DEFINITION:Psychiatry is that branch of medicine concerned with the study of the causes, treatment and prevention of mental, emotional and behavioural disorders.

GENERAL OBJECTIVES:On completion of training, residents in psychiatry will have demonstrated the ability to assume the role of consultant in the specialty. This will require them to:

• Demonstrate effective mastery of the theoretical knowledge of the specialty, including the relevant aspects of basic medical and social sciences and of the law as it relates to the practice of psychiatry.
• Demonstrate effective skill in the use of an integrated biological, psychological and social model in the diagnosis, treatment, rehabilitation and prevention of mental disorders in males and females of all ages.
• Demonstrate effective communication ability with patients, families, medical colleagues and other health care professionals.
• Demonstrate the capacity to maintain complete and accurate health records.
• Demonstrate attitudes which reflect an ability to work effectively and ethically on an independent basis and/or as a member of a multidisciplinary team, and which are founded on respect for and sensitivity to the patient, his/her family and the community.
• Demonstrate an ability to work effectively and efficiently in a health care organization and to use information technology to optimize patient care, long-term learning and other activities.
• Demonstrate an ability to identify the important determinants of health in relation to mental health problems.
• Demonstrate the capacity to contribute effectively to improved health of patients and communities and recognize and respond to those issues where advocacy is appropriate.
• Demonstrate an ability to critically assess the relevance and significance of the literature and research as it applies to the practice and study of psychiatry.

SPECIFIC OBJECTIVES:At the completion of training, the resident will have acquired the following competencies and will function effectively as:  

Medical Expert/Clinical Decision-Maker

General Requirements

• Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
• Access and apply relevant information to clinical practice.
• Demonstrate effective consultation services with respect to patient care, education and legal opinions.

Specific Requirements

1.KNOWLEDGE

Residents will have an effective level of knowledge and understanding of the following topic areas in their application to mental health (the list is not exhaustive and is not meant to be exclusive):

• normal and abnormal psychology
• normal and abnormal development
• bioethics
• cultural issues
• epidemiology
• gender issues
• genetics
• health care delivery systems
• medical statistics
• neuroanatomy
• neurochemistry
• nosology
• pharmacology
• physiology
• population health principles
• psychodynamics
• quality assurance principles
• research methodology
• sociology

Residents must have an in depth knowledge of the theoretical basis, clinical manifestations and therapeutic issues that occur in the following areas of psychiatric practice in both hospital and community settings:

• child and adolescent psychiatry
• community psychiatry
• consultation and liaison psychiatry (psychosomatic medicine)
• general psychiatry
• geriatric psychiatry
• long-term care and rehabilitation
• mental retardation and delays over the life cycle
• psychiatry and the law (forensic psychiatry)
• substance abuse/comorbidity
• transcultural psychiatry

2.SKILLS

Residents will demonstrate:

• the ability to recognize and treat the full range of mental disorders in males and females of all ages and in all clinical contexts (emergency, inpatient, outpatient, community, long-term care facility, etc.)
• proficiency in the use of all currently available psychiatric and relevant medical diagnostic techniques
• the ability to develop a treatment plan which takes into account the nature of the disorder, and the needs of the patients and their families
• effective skills in psychological treatments, (including but not limited to psychodynamic, behavioural, cognitive, and interpersonal psychotherapies for families, groups and individuals)
• effective ability to employ physical means of treatment including psychopharmacotherapies and electroconvulsive treatment (ECT)

3.ATTITUDES

Residents will demonstrate attitudes consistent with respect, empathy, compassion and caring for the patient. They will demonstrate:

• caution to avoid violation of professional boundaries so as to prevent exploitation
• awareness of bioethical issues in medicine generally and in psychiatry in particular
• analytical and problem solving skills in dealing with ethical issues
• awareness of and sensitive to gender cultural, racial, and spiritual perspectives of the patient, and strive to meet the needs of the patient in a manner that is consistent with his or her distinctiveness

Communicator

General Requirements

• Establish therapeutic relationships with patients/families.
• Obtain and synthesize relevant history from patients/families/communities.
• Listen effectively.
• Discuss appropriate information with patients/families and the health care team.

