Residency in Psychiatry: An Overview

The five-year residency training program in Psychiatry at the University of Manitoba is a well established, medium sized program designed to produce psychiatrists with broadly based academic and clinical orientations. We see our responsibilities as including the following:

1) To train psychiatrists who are fully qualified to practice within the complex, changing field that is modern psychiatry.

2) To provide a breadth of exposure and opportunity for in depth training in the many varied aspects of psychiatry appropriate to the candidate’s chosen community of practice.

3) To provide a formal education program which prepares the residents not only for success at the Royal College of Physicians and Surgeons of Canada (RCPSC) specialty examinations but will also fulfill the many roles of a competent physician including:

  • Medical Expert
  • Communicator
  • Collaborator
  • Leader
  • Health Advocate
  • Scholar
  • Professional

4) To continue to change and evolve our training program in response to the changing needs of residents, community and the specialty of psychiatry.

The program is designed to meet these objectives through several overlapping approaches including clinical rotations, didactic seminar series, psychotherapy training program, research, community-based experiences and continuing education. Each of these components is described below.

On July 1, 2020, the program began training incoming residents under a competence-based medical education (CBME) framework as outlined by the RCPSC known as Competence By Design.  Residents who began their training prior to July 1, 2020, continue under the “traditional” training model. While clinical rotation and didactic training experiences will be similar to the traditional model, the major change with CBME is a change from focus on assessment of learning to assessment for learning.  Residents under CBME undergo frequent low-stakes assessments and receive frequent feedback to improve performance and gain competency.  This is further described under Evaluation below.



Clinical Rotations

While residents under CBME are referred to by stage (Transition to Discipline, Foundations, etc), clinical rotations continue to be scheduled according to PGY year. 

The PGY 1 Year  The PGY-1 is a Basic Clinical Training (BCT) year preceding four years of formal psychiatric training. The PGY-1 consists of 52 weeks of training divided as follows:

4 Weeks

Addictions Medicine

4 Weeks

Emergency Medicine

4 Weeks

Family Medicine

4 Weeks

Internal Medicine

4 Weeks

Neurology

4 Weeks

Emergency Psychiatry

4 Weeks

Psychiatry - Psychiatric ICU

4 Weeks

Psychiatry - Consultation-Liaison

4 Weeks

Research (dedicated research time for development and commencement of scholarly project)

4 Weeks

Vacation

4 Weeks

Selectives (2 Blocks):

  • Endocrinology
  • Geriatric Medicine
  • General Internal Medicine
  • Another Medicine Subspecialty
  • Geriatric Psychiatry
  • Child/Adolescent Psychiatry
  • Sleep Medicine
  • Family Medicine
  • Palliative Medicine
  • Pediatrics (including Developmental Pediatrics and Child Protection Centre, Children's ER, inpatient CTU)

4 Weeks

Electives (1 Block):

  • Any Medical or Surgical Specialty, can include any of the options listed above (cannot include psychiatry)

During the second half of PGY-1, residents begin psychotherapy training consisting of weekly psychotherapy sessions with one patient and supervision sessions in a group format. This is incorporated into the Academic half day and represents a unique and early exposure to psychotherapy training which reflects the department’s commitment to psychotherapy training overall.

The PGY-2 consists of one year of general adult psychiatry divided equally between adult inpatient psychiatry and adult outpatient psychiatry. The PGY-3 consists of six months training in Child & Adolescent Psychiatry and six months training in Geriatric Psychiatry. The PGY-4 consists of six months training in Consultation-Liaison Psychiatry and six months of Severe and Persistent Mental Illness training (which focuses largely on the care of patients with schizophrenia). The PGY-5 is six months of elective training and six months of selective training during which the residents are encouraged to further pursue areas of individual interest. A broad range of clinical, sub-specialty and research electives are available.

A 2-year subspecialty program in Child and Adolescent Psychiatry has been accredited by the Royal College of Physicians and Surgeons of Canada. Please contact the Program Director Dr. Sarah Fotti at 204-787-3914 or sfotti@exchange.hsc.mb.ca for general information related to the program or information related to applying to the program.

