Enhanced Skills Program: Care of the Elderly Psychiatry Rotation Goals and Objectives

By the end of the rotation, the resident will be able to:

Able to proficiently assess older patients with mental health concerns, including performing an organized mental status examination with appropriate use of validated tools (e.g. MOCA) to formulate an accurate differential diagnosis and come to a provisional diagnosis of common mental illnesses (e.g. depression, bipolar affective disorder, dementia).
Recognize the atypical presentation of mental health conditions in the older adult.
Formulate patient-centred, evidence-based management plans for older patients with mental illness, including non-pharmacologic and pharmacologic strategies.
Prescribe psycho-active medications judiciously and appropriately for older adults, recognizing the need to balance risks/benefits and make adjustments in older individuals with complex health conditions.

Develop rapport, trust and ethical therapeutic relationships with patients and families.
Accurately elicit and synthesize information from, and the perspectives of, patients and families, Gather information about the patient’s beliefs, concerns and illness experience, including adjusting for impairments and disabilities.
Accurately convey needed information and provide explanations to patients and families in a way that is understandable and encourages discussion and participation in decision-making.
Develop a common understanding of issues, problems and plans with patients and families and provides and follows-up on a shared plan of care. Attempt to incorporate patient wishes even in situations of diminishing individual capacity.
Convey effective oral and written communication.

Participate effectively and appropriately in an interprofessional healthcare team.
Collaborate with community agencies (as required).
Collaborate effectively with other professionals.
Manage differences and resolve conflict between team members.
Effectively present verbal reports of clinical encounters and plans to all members of the healthcare team.

Make cost-effective use of health care resources based on sound judgement, balancing resources to maximize benefits to all patients.
Manage patient flow within a psychiatry team setting.
Contribute to the health care team; delegate and distribute tasks fairly.
Use time wisely within the health care team.
Demonstrate time management skills to reflect and balance priorities for patient care, sustainable practice, and personal life.

Respond to individual patient health needs and issues as part of patient care.
- Advocate for individual patient around relevant health matters.
- Implement health promotion and disease prevention policies and interventions for individual patients and the patient population served
Identify opportunities for advocacy, health promotion and disease prevention in the community served and responds appropriately.
Identify the determinants of health within their communities including barriers to accessing care and resources. Identify vulnerable or marginalized elderly populations and respond as needed.
Promote the health of individual patients, communities and populations. Describes approaches to implementing changes in determinants of health of the population served.

Maintain and enhances professional activities through ongoing self-directed learning based on reflective practice.
Critically evaluates medical information and its sources and its relevance to their practice, and applies this information to practice decisions. Recognizes situations where available evidence may not apply to frail older patients with dementia or mental illness.

Recognize and appropriately respond to ethical issues encountered in the care of elderly patients with mental illness and/or dementia.
Fulfill the regulatory and legal obligations required of current practice in the care of elderly patients with mental illness and/or dementia.
Demonstrate a commitment to physician health and sustainable practice.
Demonstrate a commitment to reflective practice
- gather information about personal performance, know one’s owns limits, and seek help appropriately
- demonstrate awareness of self and an understanding of how one’s attitudes and feeling impact their practice
- reflect on practice events, especially critical incidents, to deepen self-knowledge.