Department of Supportive Care

Overview

Eligibility Requirements:
Family Medicine/Enhanced Skills Match:

• Trainees currently enrolled in a CFPC accredited program, who hold a postgraduate education certificate of registration or equivalent in their province are eligible for the Match. N.B.: Those enrolled in a PGY3 Enhanced Skills Program at the time of application are NOT eligible to apply to another PGY3 Enhanced Skills position.
  • Off-cycle applicants: PGY2 residents with completion dates between July 1 and December 31 are also eligible but must declare their completion date on the application form and request a late start. You may only apply to the match one time. While some programs are able to admit residents' off-cycle, others are not. Off-cycle applicants will remain eligible to apply to the following year's match recognizing that they may have obtained an independent practice license in the interim period.
• Residents currently enrolled in ACGME accredited Family Medicine residency programs in the U.S. who are Canadian citizens or Permanent Residents may apply to the PGY3 FM Palliative Care Match if they meet the CFPC requirements outlined on the College of Family Physicians of Canada website.

Please see the Enhanced Skills Program: Academic Palliative Care 12 Month Program website for further details and restrictions.

Duration:
12 Months (52 weeks), Full-Time.

Funding Requirements:
Funded by the Ministry of Health. Please visit Enhanced Skills Program Admissions website for more details.

Clinical Components:
The Academic Palliative Care Enhanced Skills (12 Month Program) at the University of Toronto is accredited by the College of Family Physicians of Canada (CFPC). The overall goals of the program are:

• To provide physicians with added competency in the area of palliative care and prepare them to provide primary and consultant palliative care services
• To provide training for physicians who intend to pursue academic careers in palliative care

Research Components:
Not applicable.

Education/Teaching Components:
The program has a strong academic component centered around protected half-day sessions on Thursday mornings. This includes weekly seminars on key topics, journal clubs, and complex case rounds. Trainees are responsible for presenting at one journal club and one complex case round during the year. In addition, we have a day-long communication workshop, and monthly national webinars on core topics. Residents are required to complete a scholarly project, which may have a research, education, or quality improvement focus. Finally, there is a longitudinal resident wellness curriculum.

Various education activities and rounds are offered:

• Department of Supportive Care Grand Rounds
• Pain & Symptom Management Rounds

Website:

• Enhanced Skills Program: Academic Palliative Care 12 Month Program

Overview

Eligibility Requirements:
Please visit Physical Medicine & Rehabilitation Division website for details.

Duration:
1 month.

Funding Requirements:
Not applicable.

Clinical Components:
Candidate will be provided with comprehensive exposure to cancer impairments and rehabilitation management, exercise and lifestyle interventions in the cancer population.

Research Components:
Not applicable.

Education/Teaching Components:
Not applicable.

Website:

• Physical Medicine & Rehabilitation Website
  

Overview

Eligibility Requirements:
Residents.

Duration:
4 weeks.

Funding Requirements:
Not applicable.

Clinical Components:
Combined clinical rotation between geriatric medicine inpatient consults and geriatric oncology outpatient clinics.

Research Components:​
Not applicable.

Education/Teaching Components:
Daily/Weekly rounds, monthly journal clubs (geriatric medicine, geriatric oncology), teaching​ seminars.

Overview

Eligibility Requirements:
MA and PhD Graduate Students with previous experience in direct patient clinical contact (preference for applicants to have worked with oncology patients).

Duration:
Sept 15th to August 15th (11 months).

Funding Requirements:
Funding provided.

Clinical Components:

• Population: adult survivors of childhood cancer
• Clinical Assessments: psychosocial functioning; distress screening
• Clinical Intervention: individual psychotherapy

Combined with:

• Population: urologic cancers: prostate, testicular, kidney, bladder cancer patients
• Clinical Assessments: health psychological assessment
• Clinical Intervention: individual psychotherapy; couple therapy; sex therapy

Research Components:​

• Impact of late effects of cancer and cancer treatment on psychosocial development
• Transition from pediatric to adult health care
• Quality of life

Combined with:

• Health-related quality of life and survivorship in cancer patients

Education/Teaching Components:
Residents are additionally provided the opportunity to gain supervisory experience via supervision to interns.

