Transition to Discipline Stage of Training (first 2 blocks of PGY-1)

The first two blocks of training provide residents with opportunity to become oriented to our program, department and their local health care system. Beginning with one to two weeks of interactive curriculum ensures foundational knowledge with which to begin residency, while getting to know resident colleagues and meeting faculty members. Five to six weeks of clinical experiences introduce residents to inpatient, outpatient and emergency psychiatry environments, while practicing basic interviewing and case presentation skills. Consolidation of these experiences occurs in the last week of the stage when residents come back together to participate once again in an interactive curriculum.

Foundations of Discipline Stage of Training (PGY-1 to end of PGY-2 = 24 blocks)

The remainder of the PGY-1 year provides training to secure competencies required as a physician for success as a psychiatrist. Exploration and appreciation of the interface between physical medicine and psychiatry is reinforced, with a focus on the investigation and management of medical presentations relevant to psychiatry, including addictions. This also provides training vital to learner’s preparation for the Licentiate of the Medical Council of Canada (LMCC)-II exam.

Unique to McMaster is our medical team to inpatient psychiatry rotation, in which residents work with the medical team providing care for the physical health concerns of patients while they are receiving inpatient care in psychiatry. This rotation emphasizes the importance of recognition of common physical comorbidities with psychiatric conditions, their investigation and initial management strategies, as well as opportunity to gather histories and complete physical examinations for other conditions while advocating for specialized care, where appropriate.

Rotations through blocks 3 to 13 of PGY-1 include:

• Medical team to inpatient psychiatry
• Emergency medicine
• Addictions
• Family medicine
• General internal medicine (2 blocks)
• Neurology
• Pediatric neurology
• Emergency psychiatry
• Selective
• Elective (may include research)

PGY-2: The second year of training further builds on the groundwork of knowledge and skills necessary to practice psychiatry, including building of psychiatric assessment skills, development of differentials, implementation of management plans for patients of low to medium complexity and performing of risk assessments. Expertise in emergency psychiatry is developed in preparation for progression to the level of a senior resident by year three. Time with the inpatient addiction medicine service further enhances skills in providing care in the acute phase of recovery, including management of withdrawal and initiation of pharmacological strategies for opioid and alcohol dependence.

The anchored selective blocks overlapping the foundations and core stages of training enable residents to gain experience working with more marginalized, vulnerable populations. Residents may also further their work in research during this time.

Rotations during PGY-2 include:

• General adult inpatient psychiatry (6 blocks)
• General adult outpatient psychiatry (6 blocks)
• Anchored selective – 2 blocks total = 1 block in PGY-2 followed by 1 block in PGY-3

Core of Discipline Stage of Training (PGY-3 and PGY-4 = 26 blocks)

The core of discipline stage of training builds on the skills and knowledge of the previous stages, with residents developing advanced skills in conducting psychiatric assessments, developing biopsychosocial formulations and providing comprehensive management of psychiatric patients across the lifespan, including emergent situations in psychiatric care. Integration of the principles of psychopharmacology, psychotherapy and neurostimulation is fostered.

PGY-3: Year three of training at McMaster allows for learning in the more subspecialized areas of child and adolescent psychiatry and geriatric psychiatry, each for 6 blocks.

PGY-4: The design of year four of training allows for gradually increasing autonomy, while gaining experience in areas of psychiatry requiring advanced principles. Elective time, likely to be taken by most residents towards the end of PGY-4, allows initial exploration of potential career interests and further work in areas of learning need while preparing to write the Royal College exam which will occur in the spring of PGY-4 for most residents. Longitudinal experience in emergency psychiatry continues, as does longitudinal psychotherapy training.

Rotations during PGY-4 include:

• Chronic care (6 blocks)
• Consultation-liaison psychiatry (3blocks)
• Elective (4 blocks)

Transition to Practice Stage of Training (PGY-5 = 13 blocks)

The PGY-5, final year of training promotes advanced psychiatric skill development and further increase in autonomy, as well as exploration of individual interests and potential career paths through elective experiences designed by the resident to meet their learning needs. Preparation for transitioning to practice is a focus, supported by a transition to practice curriculum.