Specific Requirements

Residents will demonstrate:

• Demonstrate an ability to engage a patient in a clinical interview which not only elicits symptoms, but also lead to an understanding of the patient in all (bio-psycho-social) dimensions.
• Demonstrate an ability to convey to patients and family an accurate, coherent account of diagnosis, treatment plans and prognosis in all clinical cases.
• Effectively convey to medical colleagues, including referring physicians pertinent information and opinion on clinical cases.

Collaborator

General Requirements

• Consult effectively with other physicians and health care professionals.
• Provide treatment cooperatively with primary care physicians in a "shared care" relationship.
• Contribute effectively to other interdisciplinary team activities.

Specific Requirements

Residents will:

• Be expected to have demonstrated their ability and willingness to teach and learn from colleagues and students.
• Demonstrate an ability to work collaboratively with other members of the health care team.
• Demonstrate an ability to facilitate learning of patients, residents, students and other health professionals and to contribute to development of new knowledge.

Manager

General Requirements

• Utilize resources effectively to balance patient care, learning needs, and outside activities.
• Allocate finite health care resources wisely.
• Work effectively and efficiently in a health care organization.
• Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements

Residents will:

• Effectively plan the use of professional time.
• Demonstrate the ability to plan a work schedule that is consistent with service needs, allows time for teaching, administrative tasks and research.
• Record and maintain a complete and accurate medical record for each patient seen; this record will include history, relevant physical examination, relevant investigations, diagnosis and treatment plan.
• Coordinate the efforts of the treatment team by effectively using the varied skills of other health care professionals.
• Demonstrate an ability to evaluate the effective use of resources, to allocate finite health care resources wisely.
• Demonstrate knowledge of important community resources for patients and show ability and willingness to direct patients to those resources.

Health Advocate

General Requirements

• Identify the important determinants of health affecting patients.
• Contribute effectively to improved health of patients and communities.
• Recognize and respond to those issues where advocacy is appropriate.

Specific Requirements

Residents will demonstrate awareness of:

• structures of governance in mental health care
• the major regional, national and international advocacy groups active in mental health matters

Scholar

General Requirements

• Develop, implement and monitor a personal continuing education strategy.
• Critically appraise sources of medical information.
• Facilitate learning of patients, house staff/students and other health professionals.
• Contribute to development of new knowledge.

Specific Requirements

Residents will:

• Have the ability, motivation and desire to maintain competence through involvement in independent learning and continuing medical education activities.
• Demonstrate an ability to access and critically appraise sources of medical information.
• Demonstrate an ability and willingness to keep his/her level of skill and knowledge current through developing implementing and monitoring a personal education strategy.

Professional

General Requirements

• Deliver highest quality care with integrity, honesty and compassion.
• Exhibit appropriate personal and interpersonal professional behaviours.
• Practise medicine ethically consistent with obligations of a physician.

Specific Requirements

Residents will:

• Exhibit appropriate personal and professional behaviours, and practice ethically and in a manner consistent with the obligation to deliver the highest quality care with integrity, honesty and compassion.
• Show knowledge of the current regulations governing patient access to their medical record.
• Demonstrate understanding of the particular issues relating to patient access to their record in the context of their illness.

CONTENT AND ORGANIZATION OF THE RESIDENCY PROGRAM:

There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty.

The content and organization of each accredited program in psychiatry must be consistent with the specialty training requirements.

The program must be organized such that residents are given increasing individual professional responsibility, under appropriate supervision, according to their level of training, ability and experience in an atmosphere that ensures resident safety.

At some point in the program, under appropriate staff supervision, each resident must assume the role of a senior resident.

In addition to offering the components noted in the specialty training requirements all accredited programs in psychiatry must offer community-based learning experiences.

