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Fundamentals of Caring for the Hospitalized Patient 

Goals 

Upon completion of this rotation, the resident is expected to be competent in the care of low-to moderate complexity inpatients on a psychiatric unit. Residents must display the requisite knowledge, skills and attitudes to provide safe, patient-centred care. In all aspects of specialist practice, the resident must be able to address issues of gender, sexual orientation, age, culture, ethnicity, spirituality and ethics in a professional manner.�

Objectives 

Medical Expert –

1. Knowledge 

At the conclusion of the rotation, the trainee will acquire “introductory knowledge” (the ability to recognize, identify or describe principles) as demonstrated by the ability to:

1.1 Name the DSM-5 diagnostic criteria for depressive and bipolar disorders, all psychotic disorders, personality disorders and common comorbid substance use disorders (i.e., nicotine, alcohol, cannabis, opioid).

1.2 Name the most common medical comorbidities in admitted patients in their setting.

1.3 Describe the policy, procedure and practice dealing with patient and provider safety, including violent and potentially violent situations in the inpatient setting

At the conclusion of the rotation, the trainee will demonstrate “working knowledge” (the ability to understand the major textbooks and literature and apply it in clinical care) in the following areas as they relate to the inpatient setting:

1.4 Awareness of one’s own reactions when dealing with patients, including the suicidal, demanding, violent, hostile or withdrawn inpatient

1.5 Burden of medical, surgical and psychiatric illness to individuals, families and systems  1.6 Common Co-morbidity – medical, psychiatric, developmental or substance abuse

1.7 Capacity / Competence • Confidentiality

1.8 Consent

1.9 Long term illness and rehabilitation

1.10 Suicide, self-harm, or harm directed towards others

1.11 Etiology, symptoms, course of illness and treatment of:

1.11.1 Alcohol and other substance abuse disorders

1.11.2 Delusional disorders and other psychoses

1.11.3 Personality disorders

1.11.4 Psychiatric disorders secondary to acquired brain injury

1.11.5 Mood disorders

1.11.6 Schizophrenia

Medical Expert – 

2. Clinical Skills

At the conclusion of the rotation, the trainee will demonstrate the ability to perform the following skills consistently in low to moderate complexity patients:

2.1 Assessment & Evaluation

2.1.1 Obtain necessary historical data elements, including essential positives and negatives.

2.1.2 Access collateral sources to clarify course of illness episodes and any risk concerns.

2.1.3 Perform and report an accurate mental status examination using correct descriptive terms.

2.1.4 Construct a realistic provisional and differential diagnosis for common inpatient clinical presentations.

2.1.5 Know common DSM–5 categories and screen for other psychiatric and medical conditions.

2.2. Mental Health Legislation

2.2.1 Consistently comply with requirements of legislation in assessment, documentation and communication.

2.2.2 Use all common Laws and regulation related to Mental Health.

2.3 Comprehensive Psychiatric Management

2.3.1 Identify feasible and safe treatment options informed by assessment of patient and treatment setting.

2.3.2 Interpret available data and integrate information to generate a short-term management plan.

2.3.3 Work with the inpatient team to develop an integrated biopsychosocial treatment plan.

2.3.4 Assess suitability for appropriate psychopharmacological and somatic treatments (e.g., ECT).

2.4 Risk Assessment

2.4.1 Conduct risk assessments informed by diagnosis, patient history and patient characteristics.

2.4.2 Identify common modifiable and non-modifiable risk factors.

2.4.3 Document relevant risk factors and rationale for treatment plan.

2.4.4 Fulfill relevant duties for reporting risk as per Ministry rules and legislative guidance.

2.4.4 Seek supervision in the assessment and management of aggressive and suicidal behavior.

2.5 Pharmacotherapy

2.5.1 Determine appropriate initiation and target doses of common treatments for major depressive disorder, bipolar disorder and schizophrenia.

2.5.2 Describe common side effects including frequency and onset for commonly used medications.

2.5.3 Complete baseline screening investigations for all major classes of medications started in hospital.

2.5.4 Assess and manage emergent side effects including: akathisia, dystonia, parkinsonism, dry mouth, hyperphagia, weight gain.

