CaRMS 2012: Welcome to UBC Psychiatry

Program Overview from a Resident’s PerspectiveJanuary-February 2012

Vancouver, BC

Agenda• Welcome

• The ‘Who,’ ‘What,’ ‘Where’ of UBC Psychiatry

• The ‘How’: Program Overview PGY1-5

• Life After Residency

• Special Interests

• Life Beyond Residency

• Questions

Welcome: 2012 CaRMS Candidates!

• Congratulations, you made it!

• Thanks for coming

• Now Relax ...

• Introductions

Getting to know UBC Psychiatry

• The Anatomy of a Psychiatry program:

• The “What”

• The “Who”

• The “Where”

• The “How”

UBC Psychiatry: The “What”• Vision:

• To be the leading academic Department of Psychiatry in Canada and be internationally recognized in Psychiatry, Addictions and Neuroscience

• Strategic Plan:

• Continued commitment clinical and basic to research

• Enhancing clinical care through knowledge translation

• Investing in educational programs to develop exceptional teachers

• Continued commitment to the community

• What’s exciting:

• An already outstanding Division of Basic Neuroscience

• A cutting-edge Centre for Brain Health in the works

UBC Psychiatry: the “What” you need to know

• Medium sized program:

• Second largest psychiatry residency in Canada diverse and expansive educational opportunities

• But distributed so each site feels like a small program

• UBC has been a trailblazer with respect to the distributed site model

• A very responsive and supportive program:

• Many avenues to elicit resident contributions to build a better program

• Residents encouraged to design learning opportunities to meet their needs

• Recent FUNDED initiatives in International Psychiatry, BrainTalks, Teaching Skills Elective, Homeless Soccer League

• Cohesive and social resident body

UBC Psychiatry: the “Who”

• UBC Psychiatry Departmental “Who’s Who”

• Impassioned and accomplished faculty

• Resident Body

• Residents from far and wide and spanning life stages

Departmental “Who’s Who”• Dr. William G. Honer, MD, FRCP(C)

• New UBC Psychiatry Department Head

• Appointed after a rigorous selection process in which residents participated

• A research leader with >200 publications

• Contributing author to the Canadian Clinical Practice Guidelines on the treatment of Schizophrenia

• Selection reflects Department’s commitment to being a research leader

Departmental “Who’s Who”

• Dr. Jon Fleming, MD, FRCP(C)

• UBC Psychiatry Residency Program Director

• After today he will only make your life better - he owes you, already :)

• One of the very best things about our program

Departmental “Who’s Who”• Dr. Raymond W. Lam, MD, FRCP©

• Director of Scholarly Activity

• Internationally recognized as a clinical expert in depression with 6 books and over 250 articles

• Lead author CANMAT treatment guidelines for Depression

• Involved teacher and computer nerd

• Dr. Lakshmi N. Yatham, MD, FRCP(C)

• Lead author CANMAT treatment guidelines for bipolar disorder

• President of the International Society for Bipolar Disorders

• On editorial board for many peer reviewed journals

Departmental “Who’s Who”

• Dr. Bill MacEwan, MD, FRCP(C)

• Director of the Schizophrenia Program

• Research and Outreach Psychiatry in Vancouver’s downtown east side

• Lives in the country with a big family and menagerie of animals

• Has a donkey named “Pedro”

Resident Demographics

Year TotalAge

range ♂ ♀ PT/ML/FT UBC Children

1 22

2 23 27-40s 9 14 0/3/23 11/23 15

3 22

4 15

5 17

Resident Distribution: 2012 R1s• Vancouver Stream

• 12 Residents(including 2 Research Track and 2 IMGs)

• Vancouver Island Stream

• 3 Residents

• Fraser Health Stream

• 6 Residents

• Prince George Stream

• 1 Resident

UBC Psychiatry: The “Where”• Downtown Training Sites: “The Veterans”

• Vancouver General Hospital

• UBC Hospital

• Saint Paul’s Hospital

• Richmond Hospital

• Children’s Hospital

• Distributed Tracks and Sites: “The Up and Comers”

Downtown Training Sites: Vancouver General Hospital

• aka. “Mordor” aka. “the death star”