Website:

• Toronto Area Residency Consortium (TARC) in School, Clinical, Counselling & Health Psychology

Overview

Eligibility Requirements:
Any learner registered in a Canadian UGME training program. For non-Canadian electives, please contact education coordinator.

Duration:
We usually ask that residents apply for the duration of an entire academic block.

Funding Requirements:
Not applicable.

Clinical Components:
Combination of clinics, inpatient consults and palliative care unit placements, with medical students usually being placed on the consult service.

Research Components:​
Not applicable.

Education/Teaching Components:
Learners will be able to participate in our core palliative care teaching sessions, which cover a breadth of different topics. There will also be journal club presentations that learners can participate in.

Various education activities and rounds are offered:

• Department of Supportive Care Grand Rounds
• Pain & Symptom Management Rounds

Overview

Eligibility Requirements:​
Any learner registered in a Canadian UGME training program. For non-Canadian electives, please contact education coordinator.

Duration:
4-week rotation on the inpatient palliative care consult service.

Funding Requirements:
Not applicable.

Clinical Components:

• The palliative care team works alongside primary teams in the hospital to provide expert symptom management, palliative planning, navigation of goals of care, and end of life management to those with serious illness.
• The program serves patients and families living with a diversity of advanced illnesses, encompassing both malignant and non-malignant diagnoses. Recognized worldwide, the Toronto General Hospital provides care to a multitude of medical and surgical patient populations, including highly subspecialized populations such as multi-organ transplants, and complex cardiovascular and pulmonary diseases. We are affiliated with Princess Margaret Cancer Centre, one of the largest cancer centres in the world, and thus also collaborate to care for patients receiving quaternary cancer care.

Research Components:​
Not applicable.

Education/Teaching Components:

• Once/ week - Tuesday afternoons through Temmy Latner
• Communication teaching - no specified date/time

Various education activities and rounds are offered:

• Department of Supportive Care Grand Rounds
• Pain & Symptom Management Rounds

Overview

Eligibility Requirements:​
Any learner registered in a Canadian UGME training program. For non-Canadian electives, please contact education coordinator, Norine Mark.

Duration:
The Toronto Western Hospital (TWH) Palliative Care Clinical Rotation is 4 weeks in length.

Funding Requirements:
Not applicable.

Clinical Components:
We provide care primarily through our inpatient consultation service, as well as our outpatient Supportive Care Memory Clinic.

Our multidisciplinary team includes Physicians, a Clinical Nurse Specialist, a Social Worker, and a Spiritual Care Specialist. We serve patients and their families living with both malignant and non-malignant (non-cancer) serious illness.

The movement disorder, neurodegenerative, and neurosurgical care programs at Toronto Western Hospital and the Krembil Brain Institute are world renowned, and our rotation offers exceptional access to collaborate and care for patients in these programs.

65% of our referrals are for patients with non-cancer illnesses allowing us to offer unique, practical teaching and opportunities to build serious illness communication skills around variable illness trajectories and prognostic uncertainty.

Our team can be asked to provide consultation for any inpatient with a serious or life-limiting illness where there is need to support:

• Pain or other symptoms
• End-of-life care (e.g., a dying patient)
• Advance Care Planning
• Goals of Care
• Arranging home/clinic palliative care supports
• Screening for and applying to a Palliative Care Unit/Hospice

Research Components:
Not applicable.

Education/Teaching Components:
Our team strives to provide you with a tailored, high yield educational experience. During orientation we help learners build 2-3 specific learning goals for their rotation. Beyond this, formal educational opportunities include:

• Tuesday afternoon half day seminars through the Temmy Latner Centre for Palliative Care. Topics include:
  • Pain and Dyspnea
  • Communication Skills
  • GI Symptoms
  • Psychosocial issues, Mood, Fatigue, and Delirium
• Access and protected time to complete two high yield, 20 minute e-modules which outline how to navigate a goals of care discussion using:
  • An evidence based structured conversation guide
  • Specific, easy to remember strategies on how to navigate strong emotion from patients and families
• 20 minute one-on-one simulation based teaching with a staff MD to practice above e-module skills
• Opportunity for observed encounters where learners practice managing symptoms, and leading foundational serious illness conversations

Additional educational activities:

• Daily multidisciplinary morning rounds
• Department of Supportive Care Grand Rounds
• Pain & Symptom Management Rounds

Overview

Eligibility Requirements:​
PGY1-PGY5 Elective.