RESOURCES:There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in psychiatry.

In those cases where a university has sufficient resources to provide most of the training in psychiatry but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.

Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to psychiatry.

1. Teaching Faculty

There must be a sufficient number of qualified and dedicated teaching staff to supervise residents at all levels and in all aspects of psychiatry using a biopsychosocial model to provide teaching to satisfy the following experiences:

1. techniques of crisis intervention in children, adolescents and adults;
2. techniques of long-term treatment and rehabilitation;
3. comprehensive care of children, adolescents, and adults including geriatric patients;
4. use of the psychotherapies, pharmacotherapy and electroconvulsive therapy (ECT) in the treatment of children, adolescents and adults;
5. consultation liaison psychiatry;
6. substance abuse including dual diagnosis, psychiatric comorbidity;
7. techniques of inpatient, outpatient and community psychiatry.
1. Number and Variety of Patients

The program must provide an adequate volume of both in- and out-patients such that each resident has the opportunity for developing appropriate skills in:

1. the diagnosis and management of the full spectrum of clinical problems seen in psychiatric practice. These should include: anxiety disorders, mood disorders, psychoses (both organic and non-organic), somatoform disorders, factitious disorders, dissociative disorders, sexual and gender disorders, personality disorders, mental disorders due to a general medical condition, psychiatric disorders related to mental retardation, addictions, neurological syndromes, and other conditions that may be a focus of clinical attention;
2. the diagnosis and management of psychiatric disorders specific to children and adolescents;
3. the diagnosis and management of psychiatric disorders specific to the geriatric population;
4. the comprehensive care and rehabilitation of adult chronic psychotic patients;
5. psychotherapies oriented to children, adolescents and adults e.g. short-term, cognitive, psychodynamic, interpersonal, marital, family, and group;
6. the active treatment of emotional and behavioural disorders in children and adults with chronic psychiatric problems;
7. crisis intervention and other short-term therapies;
8. all types of emergencies involving psychiatry;
9. pre-admission investigation and post-discharge follow-up of general psychiatric patients as well as those in various subspecialty areas;
10. consultation and liaison with other medical specialties
2. Clinical Services Specific to Psychiatry
1. Clinical Teaching Services

The program must ensure that safety for staff, residents and patients is ensured in all clinical settings.

There must be:

1. appropriate clinical facilities for acute care psychiatry that includes the availability of reciprocal consultation services with medical and surgical specialties, as well as a psychiatric emergency service on site, or by arrangement with a nearby site;
2. appropriate clinical facilities to provide experience in the comprehensive continuing care and rehabilitation of long-term psychotic and non-psychotic or severely disturbed patients;
3. appropriate space for supervised experience in the psychotherapies in adults, adolescents and children;
4. opportunities for long-term active treatment of emotional and behavioural problems and clinical care of disturbed and/or handicapped children through child and adolescent clinics, in addition to adult and family clinics;
5. services organized to provide experience in the psychiatric complications of medical and surgical conditions.
1. Ambulatory Services

There must be organized clinics or other ambulatory care facilities available to provide opportunities for pre-admission investigation and post-discharge follow-up of general psychiatric patients as well as those falling under various subspecialty areas. There must be in-patient and out-patient teaching units integrated as far as possible, to provide continuity of management both in and out of hospital.

3. Consultations

An active consultation service is essential for the resident to gain experience in providing consultations to referring physicians. There must also be opportunities for consultations to schools and community agencies.

