Elective Rotations: Traumatic Stress Disorders

Elective Rotation: Traumatic Stress Disorders


Location

Operational Trauma and Stress Support Centre, Canadian Forces Health Services Centre (Ottawa)


Brief Description of Rotation

This non-resident dependent rotation will provide opportunities to develop skills in the comprehensive assessment and treatment of patients with traumatic stress disorders, including posttraumatic stress disorder with significant co-morbidity. The resident will function as part of a multidisciplinary team working with Canadian Forces members reporting significant operational trauma. They will become familiar with pre- and post-deployment screening, psychometric assessment tools (eg. Mississippi, CAPS, DES), conducting family assessments and assessing disability and work restrictions.

A three-stage approach of treatment intervention will be taught:

  1. Safety and stabilization phase
  2. Remembering and grieving phase
  3. Re-integration phase

As well, the teaching of evidence-based approaches to treatment such as Cognitive Behaviour Therapy, Emotionally-Focused Therapy, EMDR, Hypnosis/Mindfulness and psychopharmacology will also occur. There will be opportunities to work with other populations with traumatic stress disorders, including offenders at the Trauma Disorders Program of the Secure Treatment Unit in Brockville or through case-supervision of other non-military patients.


Supervision

Principal Supervisor: Colin Cameron, MDCM and FRCPC

Additional Supervisors:

  • Alexandra Heber, MD, FRCPC
  • J.R. Trudel, MD, FRCPC
  • Robin Hardagon, PhD, CPsych
  • Sylvie Bourgeois, PhD, CPsych

Description of Supervision

Supervision will include observing patient assessments/ therapy sessions done by clinic staff and similarly being observed conducting assessments/sessions. Additionally, the resident will attend weekly intake meetings and case conferences with the OTSSC team. There will one hour per week of formal 1:1 supervision where there will opportunities to discuss cases or particular subjects related to the rotation objectives.


Objectives

  • To be able to conduct a comprehensive assessment for patients reporting significant trauma, including significant co-morbidity/safety concerns, and being able to reliably apply DSM-IV-TR diagnostic criteria.
  • To be able to use and interpret formal psychometric assessment tools relevant to the assessment of traumatic stress disorders (eg. Mississippi, CAPS, DES).
  • To be able to conduct a family assessment and provide psychoeducation to significant others for patients with significant traumatic stress disorders.
  • To be familiar with the pre- and post-deployment screens used with CF members.
  • To be able to write detailed reports on patients assessed, with view of providing treatment recommendations and recommendations around disability, work restrictions/accommodations or plans for re-integration back to work.
  • To be able to prescribe with a systematic, evidence-based psychopharmacological approach to patients with traumatic stress disorders.
  • To be able to systematically use a three-stage treatment model and evidence-based psychotherapy for traumatic stress disorders (eg. CBT, EFT, EMDR).

Expectations and Opportunities

Clinical

For the first one to two weeks, the resident will sit in as an observer for several assessments with new patients being conducted by various members of the OTSSC multidisciplinary team (there will also be ongoing opportunities throughout the rotation to sit in as an observer with clinic staff in assessment and follow-up sessions). Subsequently, they will be expected to conduct at least 2 new assessments per week for the balance of the rotation. There will be opportunities to have senior clinic staff sit-in and observe some of these assessments in order to provide supervision and constructive feedback.

The resident will be expected to write a detailed report with recommendations for their assessments. Additionally, the resident will be expected to participate in the OTSSC intake assessment rounds and case conference held each Tuesday. The resident will also be expected to assume responsibility for the follow-up outpatient treatment of at least 8 patients through the course of the rotation, including at least two in formal psychotherapy. The resident may have opportunities to visit CF bases to observe pre- and post-deployment screens or conduct assessments. They may also observe or participate in the OTTSC group and family program. There will also be opportunities to observe or work with other traumatic stress patient populations, including with offenders in the Trauma Disorders Program at the secure treatment unit in Brockville, or through psychotherapy supervision with non-military patients.

Teaching

The resident will be expected to provide clinic patients and their families with basic psychoeducation around traumatic stress disorders. There may also be opportunities to participate in the psychoeducation component of OTTSC group and family programs. Additionally, there may be opportunities for psychoeducation outreach to NDHQ and CF bases, including in conjunction with the Operational Stress Injury Social Support teams. The resident will also be encouraged to participate in the OTSSC staff intramural teaching and journal club. As a member of the OTSSC team, the resident will be able to attend the annual Trauma and Dissociation Conferences put on jointly by the Ottawa Anxiety and Trauma Clinic and the OTSSC.

Research

There may occasionally be opportunities to participate in research being conducted by OTSSC staff. Research interests of clinic staff include clinical drug trials, psychotherapy trials, phenomenology, neuroimaging studies of PTSD, discriminating feigned traumatic stress disorders from genuine illness, predicting vulnerability to PTSD, and predicting treatment outcomes.

Work Structure

Regular clinic hours are 8:00am to 4:00pm Monday through Friday. Residents would not be expected to come in Wednesdays so as to be able to attend their Academic Day. Also, residents would not be expected to attend the clinic when they are post-call. Intake rounds are 8:30-9:00am Tuesday and the OTSSC case conferences are 2:00-3:30pm that same day.


General Information

Residency Level: PGY-3 to PGY-5 Residents (must be able to obtain an enhanced reliability security clearance)

Rotation Length: Three to Twelve Months

Number of Residents: One

Suitable for Half-Time: Possible, but not ideal (need to discuss prior to acceptance)

RCPSC Core Rotation: No

For More Information, Please Contact:

Debbie Hall, Postgraduate Coordinator
The Ottawa Hospital (General Campus), 501 Smyth Road, Ottawa, ON, K1H 8L6
Phone: 613-737-8955
Email: dehall@toh.ca


All visiting elective residents must comply with the University of Ottawa policies and timelines.

More Information on Visiting Electives