Duration:
Single or multi-month PLEX rotation.

Funding Requirements:
Not applicable.

Clinical Components:
Residents will be working with both inpatients and outpatients, providing care to adult cancer patients and their family members. During your rotation you will learn about the psychiatric and psychosocial aspects of cancer along the disease trajectory (at times of diagnosis, during active treatment, recurrence, completion of treatment, survivorship, and palliation and end of life care) and have opportunities to observe and perform psychiatric assessments of cancer patients with supervisors, aiding in further development of diagnostic, formulation and management skills.

Additionally, you will have the opportunity, dependent on your clinical volumes and availability, to join other clinics and work with other disciplines within our department (e.g. Half Day Adult and Young Adult AYA Palliative Psychosocial Clinic, Medically Assistance in Dying MAID Assessments, Caregiver Clinic, Music and Art Therapy, AYA Group, Managing Cancer and Living Meaningfully CALM Assessments, Existential Group Psychotherapy, and clinical, research and educational experiences focused on LGBTQ2S and cancer).

These opportunities can be discussed in more detail with your primary supervisor. You may also have an opportunity to participate in an 8-week Mindfulness Based Cognitive Therapy (MBCT) and/or learn how to provide short-term psychotherapy CALM (3-6 sessions) for advanced cancer patients with supervision.

Additional Learning Opportunities in Psychosocial Oncology:

• Adolescent and Young Adult (AYA) Clinic: Join virtual OTN/MS Teams including psychiatrist and palliative care MD Mondays 9am-1pm and Tuesdays 1:30-5pm
• Music and Art Therapy: Join virtual patient visits with Music and Art therapists
• Introduction to Managing Cancer and Living Meaningfully (CALM) Psychotherapy: Clinical teaching about CALM, join weekly CALM supervision group for introduction
• Weekly Inter-professional LGBTQ2S and Cancer Clinical Experience: Friday mornings

Research Components:​
There are multiple research streams within psychosocial oncology for trainees to participate in given sufficient time and advance planning with a supervisor.

*A sepa​​rate Psychosocial Oncology & Palliative Care senior selective in research opportunity also exists within the Department. The resident will take part in the research program in the psychiatric and psychosocial aspects of cancer and of end-of-life care as part of a multidisciplinary team. They may choose to develop their own project or assume primary responsibility for a portion of an ongoing project. They will learn research methodology from literature review through to project completion.

Education/Teaching Components:
Opportunities also exist to participate in teaching and supervision of junior trainees.

Various education activities and rounds are offered:

• Department of Supportive Care Grand Rounds
• PSO Clinical Case Conference
• Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC) Seminar

Website:

• PLEX - Personalized Learning Experience

Overview

Eligibility Requirements:​​
PGY5 – senior selective.

Duration:
Not applicable.

Funding Requirements:
Not applicable.

Clinical Components:
This elective rotation based at the Princess Margaret Hospital will provide an in-depth experience in psychotherapy in the context of cancer. With an emphasis on modern relational and attachment theory, trainees will acquire clinical skills and theoretical knowledge related to the psychological and existential challenges of cancer and incurable disease. They will receive didactic education and participate in case-based, seminar-based and ongoing psychotherapy supervision. Residents will also be trained and supervised in a brief manualized supportive-expressive intervention, Managing Cancer and Living Meaningfully (CALM). This intervention, which fulfills residency training requirements for an experience in brief dynamic therapy, addresses the disturbances in self-experience, relatedness and in the sense of meaning that arise in the context of impending mortality. Overall, this senior selective rotation offers a unique opportunity for personal and professional growth in a setting which emphasizes attention to the subjective experience of patients and the support of staff engaged in psychological care.

