Revamping Residency: Our PGY1 Pilot 2017

The College of Physicians and Surgeons of Canada has mandated that all postgraduate psychiatry programs must shift from a time-based structure to a competency-based design over the next few years.

We decided to get a head start.

In the spirit of innovation, the University of Toronto has received special permission from the Royal College to restructure our program ahead of schedule. One of the few schools taking on this initiative in advance, we ran the first PGY1 pilot in 2016 and again in 2017. Our program has used this as an opportunity to refresh our curriculum and re-evaluate how we want to educate our residents.

“How we redesign our training program is going to have a big influence on what the future of psychiatry looks like,” says Dr. Mark Fefergrad, Director of Postgraduate Medical Education. “We train about one-quarter of all psychiatrists in Canada. This pilot has forced us to look at ourselves and ask: What should the psychiatrist of the future look like? What skills should they have? We are helping to define the boundaries of psychiatry in the 21st century.”

Over the coming years, we will be rolling out our PGY2–5 pilots. For the first time ever, our Department is also including mental health service users in the development of curriculum. Another advantage of the new curriculum is that there will be greater elective time to allow residents to focus on clinical areas of interest and/or research. The resulting program will be more flexible and learner-centred, with a real focus on research, service and access.

 “We are going bigger on neuroscience, bigger on research, focusing on underserved populations and integrating physical health with mental health. This pilot emphasizes what we think will define the future of psychiatry,” says Dr. Fefergrad. “Our goal is to develop learners who have an approach to lifelong learning. Medicine is an evolving practice, and this pilot encourages self-reflection and developing the skills to go out and pursue new knowledge.”

“We train one-quarter of psychiatrists in Canada. This pilot has forced us to look at ourselves and ask: What should the psychiatrist of the future look like?”

Pilot Highlights:

• New Evaluation Standards: Trainees will be evaluated based on their capacity to master Entrustable Professional Activities (EPAs). EPAs are the key tasks in psychiatry that an individual can be trusted to perform in a given healthcare context, once sufficient competence has been demonstrated.
• Mobile Evaluation System: Supervisors can now evaluate residents via an app on the trainees’ smartphones. Replacing bi-annual online evaluations, our competency-based program offers trainees more frequent, lower stakes performance evaluations, observations and feedback.

Revamped Curriculum Highlights:

• Underserved Selective: Evidence suggests that residents who have the opportunity to work with underserved populations very early on in their training are more likely to serve these populations in their future practices. PGY1 residents now have a series of Underserved Selectives to choose from, ensuring they are exposed to a broad range of underserved groups, based on a variety of factors, including ethnicity, geography, sexuality and socioeconomic status.
• “Double Down” on the Emergency Room Experience: PGY1s will now experience two months of emergency room training (instead of one) and then a new experience in that setting in the senior years. Our pilot recognizes that the emergency room is a significant aspect of the residents’ psychiatry experience; increased hours in the ER will give our trainees valuable time to observe and learn from their teachers on the ground while practicing interviewing, diagnoses, pharmacology and psychotherapeutic interventions.
• Psychiatric Homeroom: This program brings PGY1s back from other services once a month to talk about the interface between mental health and physical health. It helps them understand complicated cases they may experience on other services through a psychiatry lens.
• Longitudinal Ambulatory Clinic: We offer a weekly, half-day clinic that allows trainees to follow patients’ illnesses long-term, enhancing their capacity to understand and treat chronic mental health issues.
• Springboard: To enhance and standardize the individual skills of each student, we now offer a four-week course at the beginning of the PGY1 year. This course identifies trainees’ weaknesses and allows them to improve their skills via interactive small-group seminars and clinical activities.