FACULTY OF MEDICINE
 |
Department of Psychiatry |
Adapted from:
1) Official Fellowship Guidelines - Canadian Academy of Geriatric
Psychiatry, 1994.
2) Gustafson et al. Skill-based objectives for specialist training in
old age psychiatry. International Journal of Geriatric Psychiatry.
2003; 18: 686–693.
REVISED FOR GERIATRIC PSYCHIATRY PROGRAM, UBC 2004
CURRICULUM GUIDELINES
UBC GERIATRIC PSYCHIATRY FELLOWSHIP TRAINING
I GOALS
1. To improve the attitudes, knowledge, and skills of Fellow about the elderly, to prepare them to diagnose, treat, and manage geriatric patients effectively. Issues relating to ageism must be addressed.
2. To increase awareness of the developmental processes of late life to give trainees a broader understanding of biological psychosocial issues associated with aging.
3. To encourage a comprehensive approach to the assessment and management of older people with psychiatric problems. This would encompass an understanding of the biopsychosocial model and of systems theory and medical knowledge.
4. To provide an opportunity for the trainee to develop firsthand knowledge and experience with the nature, course, treatment, and outcome of common psychiatric problems of the elderly, and in this way, to gain an appreciation of the differences between young and old in the presentation of such disorders.
5. To foster recognition of the need for consultation and collaborative work with other professionals involved in the care of the geriatric population through observation and participation with members of a multi-disciplinary health care team.
6. To ensure that trainees develop an understanding of the spectrum of health care systems providing care for the elderly, by providing with opportunities to work in community, long-term and cute-care settings, and other relevant areas of interest.
7. To develop knowledge and skills in special areas as they relate to the elderly, such as:
a) Teaching other health care professionals (non-physician), patients, and family’s mental health problems in the elderly;
b) Assessment of competency, ethical issues, and elder abuse;
c) Increased awareness of administrative issues and public policy.
II RECOMMENDED FORMAL CLINICAL EXPERIENCE
1. A twelve-month full-time experience in geriatric psychiatry to meet objectives outlined in III.
2. Direct supervision by a Geriatric Psychiatry educator(s).
3. Adequate facilities.
4. Provision for several selected patients to be followed under the supervision of the designated Geriatric Psychiatry educator(s).
III KNOWLEDGE, OBJECTIVES AND SKILLS OBJECTIVES
(with reference to Gustafson et al., 2003 – see Appendix 1)
KNOWLEDGE OBJECTIVES
A. General Issues
1. Attitudes and normal aging; the understanding and knowledge of normal developmental processes involved in aging; normal physiological, psychological and cognitive changes; social and physical changes.
2. Awareness that issues of autonomy and loss of control are central to this patient population.
3. Knowledge of basic sciences relevant to disorders of the aged.
4. Problems in mental health of the aged including:
a. Nosology, demography, and epidemiology.
b. Biopsychosocial factors.
c. Environmental issues.
d. Cultural issues.
5. The applicability of general psychiatry knowledge to the mental health problems of late life.
B. Principles and Methods of Acute and Long-Term Assessment and Management
1. Psychiatric interview techniques, and mental status examination and the imperatives of collateral history gathering and their interrelationship.
2. Medical, neuropsychological and neurodiagnostic techniques.
3. Psychosocial issues (e.g. losses, retirement, role change).
4. Functional issues (e.g. disability, forced dependency).
5. System and support factors (continuity, collaboration, and constraints on effective care).
6. Medico-legal aspects, i.e. capability, at-risk assessments, representation agreements, committee of person, substitute decision making, advance directives.
7. Family and couple assessments (including multi generational groups).
C. Psychopathology in Old Age
1. Knowledge of, and skills in, comprehensive assessment of mental health disorders in the aged, and of the relationship between mental disorders and physical illness. Specific disorders would include delirium, dementia, depression and other mood disorders, delusional disorder, adjustment disorders, personality disorders, and addictions, and late onset psychosis. Specific attention would also be paid to the significant comorbidity of mental health disorders in the aged.