As collaborative care is a common and important system of psychiatric care delivery, McMaster residents gain experience within this modality for a total of 3 blocks, either full time or longitudinally. If preferred, this experience may be gained in PGY-4 with additional elective experience completed in PGY-5. For those residents engaged in child and adolescent or geriatric subspecialty training during PGY-5, collaborative care experience may be completed within those subspecialties.

Block elective experiences during the PGY-4 and PGY-5 years may include research.

McMaster Psychiatry residents may spend up to six months of senior elective experiences away from McMaster sites.

Rotation Selection

At McMaster, residents choose the location and supervisor for all PGY-2 to PGY-5 rotations. This allows residents to individualize rotations to their learning needs, style and interest. With the diverse clinical programming available at our multiple teaching sites, this provides tremendous variety and choice available to our residents. Residents are not assigned to meet clinical needs.

Horizontal Electives

Residents are able to complete horizontal electives, up to one half-day per week longitudinally, in clinical, research, educational and administrative endeavours throughout the PGY-2 to PGY-5 years.

Core academic curriculum to enhance clinical learning, is delivered to PGY-cohorts so that topics covered are complementary to their clinical experiences. The interactive and dynamic core curriculum seminars take place during weekly, protected academic days. Academic days remain protected throughout the senior years for individual study in preparation for the Royal College exam.

In the Waterloo Regional Campus, four times a year the PGY-2 to PGY-5 cohorts participate together in dynamic, interactive learning sessions in the unique and acclaimed One Room Schoolhouse curriculum. This curriculum has been so well received that it is now being piloted for one module in the Hamilton Campus.

Weekly department grand rounds provide high-calibre, interesting presentation on current and relevant topics. In addition, rotation-specific rounds are held at each teaching centre.

Royal College examination preparation:

The McMaster psychiatry postgraduate program assists residents in preparing for the Royal College certification examination during the PGY-2 to PGY-5 years through the following:

• Two practice multiple choice question (MCQ) exams/year – Coordinators of Psychiatric Education (COPE) and Psychiatry Resident-in-Training Examination (PRITE)
• Objective Structured Clinical Examination (OSCE)-preparation sessions five times per year
• Two mock-OSCE exams per year
• Protected study time during academic days during the year of writing the exam
• Up to three months off the call schedule, around the time of the exam

McMaster psychiatry residents have three mandatory scholarly projects to be completed over the course of their residency. For each of the requirements, there is a designated faculty coordinator who is available to residents for assistance and guidance. Additionally, there are academic seminars reserved for training and information sharing for each of the three projects.

These projects are:

• Grand rounds presentation
• Quality improvement (QI) project
• Poster presentation at a department research day (the topic may be the resident’s CQI project)

There are numerous opportunities to develop one’s leadership skills at McMaster psychiatry. Leadership development is encouraged, valued and promoted. All senior residents are invited to participate in the department leadership course, which is conducted annually.

All educational committees include resident representation in both campuses. In each campus there is also a McMaster Psychiatry Residents’ Association, led by a resident-elected president and executive team. Within the residents’ association there are additional roles, varying in responsibilities.

Other leadership opportunities include:

• Chief resident positions
• Hospital committee resident representatives
• Postgraduate Medical Education (PGME) and university committees
• Professional Association of Residents of Ontario (PARO) resident positions
• Teaching and curriculum development within the undergraduate medical program

Areas of Excellence

Hamilton boasts a large population of over 720,000 people with tremendous economic and ethnic diversity. The clinical programing within the mental health system is designed to meet the ranging needs of this population, across the lifespan.

The Mental Health and Addiction Program is the largest clinical program at St. Joseph’s Healthcare, Hamilton. Detailed information on all of the programs through St. Joseph’s can be found on their website.