• Why it’s special: Trauma hospital and tertiary care centre for the province

• Why it’s special to us: Cutting edge 20-bed Psychiatric Assessment Unit off of the ER

• What we do there:

• Inpatient, Outpatient, Geriatrics, Consult Liaison

• Electives in Sexual Medicine, Sleep, Concurrent Disorders

• Associated with UBC Hospital: Mood Disorders, Outpatient, Neuropsychiatry

• Call ~ 1:10 or less

Downtown Training Sites: St. Paul’s Hospital

• Why it’s special: Inner City Hospital with HIV/AIDS Centre of Excellence

• Unique population

• Internship site (only downtown hospital)

• What we do there:

• Inpatient, Outpatient, Geriatrics, Consult Liaison

• Electives in Eating Disorders, Reproductive Psychiatry, HIV Psychiatry, Urban Psychiatry, Chronic Pain

• Call 1:10 or less

Downtown Training Sites: BC Children’s Hospital

• Why it’s special: Tertiary care pediatric hospital for the province

• What we do there:

• Core site for Child/Adolescent rotation

• Outpatient, ER (CAPE)

• Electives in inpatient, CL and specialty clinics (Infant Psychiatry, Eating Disorders, Concurrent Disorders, Dual Diagnosis, Mood DO, Anxiety DO, ADHD)

• Training in Family Therapy, exposure to Play Therapy

• Call 1:8-12

Downtown Training Sites: Richmond Hospital

• Why it’s special: Community hospital

• Why it’s special to us: Harry Karlinsky and super psychotherapy supervision

• What we do there:

• Inpatient, Outpatient, PAU, strong psychotherapy focus (group and individual)

• Electives in Geriatrics, Infant Psychiatry, Reproductive Psychiatry and Psychotherapy

• Call – 1:7 or less

Distributed Tracks

Prince George

VictoriaFraser Valley

Distributed Tracks: The Vancouver Island Program

• Accepting 3 in dedicated match plus 2-3 more for Internship

• Based in Victoria

• Training at Royal Jubilee Hospital, Victoria General Hospital

• Main medical centre on Vancouver Island

• Beautiful Psych ER facility

• Opportunities for rural/community rotations: Nanaimo, Comox

• Psychiatry Residents have been training here for years into senior level residency, now designated stream

• Academic days videoconferencing + return to Vancouver once per month

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*Brand new* Hospital at

Royal Jubilee site

Vancouver Island Strengths• Site of Vancouver Island Medical Program = lots of

Residents and Medical Students in various disciplines

• Many opportunities to get involved in teaching

• Kind staff, smaller community feel to hospitals; closer relationships with staff

• Staff keen to teach and supervise psychotherapy

• Continuity of care

• Unique lifestyle

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Vancouver Island Strengths

• Cost of living is less

• Amazing social life – very close-knit group of family practice and specialty residents

• Very active community: kayaking, mountain-biking, lake swimming, hiking, white-water paddling, kite-surfing, rock-climbing, triathlon training heaven, mountaineering, gulf-island excursions, fun restaurants, coffee shops, local music, relaxed down-town, can get everywhere on your bicycle

• Lots of opportunities to discover your granola side: yoga, meditation groups, veggie restaurants etc

• Almost 50% less of this:

• Annual Rainfall Victoria: 24 inches

• Annual Rainfall Vancouver: 44 inches

Vancouver Island Strengths

• The view from your seaplane when you fly to Vancouver once a month for academics:

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A few more reasons to come to the Island...

• Surfing in Tofino

• Skiing Mt Washington

Distributed Tracks: Prince George Program

• Accepting one resident in a dedicated match

• Regional hospital (large catchment)

• Full rotations provided for years 1-3, residents complete senior years in Vancouver

• Expenses paid for monthly trip to Vancouver for Academic day and Social events

• Actively involved in weekly teaching of medical students

• Lots of opportunity for outreach psychiatry

• Socializing with family practice and visiting specialty residents

• Call – 1:7

Prince George Fast Facts• 313,000 population (including surrounding areas)

• Average cost of purchasing a home in Prince George in 2007 was $240,245

• Lots of sun between May and September and lots of snow between November and March. Average January temperature is -10°C and average July temperature is 22°C

• International Airport

• University

• Very Family Friendly, Outdoor recreation, all the amenities of a city!

