The residency program is committed to training psychiatrists to work with the seriously mentally ill, as part of a team-based healthcare system, and in collaboration with other medical professionals. It believes that psychiatrists should see themselves and be seen by others as physicians dealing with disabling illness, and with a solid understanding of the body, brain, and dysfunctional psychology and behaviours.

In keeping with the Royal College of Physicians and Surgeons Specialty Training Requirements (2007), the program consists of :

• PGY I or BCT (Basic Clinical Training) year,
• PGY2-PGY5
• 36 months of mandatory rotations
• 6 months selective
• 6 months elective

Thirty-eight residents are currently enrolled in the program, and six to seven new residents are accepted each year.

Basic Clinical Training or PGY I year

The Basic Clinical Training or PGY I year is coordinated through the Faculty Postgraduate Education office.

Residents are required to do core training in Internal Medicine, Family Medicine, Pediatrics, Neurology, Neuroradiology, Emergency Medicine and Psychiatry. There is opportunity to do two to four blocks of selectives, (Geriatric Medicine, Pediatrics, Obstetrics and Gynecology, General Surgery, Internal Medicine, Neurology, Neuro Imaging, Family Medicine, Palliative Care, Psychiatry or Research) and one block of elective training from any medical or surgical rotation including research. During this year residents meet monthly for a series of psychiatry-based half days, in addition to rotation- specific academic half days. Like the overall program, this year is highly flexible, and encourages residents to focus on medical rotations which will help them not only establish their identity as physicians, but also gain solid medical grounding in areas of medicine closely related to psychiatric illness, and to become prepared for the LMCC Part II.

PGY2-PGY5 years

After completion of the PGY I year, residents begin Royal College mandated rotations

• General Inpatient
• General Outpatient
• Child Psychiatry
• Geriatrics
• Consultation-Liaison Psychiatry
• Collaborative Care
• Chronic care and rehabilitation

Residents choose their rotations and supervisors, and elective time is interwoven through the PGY2-5 years, if the resident wishes. The intention is that residents who are interested in research will be able to get involved in projects early in their training through elective blocks; residents are also allowed 1/2 day per week out of their regular placements to continue with research projects.

In addition to completing: sequential core rotations, residents complete horizontal training in evidence-based psychotherapies, running throughout the final four years of the Program. This will be discussed in detail in the next section.

Other horizontal components of the Program include treatment of patients with severe and persistent mental illness (for a minimum of two years), as well as training in addictions.

In keeping with the scholar role of CANMEDS, residents have a full academic day (Wednesday), of protected time. This consists of Grand Rounds Presentations, Journal Clubs, a series of scholarly rounds including Chief Teaching Rounds and Evidence-Based Psychiatry Rounds. The afternoon is comprised of Academic Seminars covering a broad range of topics, a two year junior and senior curriculum covering psychiatric syndromes, medical ethics, administrative psychiatry, mental health law, transcultural mental health issues, and issues related to transition to practice. The balance of topics is constantly under review by the Core Curriculum Subcommittee of the Postgraduate Training Committee, which has a resident from each year as part of its membership.

Indeed, it is worth noting that the Program is distinct in the extent to which resident input is sought and incorporated into Program design and review. The Psychiatry Residents Association of McMaster (PRAM) is a well organized, welcome, and vocal representative for residents, and meetings are held monthly between PRAM representatives and the Director of Training. This has long been a constructive and collaborative relationship and the Program's flexibility has permitted rapid incorporation of many of PRAM's recommendations.

Facilities

A wide range of general and specialized clinical facilities is available within the Department of Psychiatry which has regional responsibilities for mental health care. These facilities are fully integrated in the University Department and constitute what is locally known as the "network".

Locations include:

• General Hospitals with a range of in-patient and out-patient psychiatric services
• Children's Regional Child and Family Centre
• Community Mental Health Centre
• Community Program for Schizophrenia
• Regional Geriatric Program
• Homewood Health (Guelph)
• Other locations may be used from time to time for elective placements.

Strengths of the Program

The size and balance of the Department allows for:

• A wide variety of experiences and points of view, as well as the establishment of research groups, programs, and projects, without losing the personal quality in the relationship between members.
• A broad conceptual approach, flexibility and openness to negotiation to meet special educational objectives.
• An educational approach which emphasizes self-directed and small group learning and problem solving which is best suited to highly motivated candidates.
• Considerable emphasis on intensive individual resident supervision in the various psychotherapy modalities, using direct observation, and advanced A/V methods.
• Research mentorship and career guidance including research seminars throughout the year, and advancement in the Critical Appraisal Program, a RCPS recognized specialty, for research career track residents.

Accreditation

Every six years, The Royal College of Physicians and Surgeons reviews residency programs for accreditation. The McMaster Residency Program was again given full accreditation in 2006, with particular strengths noted in: the overall commitment of the faculty to resident training, the program's focus on evidence-based training in psychotherapy, the program's flexibility and responsiveness, and the strength of the core academic program.

Goals and Objectives

The goals and objectives of the program as a whole and on each rotation, has been reviewed and revised to reflect teaching of all CANMEDS roles, Scholar, Professional, Communicator, Collaborator, Manager, Health Advocate, Medical Expert. The Program emphasis the development of essential skills in each of the roles including enhancing skills as a teacher.