Research Components:​
*Dr. Rodin also offers a Research Senior Selective Psychotherapy Program in Cancer.

Education/Teaching Components:
Opportunities also exist to participate in teaching and supervision of junior trainees.

Various education activities and rounds are offered:

• Department of Supportive Care Grand Rounds
• PSO Clinical Case Conference
• Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC) Seminar

Website:

• PLEX - Personalized Learning Experience

Overview

Eligibility Requirements:​​
Please refer to Canadian Resident Matching Service (CaRMS) for details.

Duration:
PGY4 - 12 months, PGY5 - 12 months.

Funding Requirements:
Not applicable.

Website:

• Palliative Medicine

Overview

Eligibility Requirements:​​
PGY1-5.

Duration:
1, 2, 3, 4 months.

Funding Requirements:
Not applicable.

Clinical Components:
The Sexual and Gender Diversity in Cancer Care Program (SGDc) provides support and navigation to SGDc patients and chosen families. SGDc patients face unique challenges across the cancer care continuum Our program works towards addressing these barriers, improving the cancer experience and ultimately improving cancer care outcomes for the SGDc community. Opportunities will be provided for direct patient care and psychosocial support as well as well as to assist with various project work such as our needs assessment. The needs assessment will survey patients, caregivers, staff and PM administrators to explore needs, gaps in care and input into program development.

Specifically, SGDc PLEX trainees learn to:

• Perform a comprehensive assessment of gender, sex and relationship diversity (GSRD) in the context of cancer care and how intersectional identities need to be formulated in the context of access to care, risk of discrimination and interventions to prevent disengagement from treatment
• Assess and co-manage anxiety, depression, delirium and other common problems oncology patients experience in psychiatric consultation including minority stress and microaggressions
• Assess and co-manage emotional components of distressing symptoms such as pain, nausea, dyspnea and insomnia
• Identify, assess and work therapeutically with patients who are fearful, uncertain or struggling with dependency, loss of control, identity and/or chosen family issues and other psychosocial issues associated with life-threatening illness
• Apply pharmacologic principles to the treatment of seriously ill patients needing psychotropic and/or analgesic or other palliative medications. Choose non-pharmacologic therapies appropriate to the patients needs, using a psychodynamic and existential understanding of the patient's personality style, values, relationships and other resources
• Work effectively with an interdisciplinary team of oncology and palliative care professionals (representing medicine, anesthesia, psychiatry, pharmacy, nursing, social work and chaplaincy) in the emotional care of sexual and gender diverse patients and their (chosen) families
• Articulate ethical principles involved in choices regarding end of life care, such as designation of DNR, DNI, the use of proxies and living wills, withdrawal of treatment and assisted suicide
• Understand hospice services and refer appropriately to community hospice providers
• Identify needs and provide psychosocial support to chosen family members dealing with life-threatening illness
• Describe the bereavement process and implement appropriate interventions to support chosen families in bereavement

Clinical Components:

• Trainees have the opportunity to observe and perform comprehensive interprofessional SGDc assessments with supervisors to aid in developing diagnostic and formulation skills. Trainees receive ongoing clinical supervision as they learn about the psychiatric and psychosocial aspects of cancer for patients and families at diagnosis, during active treatment, in the event of reoccurrence, after completing treatment, through survivorship and during palliation and end-of-life-care
• Opportunity, dependent on your clinical volumes and availability, to join other clinics and work with other disciplines within our department (e.g. Half Day Adolescent and Young Adult (AYA) Palliative Psychosocial Clinic, Medical Assistance in Dying MAID Assessments, Caregiver Clinic, Music and Art Therapy, AYA Group, Managing Cancer and Living Meaningfully CALM Assessments, Existential Group Psychotherapy and clinical and educational experiences focused on Sexual and Gender Diversity in Cancer Care)
• Consultation and treatment of scheduled outpatients
• Multidisciplinary meetings of clinical staff and families regarding patients

Research Components:​
Not applicable.

Education/Teaching Components:
Various education activities and rounds are offered:

• Department of Supportive Care Grand Rounds
• PSO Clinical Case Conference
• Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC) Seminar

Website:

• PLEX - Personalized Learning Experience