Reading “Prince George” Style

Distributed Tracks: Fraser Health Program

Royal Columbian Hospital

Fraser Region:From Burnaby to Hope

20 minute skytrain from

downtown

Fraser Health Program• Accepting six PGY1 residents in dedicated match

• PGY1 and PGY2 at Royal Columbian Hospital, PGY2 Peace Arch Hospital

• PGY3 to PGY5 various treatment settings, including hospitals, community mental health centres, tertiary care facilities within the Fraser Health Authority

• Psychiatry Residents have been training in Fraser Health for years, just not as a designated stream

• Call 1:10

• Strengths: Community based, Psychotherapy supervision, Cohesive group of residents

Fraser Health Program• Training Sites:

• Royal Columbian Hospital

• Surrey Memorial Hospital – 45 bed inpatient unit, 10 bed Adolescent IPU, Adolescent Day Tx Program, Adolescent Crisis Response Program

• Abbotsford Regional Hospital

• 2 EPI teams

• Burnaby Centre for Mental Health and Addictions

• Peace Arch Hospital - 11 bed inpatient unit

Fraser Health Program• BC’s fastest growing health authority

• Serves 1/3 of BC’s population (1.5 million)

• 12 acute care hospitals and 13 community MHTs

• 25-70 km East of Vancouver

• Encompasses- Surrey, White Rock, Delta, New West, Coquitlam, Abbotsford, Mission, Chilliwack

• Majority of time spent at RCH, PAH

Program Overview: Year-by-Year

• The anatomy of a psychiatry residency program:

• Clinical Rotations

• Academic Days

• What’s Special

PGY1: The “Internship”

• Nobody said it would be easy!

• 3 potential sites for those not in a designated track:

• Royal Columbian Hospital (New Westminster) - 6 ish

• St. Paul’s Hospital (Vancouver) - 4 ish

• Royal Jubilee (Victoria) - 3 ish

• Program aims to get everyone his/her first or second choice but this doesn’t always happen

PGY 1: Royal College Core Rotations

• “PGY1-Basic Clinical Training” = Internship without all the blood and guts!

• Rotations differ slightly between training sites but include blocks of: Medicine and/or Family (3) Peds (1) Neurology (1) Special psych focused neuroimaging course (1) Emergency (1) Emergency Psychiatry (1) Psychiatry (2)

• 3 months of electives!

PGY 1: Academic Days

• Academic day provided monthly at the home program

• All residents flown to encourage class unity

• Curriculum aimed to introduce residents to a variety of topics in psychiatry

PGY 1: What’s Special

• A monthly academic day with your class

• No more exams until your PGY2 year

• CaRMS is OVER!

• You get PAID to do Internal Medicine this time! Salary for PGY1: $48,565.20

PGY2: Royal College Core Rotations

• “PGY2-General Adult Psychiatry” = Finally doing what you want to be doing and nothing else!

1. 6 months inpatient

2. 6 months outpatient

• Training Sites for Vancouver Residents include: Vancouver General Hospital, Richmond Hospital, St. Paul's Hospital and Peace Arch Hospital.

PGY 2: Academic Days

• Weekly academic days so videoconferencing begins!

• Aims to provide an overview of the major psychiatric disorders, prepare for first year clinical rotations and on-call experiences

• Longitudinal courses in:

Emergency Psychiatry, Mood Disorders, Ethics, Anxiety Disorders, Schizophrenia, Geriatric Psychiatry ,Religion and Spirituality, Personality Disorders, Addiction Psychiatry, Somatoform Disorders

PGY 2: What’s Special

• Weekly academic days taught by the best and brightest “Who’s Who”

• Developing autonomy and Skill in your chosen profession

• Still getting PAID! PGY2 Salary: $54,177.71

PGY 2-5: Long Term Psychotherapy• From PGY 2-5 requirement for one long term

psychodynamic psychotherapy patient

•Weekly appointments and weekly supervision by assigned supervisor

• Given one afternoon off a week to do this

• Can carry more patients and for longer/do an elective if this is an area of interest

