MEDICAL EXPERT
1. KNOWLEDGE:Demonstrates the knowledge necessary to practice as an effective clinician with children, adolescents and their families presenting with mental health problems. This knowledge is broadly encompassed within the following areas:
1.1 Developmental processes and milestones including normal and deviant fine motor, gross motor, speech/language, cognitive, emotional and social development from birth to age 18 years, including the major theories of development such as Erikson, Piaget, and attachment
1.2 Epidemiology, causes, signs, symptoms, clinical course and treatments of child psychiatric disorders:
1.2.1 Attention Deficit Hyperactivity disorder
1.2.2 Conduct disorder
1.2.3 Oppositional Defiant disorder
1.2.4 Substance-related and addictive disorders
1.2.5 Mood and anxiety disorders,
1.2.5 Eating Disorders
1.2.6 Psychotic spectrum disorders
1.2.7 Adjustment Disorders
1.2.8 Somatic symptom and related disorders
1.2.9 Elimination disorders
1.2.10 Communication Disorders
1.2.11 Specific Learning Disorder
1.2.12Motor Disorders
1.2.13 Intellectual Disabilities
1.2.14 Autism Spectrum Disorder
1.2.15 Tourette’s Disorder and other tic disorders
1.2.16 Relevant V-Codes: physical/sexual abuse, neglect, parent-child, and sibling relational problems
1.3 The impact of parental and child mental disorder on the family, on parenting, and on parentchild relationships
1.4 The impact of psychosocial trauma on children (e.g., poverty, divorce, death, immigration, domestic or community violence, bullying, medical illness)
1.5 Medico-legal issues (especially informed consent, capacity to consent, consent for sexual activity, confidentiality, duty to report abuse)
1.6 The structure of the children’s mental health system (e.g. Children’s Mental Health Centres, MOH facilities), and available community resources (e.g., Child Protection Team, specialized schools, youth court)
1.7 When and how to refer to a child psychiatrist
2. SKILLS: Demonstrates the ability to assess, diagnose and treat the full range of child psychiatric disorders in different clinical contexts. By the end of the rotation, the resident will be able to:
2.1 Assess a child of any age from birth to age 18 years, both alone and with his/her family (i.e., take the history, conduct a mental status examination, assess family interaction). This may include the use of non-verbal techniques with drawings, puppets, and toys with very young or developmentally disabled children
2.2 Generate a differential diagnosis and formulation along developmental, biological, psychological, familial, gender, and socio-cultural dimensions
2.3 Derive an evidence-based, efficient, feasible, contextually appropriate management plan from the formulation. This should include specific treatment goals and/or proposed measures of outcome
2.4 Assess and manage previously unknown children/families in acute emergency situations (e.g., suicidal, homicidal, psychotic, “uncontrollable” children and adolescents)
2.5 Administer various forms of treatment within a 6-month time frame:
2.5.1 Crisis intervention
2.5.2 Parent counseling/psycho-education
2.5.3 Pharmacotherapy with a range of medications (e.g., ADHD medications, antidepressants, antipsychotics, lithium, anticonvulsants)
2.5.4 Individual psychotherapy (1 CBT case is mandatory and another case in the modality of the resident’s choice is strongly recommended)
2.5.5 Family therapy (1 case is mandatory)
COMMUNICATOR:
Demonstrates clear, accurate and timely verbal and written communication. During the course of the rotation the resident will demonstrate good communication:
- With referral sources and other members of the health care team
- In clinical interactions with young children, adolescents, parents and other family members as appropriate. The resident will demonstrate the specific language skills required in communicating with young children at a level that they understand
- In the maintenance of complete and accurate written records of all assessments and/or therapeutic interventions
COLLABORATOR:
Demonstrates ability to work effectively with other members of the health care team and with child-serving community agencies. During the course of the rotation, the resident will demonstrate the ability:
- To use multi-disciplinary direct and indirect consultation in diagnosis and treatment planning
- To obtain psychological testing, teacher reports, speech and language, or OT assessments as appropriate
- To work within a multidisciplinary team structure
LEADER:
Demonstrates competence and efficiency as follows:
- In utilizing personal and system resources effectively to balance clinical care, learning needs and outside activities
- In utilizing information technology efficiently in clinical practice and to support learning
- In effectively planning use of professional time
- In setting realistic priorities and using time effectively in order to optimize professional performance
- In coordinating the efforts of the treatment team by effectively using the varied skills of other health professionals
- In demonstrating knowledge of key community resources pertaining to children, adolescents and families/caregivers and showing willingness to direct patients and families to those resources
HEALTH ADVOCATE:
Demonstrates readiness to advocate on behalf of children with mental health problems and their families as evidenced by:
- Awareness of determinants of child mental health and wellbeing
- Participation in advocating for rights or access to services of child and adolescent patients
- Demonstrating an understanding of system-based care services available to children (child and adolescent mental health community agencies, schools, child welfare, child protection services, adoption, foster care and rehabilitation services)
SCHOLAR:
Demonstrates the following skills and attitudes as they apply to child psychiatry:
- Synthesizes basic science and clinical research knowledge relevant to child psychiatry including but not restricted to knowledge in the following areas – developmental psychology and psychopathology, neurophysiology, neuroanatomy, neurochemistry, genetics, epidemiology, medical statistics, pharmacology, psychotherapy, and research methods
- Demonstrates critical appraisal skills regarding current knowledge about causes and clinical features of child psychiatric disorders including treatments
- Is able to integrate information from various sources using critical thinking and is able to apply this to specific clinical problems
- Facilitates the learning of others (patients, families, students, other health professionals) and/or contributes to development and sharing of new knowledge in the area of child psychiatry
- Conveys an attitude that recognizes the limits of one’s knowledge and the need for further education and/or research
- Demonstrates a commitment to continuous learning along with the necessary skills to acquire new knowledge, for example by using self-reflective practices such as the clinical log.
PROFESSIONAL:
Demonstrates commitment to delivering the highest quality care with integrity, honesty, compassion and respect for diversity. The resident practices medicine ethically, fulfilling all medical, legal, and professional obligations of a specialist while exhibiting appropriate personal and interpersonal professional behaviours.
- Demonstrates collaborative and respectful relationships with children, adolescents, families/caregivers, and interdisciplinary team and support staff that include gender, cultural, and spiritual awareness about their distinctiveness.
- Demonstrates attitudes consistent with respect, interest, understanding, empathy, compassion and caring for the child and adolescent patients and their families/caregivers in all assessments and patient contacts
- Demonstrates responsibility, dependability, self-direction and punctuality in regard to clinical and educational activities
- Demonstrates acceptance and constructive use of supervision and feedback
- Demonstrates awareness and application of ethical principles in medicine generally and child psychiatry in particular
- Demonstrates an understanding of the issues related to patients’ access to their medical records in the context of working with children, adolescents, and families/caregivers
- Demonstrate awareness of personal limitations, seeking advice when necessary