Communicator

At the conclusion of the rotation, the trainee will demonstrate the ability to:

1. Establish and maintain an effective working relationship with patients presenting with acute psychiatric symptoms • Facilitate a structured clinical encounter effectively
2. Establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy
3. Provide education on diagnosis in clear language to patient and family.
4. Seek out and synthesize information from other sources, such as a patients’ family, caregivers and other professionals.
5. Maintain clear, concise, accurate, appropriate and timely records, written or electronic, of clinical encounters and plans.

Collaborator

At the conclusion of the rotation the trainee will demonstrate the ability to: 

Participate effectively and appropriately in an interprofessional health care team by consistently demonstrating the following:

1. Maintain a respectful attitude towards members of the interprofessional team in verbal and non-verbal communication.
2. Identify overlapping and shared responsibilities between team members.
3. Work with others in the inpatient unit to assess, plan and provide care for individual patients.
4. Use non-stigmatizing language in discussions with colleagues and team members. Ensure safe transitions in inpatient care by consistently demonstrating the following practices:
5. Provide succinct and relevant verbal reports to other team members during rounds.
6. Communicate absences to the team.
7. Ensure relevant information is communicated to team members prior to all planned absences.
8. Notes are legible and structured, identifying key safety issues and plans for ongoing care.
9. Communicate discharge plans to outside care providers with timely written summaries.
10. 10.Participates in medication reconciliation.

Leader 

At the conclusion of the rotation the trainee will demonstrate the ability to:

Effectively prioritize clinical, educational and personal demands in order to provide safe patient care as demonstrated by:

1. Awareness of ward routines and scheduled rounds.
2. Planning daily work to minimize disruption to the schedules of patients and team members.
3. Discussing inpatient workload requirements and other clinical or personal obligations in a timely and collegial manner.
4. Delegating tasks appropriately to other team members.

Recognize the importance of just allocation of health care resources, balancing effectiveness, efficiency and access with optimal patient care as demonstrated by the trainee’s ability to:

1. Describe the different services available to inpatients upon discharge including (but not limited to): Out Reach Program, Day Care Program and Ambulatory Care.
2. Describe how to access different level of care in their clinical setting.
3. Identify the average wait time for different services in their clinical setting.
4. Discuss the role of patient safety when considering resource allocation.

Health Advocate 

At the conclusion of the rotation the trainee will demonstrate the ability to:

1. Identify the determinants of mental health of the populations served by the inpatient unit, including barriers to access to care and resources.
2. Identify the common sources of support available to patient and their role in identifying need and facilitating access if indicated.
3. Identify admitted patients with complex health needs
4. Consult and collaborate with the interprofessional team to support access to appropriate services in the post-discharge period including medical and non-medical interventions.

Scholar

At the conclusion of the rotation the trainee will demonstrate the ability to:

Maintain and enhance professional activities through ongoing learning as demonstrated by the trainee’s ability to:

1. Identify current best practice guidelines related to a patient’s presenting problem 
2. Access reliable medical information via electronic databases
3. Consult with other colleagues and team members to address clinical questions
4. Collaboratively identify learning goals with supervisor and follow-up on progress in supervision.

Facilitate the learning of other professionals, as demonstrated by the trainee’s ability to

1. Display a professional and respectful attitude towards all professions
2. Provide a safe learning environment.
3. Provide one-to-one teaching around clinical cases.

Professional 

At the conclusion of the rotation the trainee will demonstrate the ability to:

1. Exhibit appropriate professional behaviours and relationships in all aspects of practice including honesty, integrity, respect for diversity, and maintenance of confidentiality.
2. Use non-stigmatizing language in clinical discussions.
3. Maintain appropriate relations with patients, colleagues and students.
4. Adheres to the principles respecting boundaries in all areas of interaction.
5. Identify and access relevant Ministry, Institute and local hospital policy documents.
6. Recognize ethical issues encountered in practice and uses supervision to reflect upon them.
7. Display openness to feedback on lapses in professional behaviour.
8. Identifies areas of uncertainty and seeks supervision.