• Psychotherapy Journal Club

PGY 3: Royal College Core Rotations

• Two six month blocks:

1.Child and Adolescent Psychiatry

2.Geriatric Psychiatry

PGY 3 Rotations: Child and Adolescent Psychiatry

• Three sites : BCCH, Richmond and Surrey (also Victoria and Prince George)

•Mix of Inpatient and Outpatient

• Opportunities to specify areas of interest (eg. afternoon in eating disorders)

• Introduction week of lectures, weekly teaching rounds

• Exposure to wide variety of cases

PGY 3 Rotations: Geriatric Psychiatry

• Sites: VGH, SPH, MSJ, LGH, PAH, RCH (Also Victoria and Prince George)

• Integrated mix of inpatient and outpatient at most sites

• Opportunity for ECT, TMS exposure in addition to a unique one week training course in ECT

• Exposure to home visits, geriatric C/L work, mental health teams etc.

PGY4: Royal College Core Rotations

1. Consultation-Liaison (3-6 months) - VGH; St. Paul’s; BCCH

2. Collaborative/Shared Care (2-3 months)

3. Chronic Care (3-6 months) - Community mental health team; Maples; Riverview; Inner City Youth Mental Health Program

4. Addictions (1-3 mo) - Burnaby Centre, Concurrent Disorders Unit, Methadone Clinics, DTES clinics

PGY 3/4: Academic Days

• Full day every Thursday

•Morning: Child Psychiatry, Forensics, Mood Disorders, Psychotic disorders, Anxiety disorders, Geriatrics, Psychopharmacology

• Afternoon: Psychotherapy (formalized course) with exposure to psychodynamic, CBT, IPT, Group, Brief Dynamic Therapy etc.

PGY 3/4: What’s Special

• Starting to figure out what you actually want to do

• Setting up electives

•Mentorship opportunities

• Salary PGY-3: $59 038.36; PGY-4: $63 549.53 with ‘on call’ pay of $400.90 per month

PGY 5: Royal College “Core” Rotations• 12 months of Electives:

• Neuropsychiatry, forensics, sexual medicine, HIV psychiatry, sleep disorders, eating disorders, mood disorders, reproductive psychiatry, infant psychiatry, psychotherapy, urban psychiatry, research etc.

• International electives:

• Adolescent Addictions, Australia

• Crystal Meth Psychosis, Hawaii

• Sleep disorders, Belgium

• Forensics, Maudsley Hospital, England

• Neuroimaging, Australia

• Beijing, China

• Uganda, Africa

International Electives• Ilana Shawn PGY 4 In Uganda

PGY 5: “Academic” Days

• Curriculum: Independent Study Day weekly

• Preparation for practice curriculum

• Royal College Review Courses – Ottawa, London, Kamloops

• Mock Orals

PGY 5: What’s Special

• Salary PGY-5: $68 341.81 with ‘on call’ pay of $400.90 per month

• Call is half-time from Jan - April in preparation for Royal College exams and is site specific

PGY1-5: What’s ‘Kind-of’ Special• Not-so-Special = EXAMS

• Kind-of Special = Not high-stakes, Not for marks, For OUR Benefit

• Goal is for your own self assessment and to guide reading – we see these informal exams as a positive :)

• In Training Evaluations:

• PRITE Exam yearly (US Exam)

• COPE Exam yearly (Canada)

• Mock OSCE PGY 2-4

• Short Case Assessments by Supervisors

• Some residents write the USMLE

Life after Residency

Life After Residency: Subspecialty Training at UBC

• Clinical Investigator Program

• One Year Fellowship Programs:

• Forensic Psychiatry

•Geriatric Psychiatry

•Child Psychiatry

• Additional Fellowship opportunities through UBC: Neuropsychiatry, Consult-Liaison, Psychotherapy, Mood Disorders, Choose-your-own-adventure

Life After Residency: Job Opportunities

• No shortage!