2. Assessment of behavioural disturbances and difficult to manage patients.
D. Therapy and Management
1. Biological
a. Pharmacology (not necessarily limited to psychiatric medication)
i. Acute (emergent)
ii. Short-term
iii. Long-term
b. ECT – indications, procedure, consent, risks vs benefits, maintenance, medication / anaesthesia issues.
c. Light therapy.
d. Others – rTMS / VNS / Psychosurgery
2. Psychological
a. Psychotherapy as it relates to the aged
i. Supportive
ii. Cognitive-Behavioural
iii. Psychodynamic
iv. Family and group therapies
b. Incorporate the role of spiritual / religious guidance
E. Service Delivery
1. Knowledge and awareness of continuum residential support services.
2. Knowledge and awareness of continuum of acute to prolonged stay geriatric psychiatry services.
3. Developing and networking with #1 and #2.
4. Special problems (e.g. outreach, a hospital, respite).
5. Interdisciplinary model of training:
a. Mode of interdisciplinary practice;
b. Opportunities to acquire skill sets from related disciplines;
c. Expanding definition to include medical subspecialties;
d. Multiple service delivery models.
F. Special Topics
1. Grief and bereavement.
2. Terminal care, the living will and dying.
3. Legal and Ethical issues.
a. Includes at-risk assessments and capability.
4. Cultural issues.
5. Elder abuse and squalor issues.
6. Multi-disciplinary team function and leadership skills.
7. Psychiatrists as educators in geriatrics.
8. Consultation liaison differences in acute care, long-term care, and community agencies.
a. Also see skills objectives 4d) & 4e) below for details.
9. Administrative psychiatry:
a. Service delivery models;
b. Resource utilization;
c. Quality assurance.
10. Prevention
SKILLS OBJECTIVES
The fellow will have:
1. Working knowledge of multi-disciplinary assessment and management, including competence in providing leadership to a geriatric multi-disciplinary team.
2. Competency in assessment of the older patient including the following:
a. Interviewing skills;
b. Mental status examination; indications for and interpretation of psychological testing;
c. Community and environmental assessment;
d. Family assessment, including role of caregiver, burden and indications for therapeutic interventions;
e. Medical assessment, including physical examination, neurological examination, and selection of laboratory test.
3. Formulation of biomedical, psychological, and social information into a multi-disciplinary
treatment plan.
4. Competency in the treatment of the older patient including:
a. Psychotherapy;
b. Pharmacotherapy and other biomedical therapies, such as ECT with emphasis on features that distinguish their applications to the elderly;
c. Coordination of community, environmental, and legal interventions, including interventions for individuals unable to care for their own needs or resources.
d. Functioning within a multi-disciplinary team (appreciation of team member roles, skills, leadership, conflict resolution)
e. Rehabilitation (continuity of care, functional outlook)
5. Provide attitudinal leadership to recognize and deal constructively with biased attitudes to the
elderly.
6. Teaching opportunities:
a. Acquisition of appropriate teaching skills;
b. Exercise of teaching skills;
c. Residents;
d. Medical students;
e. Multi-disciplinary team members.
7. Evidence-based practice / critical appraisal of literature.
8. Completion of an academic project.
IV CRITERIA FOR PROGRAMS DESIGNATED FOR THE TEACHING
OF GERIATRIC PSYCHIATRY
1. Must have an approved geriatric psychiatry educator(s) to offer direct supervision.
2. Must have an organized service/educational structure with the following features:
a. A multi-disciplinary health care team allowing the fellow to observe and participate in multi-disciplinary assessment and management of the elderly.
b. Opportunity for the development of knowledge and skills in a variety of service modalities representing the following settings: acute care, long-term care, and community.
c. A comprehensive approach to the care of the elderly including networking with community agencies.
d. Ability to provide at least two new assessments per week for each resident.
e. Provision of follow-up opportunities in a supervised, multi-disciplinary manner for selected patients over the course of the fellowship.
Appendix 1:
Gustafson et al. Skill-based objectives for specialist training in old age psychiatry. International Journal of Geriatric Psychiatry. 2003; 18: 686–693
Summary of Objectives:
1. Ageing (normative)
2. Recognition of mental health problems
3. History taking
4. Mental state
5. Physical examination
6. Investigation and further assessment
7. Mental health disorders and related problems
8. Treatment management and care
9. Services
10. Multi-disciplinary working
11. Rehabilitation
12. Communicating with patients and their families
13. Support for careers
14. Legal and ethical issues
15. End of life issues
16. Cultural issues
17. Elder abuse
18. Quality assurance
19. Prevention
20. Teaching and provision of information
21. Knowledge management
22. Research
FACULTY OF MEDICINE
|
Department of Psychiatry |