Some notable clinical areas of excellence include:

• Child & Youth Mental Health
• Global Mental Health
• Collaborative Care
• Consultation-Liaison Psychiatry
• Forensic Psychiatry
• Addiction Psychiatry
• Severe and Persistent Mental Illness
• Anxiety Disorders
• Women’s Health Concerns
• Geriatric Psychiatry

Teaching Sites

St. Joseph’s Healthcare, Hamilton, West 5th Campus

The 2014 opening of the St. Joseph’s Healthcare, West 5th Campus on February 9, 2014 was a landmark event for clinical, research, education and advocacy activities in Hamilton. This is 250,000 square-foot, state-of-the-art facility, provides extensive acute and tertiary inpatient psychiatric services as well as supports novel research and educational facilities. This facility also includes a 20-bed Addiction Inpatient unit, as well as a mobile concurrent disorders team, providing consultation to all inpatient units. Other inpatient tertiary services will include schizophrenia, mood disorders, geriatrics and both minimum and medium secure forensic psychiatry units.

In a ground-breaking maneuver to truly integrate care for psychiatric patients, this facility will host general internal medicine and bariatric medicine clinics, imaging suites and outpatient psychiatric services.

All McMaster psychiatry residents have their own office, which remain theirs throughout their residency. Resident offices are located close to the Resident Lounge, as well as the Psychotherapy Training Suite, a large amphitheater and numerous meeting and conference rooms.

St. Joseph’s Healthcare, Hamilton, Charlton Campus

Just minutes away from the West 5th Campus is the Charlton Campus, home of the centralized Psychiatric Emergency Service, where all Hamilton psychiatry residents do their call. The Charlton Campus also holds two acute general adult inpatient units, as well as an outstanding Consultation-Liaison Service.

We are tremendously fortunate in Hamilton to be home to two other general hospitals through Hamilton Health Sciences, with the Juravinski Hospital neighboring the Regional Cancer Clinic and the Hamilton General Hospital supporting the Regional Trauma Centre. These too provide outstanding Consultation-Liaison training and research opportunities.

McMaster University Medical Centre (MUMC)

McMaster Children’s Hospital is one of the principal pediatric academic health science centres in Canada, with approximately 180,000 visits per year. This includes pediatric care of all disciplines, including mental health with both inpatient and outpatient services, as well as the McMaster Child Health Research Institute, in partnership with the Offord Centre for Child Studies.

At McMaster, faculty work in hospitals in the neighbouring communities of Burlington, as well as Halton Region, including the Oakville Trafalgar Memorial Hospital. These sites offer additional expertise in general adult inpatient and outpatient psychiatry, child and adolescent psychiatry, first episode clinics and geriatric psychiatry.

Community Sites

A multitude of community based clinical programs offer residents to gain experiences across a breath of clinical areas, including general psychiatry, refugee and immigrant health, shelter health, Indigenous health, addictions, case-management teams and assertive community treatment teams.

On-Call

In 2010, the innovative and personalized training that defines the McMaster program expanded to include the expertise of our community-based faculty in the Waterloo and Wellington regions. The Waterloo Regional Campus (WRC) program affords residents all of the educational and service highlights of the Hamilton program, with further opportunities to learn through innovative and technologically advanced strategies in community settings.

As psychiatric care becomes more focused within the community, particularly for those with severe and persistent mental illness, the training of psychiatrists within this setting will foster the necessary skills required for community-based psychiatry practice of the future. At McMaster University, we are delighted to offer training within the WRC, which is rich in learning opportunities and dedicated faculty, yet only 65 kilometers away from the city of Hamilton. Training within the Waterloo division of the McMaster provides residents with experiences in a variety of community and rural settings, while maintaining strong connections to the academic environment.

The Waterloo program is fully integrated with the Hamilton site of the McMaster psychiatry program, with ongoing opportunities for residents and faculty of each site to work and learn together. Such collaboration allows residents a greater pool of expertise and experiences from which to draw in order to tailor their training to their individual interests and needs.