• Recent Grads being hired at tertiary centres in Vancouver

• New Psychiatric Facilities being built at VGH, LGH and renovations at others

• Opportunities in all subspecialties

• Plethora of rural jobs

2011 Recent Graduates• BC Children’s Hospital: Dr. Ryan Chan, Dr. Matthew

Chow, Dr. Jennifer Yeh

• SPH: Dr. Jen Wide

• RCH: Dr. Janel Casey

• VGH: Dr. Cameron Anderson, Dr. Summer Telio

• Vancouver EPI: Dr. Nicole Tsang

• CIP and ECT: Dr. Fidel Vila-Rodriguez

Special Interests

Special Interests: Research and Scholarly Activity

• Research is not mandatory but it is very much encouraged and supported

• ½ day a week for research PGY 2-5 (for non-research track residents)

• Large resident representation at conferences, workshops

• Grand Rounds at least once a year starting in PGY2

• Popular monthly Journal Club at a local restaurant is department funded

Research and Scholarly Activity

• Formal Research Track

• 6 residents currently

• Full research day/week from PGY 2-5

• Individual mentoring and guidance

• Conferences

• Opportunity for Masters/PhD or CIP

Current Resident Research Areas

• Brain Injury

• Neuroimaging

• Reproductive Mental Health

• Social Networks

• Street Soccer

• Mindfulness

• Cognitive Training for Psychosis

• Cross-Cultural perspectives on Eating Disorders

Special Interests: Rural Opportunities

• Outreach with Staff

• 2 trips PGY2-5

• Elective opportunities

• Prince George Program

• Duncan, Comox, Nanaimo, Penticton, Vernon, Nelson/Trail, Kamloops

Special Interests: Marginalized Groups

• Strong cross-cultural emphasis in our training

• Exposure to immigrant issues and training in work with translator services

• First Nations population

• Downtown Eastside of Vancouver –HIV, substance use

• Street Youth – Covenant House

• Specialized clinics in Vancouver

Life Beyond Residency

Life Beyond Residency: Getting to Know Your UBC Family

• Faculty Supported Social Events:

• Summer Welcome BBQ

• PGY1 - 2 Welcome Mixer

• Staff vs. Residents Soccer Game

• Resident Retreat

• Department Christmas Party

• Monthly Movie Nights (Frames of Mind)

• Other Group Activities:

• Monthly Resident Meetings, periodic Town Hall with Program Director and Resident Business Day

• Entire day to systematically review program

• Conferences, Meetings and Academic Days are social too! (shhh .. don’t tell anyone)

Life Beyond Residency: Leaving Work at Work

• There’s time for other parts of life too!

• The department actively encourages work-life-balance

• A number of residents have children

• A number of residents have pets

• Residents and staff are involved in arts, sports, music etc.

Welcome BBQ

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PGY1-2 Evening

Social

Faculty vs. Resident Soccer Match

Resident Retreat 2011: Whistler HI

Resident Holiday Party 2011: Sanafir, Vancouver

APA Conference Honolulu 2011

Life Beyond Residency: Beautiful British Columbia

Beautiful British Columbia ...

The West Coast Trail

...and Beyond

Banff

Just a Hop, Skip and a Jump to ...

and a short flying Jump to ...

UBC Psychiatry: more PERKS• Educational Fund - $400 for PGY1, $900 for PGY2-5

• 5 days Conference leave, often partial expenses paid

• 2 weeks paid vacation every 6mo, flexible distribution

• Journal Clubs funded

• Flexibility- great balance for family life

• Annual Retreat, Business Meeting, Resident Research Day

• Call Frequency

• Heavily Education Oriented vs. Service Oriented

• Full Academic Day (!!)

• Regular Resident Evaluation (monthly logs, short case assessments, PRITE and COPE exams (anonymous), orals)

Questions?• Social event TONIGHT 6pm at Milestones (Cambie and 8th)

• Vancouver questions: Willough Jenkins wjenkins@interchange.ubc.ca or Patricia Nolan trish.nolan@gmail.com

• Victoria questions: Jeanine Marshall j9marshall@gmail.com

• Fraser questions: Salina Chan syzchan@gmail.com

• Prince George questions: Ashley Malhotramalhotra.ash@hotmail.com