Allan Memorial Institute, Montreal General Hospital, Glen Campus McGill University Health Centre

***All elective requests are to be submitted to undergrad.muhcpsychiatry [at] muhc.mcgill.ca

NOTE: Requests for electives of less than 3 weeks duration will not be considered.

Elective Description 
Full-time rotation

Elective Duration 
4 weeks

Educational Objectives 

• Learn how to do comprehensive neuropsychiatric evaluation in patients with neurological comorbidities including epilepsy, multiple sclerosis and movement disorders
• Perform cognitive examinations and interpret results as part of the investigation of neurocognitive disorders
• Execute and interpret relevant components of the elemental neurological examination as part of a neuropsychiatric assessment
• Learn the indications for investigations including laboratories, electrophysiology (EEG, EMG, sleep studies) and neuroimaging (CT, MRI, PET) in neuropsychiatric conditions
• Learn specific psychiatric conditions observed in patients with epilepsy, multiple sclerosis, movement disorders, traumatic brain injuries, encephalitis, ALS, etc.
• Learn the principles and indications of rTMS treatments in patients with major depressive disorders
• Psychopharmacological management of neuropsychiatric symptoms in patients with complex neurological comorbidities
• Interpret structural and functional neuroimaging reports (CT, MRI, PET)
• Perform diagnostic evaluations of early-onset or atypical neurocognitive disorders
• Prescribe investigations for the diagnosis of neuropsychiatric disorders

Scope of Work 
Description of Clinical Activities and Weekly Schedule

• Monday AM: Readings
• Monday PM: Movement disorders clinic (TTK)
• Tuesday AM: Inpatient consults on the epilepsy telemonitoring unit (SD)
• Tuesday PM:  Outpatient epilepsy clinic (SD)
• Wednesday AM: Neurology grand rounds (8-9AM); Readings or work on clinical reports
• Wednesday PM: rTMS clinic (MB)
• Thursday AM and PM: Neurocognitive and general neuropsychiatry clinic (SD)
• Friday AM: Multiple sclerosis clinic (MB)
• Friday PM: Movement disorders clinic (TTK)

Number of new assessments, typical case load
Medical students will interview new patients in the presence of the supervisor in most circumstances (1 per half-day). Given the short length of the rotation students will not carry their own caseload, but they will observe follow-ups with the supervisor.

Amount of time spent in clinical meetings or consulting with other professionals
Students will attend the Thursday lunchtime multi-disciplinary meetings of the Cognitive Affective Behavioral group. They will interact with the epileptologists and other allied professionals on the epilepsy telemonitoring unit. 

Amount of time spent in additional academic or administrative activities
Students will have the opportunity to attend Wednesday AM neurology grand rounds if the topic is relevant to neuropsychiatry. There are no administrative activities. Students could be asked to present articles in journal clubs (not more than once per rotation).

Supervision
Students will be observed directly by the supervisor for most cases. If a student shows a good level of competence they might be allowed to initially evaluate patients by themselves, immediately followed by a case revision with the supervisor. Medical students will be asked to write some reports of new evaluations in a timely fashion and will be reviewed by the clinical supervisor. 

Description of Teaching Methods
Case based teaching and guided readings

Other Academic or Nonclinical Activities
Students will have the opportunity to undertake academic endeavours such as writing case reports and review articles. Periodic journal clubs will be organized with supervisors when student/residents are on the service.

The Day Hospital offers an intensive day program with a 12-16 week length of stay, where the focus typically is on treatment-resistant illness, comprehensive evaluation, and community reintegration.  Students coming to this elective will receive supervision from Dr. Fielding, the Director of the Day Hospital and potentially work with a psychiatry resident or other medical students.  It is a full-time experience with gradually increasing responsibility based on the student’s skills and knowledge. In addition to exposure to individual and group psychotherapy, Occupational Therapy, Psychoeducator courses, family interventions and pharmacotherapy, the student will get to work with a full multi-disciplinary team.  If desired, the student may also attend resident teaching sessions offered as core training and teaching interviews for Short-Term Dynamic Therapy with Dr. Said.  For those considering a career in Psychiatry, this provides good first-hand exposure to the training program at McGill, a good feel for working as a case manager, and a chance to have more in-depth interactions with residents already in our program.