The majority of rotations will be completed in the Kitchener-Waterloo area, with only four months of BCT training being completed in Hamilton.

Areas of Excellence

• Community psychiatry
• Addiction psychiatry
• Traumatic stress Rrecovery
• Psychiatric eating disorders
• Severe and persistent mental illness
• Emergency psychiatry
• Additional outpatient programs

Teaching Sites

Grand River Hospital (GRH)

GRH is a key provider of acute health care services in Waterloo, with new and expanded services designed to meet the rapidly growing community’s health care needs. Grand River Hospital’s Mental Health and Addiction Program is an integral part of the continuum of health care in the community, collaborating with community service providers as well as patients and families to provide client-centred care.

Grand River Hospital is home to a newly rebuilt, three-division Adult General Inpatient Psychiatry unit. Within the hospital, psychiatry provides consultation-liaison services to other specialties as well as emergency psychiatry assessments. There are a variety of adult outpatient services including Psychogeriatrics, a Rapid Response Team, a Community Outreach Treatment Team and Crisis Services. Other outreach services coordinated through GRH include the Hazelglen Mental Health Outreach Program.

Grand River Hospital Freeport Site

Grand River Hospital’s Freeport Site completed expansion and renovation includes a new 33 bed unit for those with severe and persistent mental illness, a seven-bed transition unit, a ten-bed psycho-geriatric assessment unit and further outpatient and outreach services, including day programs.

Guelph General Hospital

Guelph General Hospital is a dynamic, comprehensive acute care facility serving a population of 180,000 people throughout Guelph and Wellington County. In 2001, all of the City of Guelph’s hospital-based, acute care services were integrated into an expanded and completely updated Guelph General Hospital. Services include 24-hour emergency coverage, advanced technology and diagnostic support and specialty programs such as surgery, orthopedics, cardiac care, obstetrics, gynecology and pediatrics. Emergency room services include assessment of psychiatric presentations and partnership with Homewood Health Centre.

Homewood Health Centre

Homewood Health Centre is a leader in mental health and addiction treatment, providing local acute mental health services, as well as specialized mental health services to Canadians who travel from all parts of the country. Located in Guelph, Ontario, Homewood holds 286 beds and provides care to more than 4,000 inpatients and outpatients annually. Homewood has received numerous awards, including the prestigious Canada Award of Excellence – Quality Award, Healthy Workplace Award and the Order of Excellence Award. All programs are outcomes focused and structured on integrated patient care and interdisciplinary teams.

On-Call

To enhance the community-based experience, WRC residents take call for emergency psychiatry, learning to manage cases within a community hospital emergency room. Cases may be seen only until 11 p.m., after which time residents go home. As there is no overnight call, residents attend their clinical rotation the next day, resulting in less fragmentation of their core experience. Residents on-call are always supported by a psychiatrist on-call. Call frequency for junior residents (PGY1 & PGY2) ranges from an average of 1/7 to 1/9. Frequency for senior residents (PGY3 to PGY5) goes down to an average of 1/12 to 1/14. Residents are not required to cover ward call.

To prepare residents for practice, McMaster psychiatry residents also gain periodic experience with inpatient and consultation-liaison psychiatry on-call, with shifts occurring two to four times per year. The location of the call is aligned with the resident’s core rotations during that academic year. Inpatient on-call experiences begin in house and then convert to home call, ending at 11 p.m.

Program Objectives

The specific aim of our program is to graduate highly skilled young psychiatrists, who are able to practice a variety of psychotherapies in an empirically informed manner with patients with general psychiatric disorders and other psychological problems. The focus in training is to teach residents the important general therapeutic skills, as well as specific skills necessary in the treatment of specific disorders. The graduate psychiatrist will have the skills to develop a good therapeutic alliance with a patient, regardless of the therapy being practiced, including pharmacotherapy. They will be able to implement appropriate, effective psychotherapeutic treatment for patients with major mental illness. The program should further instill in our residents open-mindedness about the different schools of psychotherapy, so that it is more objective and amenable to evaluation of competence, a much needed direction in this field.