4. Community Learning Experiences

There must be:

1. facilities for supervised experience in community consultations, and for the long-term active treatment of emotional and behavioural problems, as well as the care of the chronically handicapped;
2. community or correctional facilities for forensic psychiatry.
4. Other

There must be:

1. facilities available for training in the use of various modalities of treatment, including biological, psychopharmacological, and psychotherapeutic, as well as milieu and other social therapies;
2. access to appropriate laboratories;
3. adequate facilities available for teaching in the comprehensive care of children and adolescents and for the assessment of handicapped children including access to psychological testing, electroencephalography, and biochemical and genetic laboratories;
4. an adequate staff of allied professionals including psychologists, psychiatric nurses, social workers and occupational therapists;
5. ready access to a clinical psychology service.
3. Supporting Services - Clinical, Diagnostic, Technical
1. Liaison with Other Specialties and Subspecialties

There must be active clinical teaching services in internal medicine, pediatrics, neurology, surgery and diagnostic radiology, with available consultation and liaison. Active services must be available in these disciplines for the training of psychiatric residents. Close liaison should also be maintained with those subspecialty services of particular importance to psychiatry, such as endocrinology and clinical pharmacology.  

2. Emergency Facilities

There must be emergency settings for development of expertise in the diagnosis and management of all types of emergencies involving psychiatry. Experience in providing a consultative service is an important feature of such training.

ACADEMIC AND SCHOLARLY ASPECTS OF THE PROGRAM:

The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.

1. Organized Scholarly Activities

There must be a program of organized scholarly activities such as journal clubs, rounds, seminars and research conferences. Service demands must not seriously interfere with the ability of the residents to follow the academic program.

2. Basic and Clinical Sciences Relevant to Psychiatry

The academic program must include organized teaching in the basic and clinical sciences relevant to psychiatry.

3. Biomedical Ethics

The academic program must ensure that residents gain an understanding of the basic principles and practice of biomedical ethics as it relates to psychiatry. Residents must also be provided with opportunities to become sensitive to the consequences of the broad range of social factors relevant to psychiatric disorders.

4. Communication Skills

The program must ensure that residents learn effective communication skills for interacting with patients and their families and co-workers from other disciplines. The educational program must provide opportunities for residents to learn and demonstrate cooperation and respect in order to function effectively as a member of the health care team.

In relationships with patients, colleagues and students, residents must demonstrate a professionalism that adheres to the principles respecting boundaries in all areas of interaction specifically including sexual and financial matters.

5. Patient Care Team

Residents must be given opportunities to develop effective skills in collaborating with all members of the patient care team.

6. Teaching Skills

Residents must be given opportunities to develop effective teaching skills by teaching junior colleagues and students, as well as through conference presentations, clinical and scientific reports, and patient education.

7. Management Skills

Residents must be given opportunities to develop skills in management as applied to psychiatry such as efficient practice and records management and the ethical use of health care resources. Residents should also be prepared for their role as a health care advocate.

8. Quality Assurance/Improvement

The program must provide residents with opportunities to gain an understanding of the principles and practice of quality assurance/improvement. Opportunities should be provided for residents to participate actively in such programs in their hospital departments.

9. Research Opportunities for Residents

There must be a faculty member with the responsibility to facilitate the involvement of residents in research and other scholarly work. The academic program must provide the opportunity for residents to learn biostatistics and the critical appraisal of research methodology and medical literature. Such teaching must include issues related to age, gender, culture, and ethnicity in research protocols and data presentation and discussion. Residents should be encouraged to participate in clinical research during the course of the program. Clinical research is defined as research involving human subjects or experimental studies of direct clinical relevance.

10. Faculty Research

A satisfactory level of research and scholarly activity must be maintained among the faculty identified with the program.

11. Life-Long Learning

All programs must promote development of skills in self-assessment and self-directed life-long learning. To promote this end, the program should provide opportunities for residents to attend conferences outside their own university.

SPECIALTY REQUIREMENTS:Approved residency training which must include: 

1.  Basic clinical residency &

2. Approved residency training in Psychiatry.

PROGRAMS (WITH TRAINING REQUIREMENTS):

Diplomas(Dip):

Six months of approved residency training.

Doctor of Medicine(M.D):

Eighteen months of approved residency training.

Doctor of Philosophy(Ph.D):

Forty eight months(four years)of approved residency training.