A 2-year subspecialty program in Geriatric Psychiatry has been accredited by the Royal College of Physicians and Surgeons of Canada. Please contact the Program Director Dr. Vishal Kaushik at 204-477-3556 or vkaushik@sbgh.mb.ca for general information related to the program or information related to applying to the program.

On-call duty is part of the clinical training of all residents throughout residency training. This is done by residents being part of the on-call team which consists of 1 senior resident, 2 junior residents along with medical students and off-service learners. 


Didactic Curriculum

There are protected academic sessions throughout all five years of the residency program. These usually take the form of weekly half-day seminars.

The PGY-1 seminars focus on developing relational skills with patients through interview observations, as well as a weekly group psychotherapy supervision experience provided in parallel to seeing patients in a therapeutic context. Seminars are provided which focus on an introduction to many of the different psychotherapeutic approaches and an introduction to research, diagnostic issues and biologic therapies.

The PGY-2 curriculum is subdivided into four areas. These include theoretical bases, psychopathology, therapeutic modalities and professional development. The theoretical bases stream covers basic theories in both psychological and biological spheres. The therapeutic modalities stream covers the various therapeutic techniques used in psychiatry. This includes modes of psychotherapy and psychopharmacology. The psychopathology stream covers phenomenology and classification. The PGY-2 seminar series has an adult psychiatry, problem-oriented focus.

The PGY-3 seminars have been developed to parallel the clinical rotations. Seminars will focus on developmental and psychiatric problems of the child and adolescent as well as geriatric psychiatry. The seminars cover a broad range of topics including: child development, assessment of the child, adolescent and family, psychiatric disorders in childhood and adolescence, psychotherapeutic and pharmacological therapeutic interventions.

The PGY-4 didactic seminar series includes advanced seminars covering topics such as object relations therapy, mood disorders, schizophrenia, research methodology, cognitive behaviour therapy, family therapy and topics in professional development. A series of neurosciences lectures are also presented.

Over the next 3 years, the seminar series will undergo changes due to the change in timing of the Royal College examination, which will take place at the end of PGY-4 beginning in 2024. The revised seminar series will provide CBME residents with didactic topics through PGY-1 to early PGY-4 and protected group study time in PGY-4.  Advanced topics in patient management and practice management will be scheduled for PGY-5.


Psychotherapy Programs

The training program has dedicated longitudinal supervision of various psychotherapeutic modalities beginning in the latter half of the PGY1 year and continuing through PGY5.  Psychodynamic psychotherapy, Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are areas of particular expertise in the department.  As well, all residents have a longitudinal Family Therapy supervision during their PGY2 year.


Research

In keeping with the RCPSC recommendations, residents are strongly encouraged to complete a research project during the course of the residency. These projects may include, but are not limited to critical literature reviews, formal case review and discussion, program development and analysis, quality assurance/improvement as well as more formal and traditional scientific endeavors. In addition, residents are encouraged to develop their research projects so that they may submit them for publication and/or presentation at appropriate venues. Supervision and mentorship for such research is available through many of our teaching faculty.

Each fall, the department sponsors a Resident Research Day, at which time residents are strongly encouraged to present their various research interests in the form of an oral presentation. This protected, all day event is capped by an evening resident’s award dinner, hosted by the department. Distinguished visiting professors are invited to facilitate a learned dialogue.


Community Based Experiences

Many of the clinical rotational experiences have community-oriented training opportunities available.  Residents are supported to further explore rural and remote community psychiatry as well as urban-based community endeavors.  PGY-2 to PGY-4 residents are required to complete eight visits (approximately 2½ to 3 hours) per year to a community clinic or one to two visits/year to remote placements for a total of four or five working days.  PGY-5 Residents will make four visits (approximately 2½ to 3 hours) per year to a community clinic or one to two visits/year to remote placements.  Residents must choose a second community placement to complete their community psychiatry training if they are on rotations where community components such as Child and Adolescent Psychiatry, Forensic Psychiatry and Psychogeriatrics/Consultation-Liaison (CL) are already established unless negotiated with the Medical Director of Community Psychiatry.  During PGY-4, residents are matched to a Shared Care clinic to attend for one half day per week throughout the year.


Continuing Education

Departmental Grand Rounds, Visiting Professor Workshops and special academic programs and conferences are organized under the aegis of Continuing Education.