Program Outline

Psychotherapy training is completed longitudinally through our award-winning McMaster psychotherapy program. The McMaster program is unique in providing comprehensive systematic clinical training in evidenced-based psychotherapies, working from the more simplistic and building up to the more sophisticated. Principles of each modality are taught during academic day seminars. McMaster residents then have the advantage of observing and practicing their skills using a virtual therapist via the Psychotherapy Training e-Resource (PTeR), developed here at McMaster. This allows residents to feel more prepared before they begin working with a patient in the modality. Residents audio-tape their weekly sessions with patients and then review the sessions during psychotherapy supervision. Modules are typically 16-20 sessions in length, with the exception of psychodynamic psychotherapy, which is 40 sessions.

McMaster residents develop proficiency in each of:

• Cognitive-behavioural therapy for depression
• Cognitive-behavioural therapy for anxiety
• Group therapy
• Family therapy
• Psychodynamic psychotherapy
• Interpersonal therapy

McMaster residents develop working knowledge in each of:

• Dialectical behavioural therapy

McMaster residents develop introductory knowledge in each of:

• Brief
• Mindfulness
• Motivational interviewing
• Relaxation

Each individual module is integrated into the core rotations, allowing residents to develop their psychotherapeutic skills over time. However, should a resident wish to have a patient experience in any of the above modalities, opportunities are available in which residents may participate.

Psychotherapy seminars teach basic principles and research in each area. Residents conduct therapy with the aid of manuals and all sessions are audio or video-taped for ongoing feedback from expert supervisors.

Each of the modules is complemented by an online educational component, utilizing PTeR. The online component of the program includes a series of modules designed to enhance and support learning in each of the psychotherapy modalities. Each online module includes an overview of the course, pre and post-tests, detailed reading lists and a session-by-session outline of classroom seminars (including PowerPoint presentations), supervision requirements and videotaped vignettes, which demonstrate the techniques used in the type of psychotherapy being illustrated.

Therapist competency is assessed by an objective evaluator using therapist rating scales to provide early and late session ratings of resident performance based on recorded audiotapes. The emphasis of the program is on providing a broad-based, empirically-oriented learning experience, teaching specific skills, establishing a positive therapeutic alliance and connecting the teaching of psychotherapy to treatment of general psychiatric disorders. Success of this program has depended on active collaboration between disciplines, proponents of different psychotherapy schools, clinics and hospital teaching units and specialty programs.

Learn more about the Royal College specialty training requirements for psychiatry.

There is strong support and a plethora of opportunities for residents to gain experience in research at both our Hamilton and Waterloo Regional campuses, whether working on a small, extracurricular project or taking the lead as a principal investigator. Though involvement in research is not required, our faculty members welcome resident involvement in research. Research experience can be gained through a spectrum of opportunities spanning from extracurricular projects to horizontal and block electives. Protected time for research can be designed through these opportunities.

The McMaster Clinician Investigator Program (CIP) supports residents in their completion of a graduate level research program concurrent with their clinical residency program. The CIP is designed for those residents whose career goals if that of a clinician-researcher.

The CIP provides residents with faculty mentors experienced in research and academia, CIP-specific academic sessions relevant to clinician-investigators, support with grant and manuscript writing and guidance in career building.

Graduate programs available through the CIP include:

• Medical Sciences
• Health Research Methodology
• Neuroscience
• Biochemistry and Biomedical Sciences

McMaster psychiatry residents may apply to the CIP either through the Canadian Resident Matching Service (CaRMS) PGY-1 direct entry route or at a later time during their residency.

Learn more about the Clinician Investigator Program.

Residents may pursue concurrent graduate level studies during their residency training, even outside of the Clinician Investigator Program. Graduate studies may be pursued within McMaster University or through other schools. Protected time to work on graduate studies may be afforded through horizontal and block elective opportunities.