Elective Description
This elective offers extensive training in the psychosocial aspects of medical practice and physical illness. The experience is individually designed, but includes supervised psychiatric consultations on patients in the medical and surgical wards of the MUHC, MGH and Glen sites, as well as exposure to the liaison model of medical and/or surgical services.

Elective Duration
3 and 4 weeks

Educational Objectives
Students will learn how to perform a psychiatric assessment on physically ill patients, including completing an interview, neurocognitive testing as indicated, formulating a diagnosis and treatment plan, as well as initiating its implementation, and determining the disposition. There will be supervision appropriate to the level of training.   

Scope of Work
Students will participate in consultations on in-patients at the MUHC. Individual assignments may be possible to a variety of Liaisons settings where opportunities are available in ambulatory settings. The student will be part of a Clinical Teaching Unit, and will be assigned tasks based upon graded responsibility. 

Out-patient experience is offered to medical students.  The MDP is staffed by 10 psychiatrists and an interdisciplinary team. The elective is available to one student at any one time. Teaching includes weekly MDP Academic Rounds and team discussion of cases. The student participates in the assessments of referrals to the MDP.

This elective is available to clerkship students who wish to gain practical experience in conducting initial intake assessments and screening interviews of patients referred to the Unit.  Students will be able to conduct interviews in a closely supervised setting, in a closed-circuit setting, as well as observe extensive interviews conducted by senior staff.  The Unit can only a maximum of one student at any time.  Ideally this elective requires a duration of eight weeks but can accept students for a period of four weeks.  This applies to both McGill and non-McGill students.  At the end of this elective, the student will be able to conduct initial interviews in this modality of psychotherapy, assess suitability of patients to be treated and initiate Short-Term Dynamic Psychotherapy on a variety of patients with neurotic conflicts and emotional crisis. This is a full-time elective.

The in-patient service in Psychiatry at the Montreal General Hospital consists of a 49-bed clinical teaching unit (CTU) on 4-West.  General adult psychiatric patients are eligible for admission.  Four psychiatrists are responsible for the clinical care of these patients and for the teaching and supervision of residents and medical students.  The CTU employs a multidisciplinary team approach that utilizes the biopsychosocial model of treatment.  Each team consists of a psychiatrist, resident, medical students, nurses, social worker, occupational therapist and psychology interns.  Training in psychopharmacology and electroconvulsive therapy is available.  Dynamic/Psychoanalytic interviews of in-patients rounds out the clinical experience. This is a full-time elective.

Elective Description 
The unit treats alcohol and drug dependent individuals in large numbers.  An active program of detoxification and rehabilitation is carried out at the Montreal General Hospital.  In-patient and out-patient services are offered. The student will be involved in the inpatient component of the treatment which is offered to a few patients for whom it is indicated.  The student will be exposed to a variety of interventions.  It is one of the few opportunities for the student to gain experience in this special area. 

This is a Part-Time Elective to be combined with other services in Psychiatry.

Elective Duration
4 weeks

Scope of Work 
This elective has a minimum availability of 5 mornings per week for four weeks. This is not a full time elective, and must be combined with other services in Psychiatry.

Name of Clinic: The McGill University Sexual Identity Centre (MUSIC)

Main supervisor and point-person:

Richard Montoro, MD CM, MSc
richard.montoro [at] mcgill.ca
514.934.1934, ext. 42371

Secretary:

Marsha Kagan
marsha.kagan [at] muhc.mcgill.ca
514.934.1934, ext. 42365

Address, Room Number and Times of Clinic:

Clinics are held Mondays and Wednesdays
Montreal General Hospital
1650 Cedar Avenue, Room A2.160
Montreal, Quebec H3G 1A4

Description of clinic

This is Canada’s first out-patient mental health clinic in psychiatry serving gays, lesbians, and other sexual minorities in a non-pathologising setting.  The team is made up of two psychiatrists: Drs. K. Igartua and R. Montoro, as well as a psychiatric nurse.  Clinical activities for students include conducting psychiatric evaluations under direct supervision as well as follow-ups.  Weekly team meetings are part clinical, part academic.  CBT groups on Internalized homophobia run 3-4 times per year based on enrolment and can be part of the elective experience.  Skills acquired with our sexual minorities population are easily transferrable to the evaluation of sexual and gender expression in broader populations.  This is a part-time elective of 4 half days per week.  This clinic is available on Mondays and Wednesdays from September to June.