The Visiting Professor Program is particularly active, bringing in approximately twenty distinguished visiting faculty each academic year.  In addition to presenting at Grand Rounds, the visiting professors meet with the residents informally and present workshops, primarily attended by the residents.

Local faculty provide many additional Grand rounds presentations, both from within the Department of Psychiatry and from other University departments.  The department financially supports resident travel to one scientific meeting per year during available protected time.


Evaluation and Feedback

The process of informal and formal evaluation of the residents’ progress is continuous throughout the training program.  Similarly, the opportunity for residents to provide feedback on rotations, seminars and supervisors, goes on throughout the year.  In this way, both the functioning of the individual residents and supervisors, and more general organizational issues, can be addressed in what is a responsive and constructive manner.

Residents who are training under the CBME framework undergo assessment using workplace-based assessments that assess Entrustable Professional Activities (EPAs).  EPAs are frequent, low-stakes assessments of single patient encounters by a single observer.  EPAs typically focus on assessment of the Medical Expert, Communicator and Collaborator competencies, but do not typically assess all seven CanMEDS competencies.  In order to ensure that residents are regularly assessed in all competencies, rotation supervisors will regularly complete a Periodic Performance Review evaluation.

For residents completing training under the "traditional" stream (non-CBME), formal evaluation of clinical performance takes place four times per year in the PGY-2 to PGY‑5 years and are submitted on Entrada, the online residency management system used by the University of Manitoba.  Evaluation of psychotherapy skills occurs two times per year.  Departmental Oral Examinations (which are modeled after the RCPSC oral exam) occur annually.  A global evaluation, taking into account the various components of the evaluation process, occurs once each year.  Residents are required to challenge the national COPE exam annually each spring.

Residents are regularly asked to provide written, formal evaluations of supervisors, rotations, and seminars.  These are taken into account in planning for the subsequent year.

Evaluations are fundamental in the continuous process of program development.  As well, there is also an annual resident group evaluation day, which is protected time.  These group-generated evaluations are also used to provide constructive feedback to the faculty as well as stimulate program development.


Competence Based Education Quick Reference Guides for Entrada and EPAs


Summary

The psychiatric residency is a critical period in the development of a psychiatrist, from learning new skills to enhancing the resident’s knowledge to the development of one’s own identity as a psychiatric specialist.  The residency sets the stage for an ongoing process of continuing education, growth and maturation, rooted in both scientific medicine and the humanistic traditions.

The above description is a brief summary of our training program.  Additional information on the selection process, program objectives and other aspects of the program are available to all potential candidates.  If any questions arise, or you wish to further discuss any aspect of our training program, please feel free to contact us.

M. Harrington, MD, FRCPC
Program Director
Postgraduate Education
Department of Psychiatry
Phone: (204) 787-3610

 S. Fotti, MD, FRCPC
Child and Adolescent Psychiatry
Subspecialty Program Director
Health Sciences Centre
Phone: (204) 787-3914

 V. Kaushik, MD, FRCPC
Geriatric Psychiatry
Subspecialty Program Director
Victoria General Hospital
Phone: (204) 477-3556

 M. Ratzlaff, MD, FRCPC
Victoria General Hospital
Psychiatry Site Coordinator
Phone: (204) 477-3445

J. Moody, MD, FRCPC
Saint Boniface Hospital
Psychiatry Site Coordinator
Phone: (204) 237-2820

N. Kuzenko, MD, FRCPC
Health Sciences Centre
Psychiatry Site Coordinator
Phone: (204) 787-3610

PROGRAM SUMMARY

The psychiatric residency is a critical period in the development of a psychiatrist, from learning new skills to enhancing the resident's knowledge to the development of one's own identity as a psychiatric specialist.  The residency sets the stage for an ongoing process of continuing education, growth and maturation, rooted in both scientific medicine and the humanistic traditions.

FOR MORE INFORMATION CONTACT

Dr. Michael Harrington
Director, Postgraduate Education (PGE)
Department of Psychiatry
PZ277 PsycHealth Centre,
771 Bannatyne Avenue,
Winnipeg, Manitoba, Canada
R3E 3N4
Phone: 204-787-3610
Fax: 204-787-4879
E-mail: mharrington@exchange.hsc.mb.ca