the Rotation

A few weeks before the rotation, you will receive an email from Faye asking about academic half days, core days, clinic half days and any other time you need off. Psychiatry may ask that your half days back are not on Thursday or Friday afternoons. She will also accept any requests to include clinical exposure to any areas of interest, including:

Adolescent Mental Health
Addictions
CBT Groups
Eating Disorders

Prior to the rotation, she will send you a detailed daily schedule of the month, as well as any contact information you may need during the rotation.

On-Call Duties

ON CALL GUIDELINES AT NORTH YORK GENERAL HOSPITAL

1. Call is IN HOSPITAL weekdays and weekends and there is no overnight call. You are expected to leave at 11pm.

2. Call starts at 5:00 PM to 11:00 PM on weekdays and 9:00 AM to 11:00 PM on weekends. Please meet the crisis nurse in the crisis office in the emergency department at the start of each shift. During the COVID-19 pandemic you can meet with the crisis nurse on 7S. We are aware that call at NYGH is not overnight and that residents have full days booked the day after call. To respect this, we suggest the following:

· 5:00 – 9:30 PM – all consults are taken and reviewed with staff on call

· 9:30 – 10:00 PM – more straight-forward consults taken and reviewed with staff on call (applies to more senior psychiatry residents)

· 9:30 – 11:00 PM – discuss with crisis nurses how residents can support them with referred cases (i.e. obtaining collateral information, medication history, etc.). To ensure that the resident leaves by 11 PM, the cases do not have to be reviewed with staff (crisis nurses will review).

** NB: Of course, you can decide to stay later out of professional courtesy if the ER suddenly gets busy, but this is entirely up to the resident’s discretion. If by some chance you happen to stay late past midnight, follow the PARO call guidelines and take a post-call day if you have met the requirements.

3. As with other sites, your responsibility is the ER. Doing ward/CL work is seen as a favour to the staff when there are cases to be seen in the ER. This is a departmental policy and you should feel free to let staff know that it is not possible to do CL if you are busy in the ER (aside from emergency/urgent issues). If you are accidentally paged / asked to go to the ward for an issue by a nurse/clinician, please tell them to page the staff first. Of course, if there are no consults in the ER in the morning on weekends, then we often suggest that residents tag along with staff for ward/CL stuff until something comes up in the ER. Negotiate this with the staff on call.

4. There is a resident lounge with call rooms on the 6th floor. The code is 6828# and should be written on the door. If you happen to take a nap, make sure there are enough call rooms for the residents needing them overnight and change the sheets when you are finished with the room.

5. When you dictate a note, please copy the doctor who requested the consultation as well as the staff on call with whom you review. Also, please copy the patient’s family doctor and outpatient psychiatrist to ensure continuity of care.

Call Requirements

Each resident will be required to complete 3 weekdays and 1 weekend day of call (i.e. Sat or Sun).

Educational Activities

Mental Health Grand Rounds occur on Fridays from 9-10AM except for the first Friday of the month. There may be some one-to-one teaching done by the psychiatry residents on basic psychiatric topics.