Goals and rationale of this tertiary care clinic

Sexual minorities are an underserved population both because they are reluctant to seek out a mental health care they are unsure will be welcoming, and because issues unique to sexual minorities are often poorly understood even by well-meaning clinicians. The creation of this centre of excellence has fostered the development of expertise for training clinicians and improved the acceptability of mental health care services to this population.

Processes of the clinic

Trainees participate in two assessment clinics per week.  All assessments are referred from their treating physician.  We have one team meeting per week, plus one individual supervision hour per week.  Medical students also participate in follow-ups, both psychopharmacological and psychotherapeutic.

Intervention modalities

Every patient has an initial assessment.  Follow-up modalities include medication management and/or psychotherapy (individual, couple and family, or group).

Elective Description 
An introduction to important clinical concepts in reproductive psychiatry, such as the evaluation and management of premenstrual dysphoric disorder, mood and anxiety disorders during pregnancy and the postpartum period, as well as during the perimenopausal transition. Includes teaching on the risks and benefits of pharmacotherapy during pregnancy and the postpartum period, as well as on hormonal and complementary alternative medicine alternatives to psychotropics.

This Elective can be done Full-Time or Part-Time.

Elective Duration
4 weeks

Educational Objectives 

• ​Learn how to adequately counsel patients concerning pharmacologic management during pregnancy and the postpartum period (pre-conception psychiatric consultations)
• Learn how to diagnose and treat premenstrual dysphoric disorder
• Learn how to evaluate and treat perimenopausal-related anxiety and mood disorders
• Learn more about the management of high-risk populations such as infertility patients or patients having suffered from recurrent perinatal losses

Scope of Work 
Clinical practice and research focus on the effects of steroid/sex hormones on behavior; includes the full range of psychiatric disorders related to hormonal fluctuations, from reproductive stages such as the premenstrual, pregnancy/postpartum and perimenopausal stages to critical developmental stages during middle childhood and adolescence when hormones modulate the risk of psychiatric disorders.

Clinical activities:

• Gynecology clinic: new consults and follow-ups of patients with premenstrual or perimenopausal exacerbations of psychiatric symptoms as well as infertility and perinatal loss + group therapy for infertility and perinatal loss
• Obstetrical clinic: new consults and follow-ups regarding pre-conception psychiatric counselling, pregnant and postpartum patients + group therapy for pregnant and postpartum women
• Full-time option can include involvement in group therapy for mood/anxiety during pregnancy and the postpartum period; and/or group therapy for perinatal loss

Number of new assessments per week: 2, typical case load: ~ 5-6 patient visits, including new assessments and follow-up visits +/- group therapy week

Amount of time spent in clinical meetings or consulting with other professionals: 3 hours per week, with monthly meetings with the Quebec provincial network of reproductive psychiatrists

Description of Research Activities (if research option is taken- can be half-clinical, half-research)

Clinical projects involving data collection and analyses related to:

• Pregnancy-related anxiety and risk for hypertensive disorders of pregnancy
• Sex differences in coping mechanisms related to perinatal loss
• Influence of sex hormones on cognition and behavior during adolescence

Description of Supervision

• Supervisors: Tuong-Vi Nguyen, David Sinyor
• 1-hour meeting every week after each clinic (Gynecology and Obstetrics) and 30 min before each of the two group therapies, for a total of 3 hours
• 20 percent of new assessments and follow-ups will be directly observed

Description of Teaching Methods

• Case based teaching (weekly)
• Journal club (monthly)
• Readings (a list of readings will be provided at the beginning of the rotation)
• Group therapy

Description of Other Academic or Nonclinical Activities

•  Journal club presentation for the provincial network of reproductive psychiatrists

Research Electives

A number of research electives are available through the Department of Psychiatry. Interested students should contact the Elective Chairman.

Link to Department of Psychiatry