The Psychotherapy Program

The Department's training in psychotherapy, developed and led by Dr. Priyanthy Weerasekera, is unique in Canada, and has set the standard for resident training in North America. Its award- winning and innovative approach to teaching psychotherapy emphasizes an evidence-based and multidisciplinary approach to learning. Each resident must successfully complete seven mandatory psychotherapy modules: Emotion-Focused Therapy, Cognitive Behavioural Therapy (CBT}(depression), CBT (anxiety), Interpersonal Therapy (IPT) (depression), Dynamic Psychotherapy, Group (e.g. CBT for social phobia), and Couple or Family Therapy. These therapies were chosen because there is solid evidence that they are effective treatments for serious mental illness. Seminars teach basic principles and research in each area. All therapy sessions are audio or videotaped, with each taped session reviewed with the resident by a supervisor with recognized expertise in that therapeutic modality. Resident competency is assessed by an objective evaluator who reviews an early and late session tape using validated rating scales. The emphasis of the program is on providing a broad-based, empirically validated learning, teaching specific skills, establishing a positive therapeutic alliance, and connecting the teaching of psychotherapy to treatment of serious psychiatric illness. Success of this program has depended on active collaboration between disciplines, proponents of different psychotherapy schools, clinics and hospital teaching units, and specialty programs.

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 skill 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 they may collaborate with different individuals who work in these fields.

The Psychotherapy Training Program has garnered awards and has been nationally and internationally recognized for its excellence. Modified versions of this model have been adopted at the University of British Columbia and the University of Toronto.

The program has developed an on-line interactive psychotherapy program.

International Mental Health

1. Exchange Program with Mulago Hospital, Makere University in Kampala, Uganda.

2. Trans cultural Mental Health training. The trans-cultural framework is a capacity-building strategy that focuses on developing the skills, attitude and knowledge to provide services to culturally diverse populations in Hamilton.

Advanced training

Students from a variety of backgrounds can choose from a number of post-graduate and/or advanced training opportunities available within the Department.

Clinical Investigators Program

The Clinical Investigator Training Program (CITP), currently directed by Dr. Harriett MacMillan was developed by the Department in 1987 to recruit and train young researchers interested in developing their skills in investigating the continuum of mental health and disorder. The CITP was developed by a group of senior researchers to provide exceptional students with a structured training program in Psychiatric research so that they might eventually become independent investigators in their own field. It has been widely copied across Canada. The program provides CITP Fellows with a unique combination of academic instruction in research methodology and an apprenticeship as an active member of an established research team. Fellows can also acquire further training as graduate students (Master's degree or Ph D) in any of the Faculty's graduate programs. The duration of the program depends on the Fellow's previous background. Generally, it takes three years from the beginning of the fourth year of residency; three years after a Masters degree, and perhaps one year for an M.D with a Ph.D. in a basic science area.

Once an applicant is accepted into the program, he/she is assigned to a faculty mentor, a senior clinical investigator, who will be responsible for setting specific goals and objectives. The mentor acts both as a research supervisor and as a facilitator of the Fellow's career development. The Fellow and the mentor establish a supervisory committee composed of faculty members in the Faculty of Health Sciences, including some from outside the Department of Psychiatry. Each supervisory committee represents balanced interests so that the Fellow can benefit from input from other related areas particularly in methodology, research design, and measurement. Concrete goals are set out for each year of the program and the supervisory committee meets at least quarterly to review the Fellow's progress. Residents are able to receive salaries equal to their peers while devoting 80% of their time to research. It is a point of pride that the Program has had 100% success in its graduating fellows receiving a minimum of two year's personnel awards from independent grantors, guaranteeing them the ability to get a solid start on their research careers. There are currently three fellows enrolled in this program.

At this time, the CITP is incorporated within the Faculty's new Clinical Investigator Program, which is closely modeled on the Department's original CITP template. It is expected that with an increased focus on recruiting residents with a track record in research, the CITP will play an increasingly important role in the Department.

Clinical/Research Postdoctoral Fellowships

A number of one or two year fellowship training opportunities are available to applicants with an FRCPC or PhD, as applicable. Training takes place within the clinical setting. Funding comes from a variety of sources: clinical earnings; peer-reviewed training awards; established funded fellowships, and research grant funding:

• Anxiety Disorders, 1-2 years, (Drs. Martin Antony/Richard Swinson)
• Child Maltreatment/Women's Mental Health, 1-2 years, (Dr. Harriet MacMillan).
• Offord Centre for Child Studies, 1-2 years (Dr. Michael Boyle/Dr Peter Szatmari).
• First Episode Psychosis (Cleghorn Program: Dr Suzanne Archie/ Dr R Zipursky)
• Forensic Psychiatry, 1-2 years, (Dr. Gary Chaimowitz).
• Geriatric Psychiatry, 1-2 years, (Dr. Karen Saperson)
• Mood Disorders, 1-2 years, (Dr. Lawrence Martin).
• Primary Care, 1-2 years, (Dr. Nick Kates)
• Psychotherapy, 1-2 years, (Dr. Priyanthy Weerasekera).
• Women's Mental Health, 1-2 years, (Dr. Meir Steiner)
• Nahum Spinner Memorial Fellowship
• Other fellowships, as developed in response to graduating resident's interests.

Basic Science Postdoctoral Fellowships Postdoctora positions are also available and are offered by our neuroscience faculty members. Training takes place within laboratory settings, can be up to three years in duration (renegotiated annually) and are funded through research grant funds held by the primary supervisor. Currently, there are two basic science Postdoctoral Fellows undergoing training.

Positions

The program has 38 postgraduate positions of which 7 are available each year. There are opportunities for Clinical or Research Fellows, i.e. fully trained psychiatrists who seek specialized training in an academic setting. Outside funding is normally necessary to obtain such positions.

Eligibility for licensure in Ontario is a requirement for acceptance into residency.