Enhancing forensic exposures in residency training

DOIhttps://doi.org/10.1108/JMHTEP-04-2019-0021
Date03 December 2019
Pages13-19
Published date03 December 2019
AuthorTobias Wasser,Saksham Chandra,Katherine Michaelsen
Subject MatterHealth & social care,Mental health,Mental health education
Enhancing forensic exposures in
residency training
Tobias Wasser, Saksham Chandra and Katherine Michaelsen
Abstract
Purpose The purpose of this paper is to review the impact of a new, brief forensic rotation for general
psychiatry residents on the variety of residentsforensic exposures.
Design/methodology/approach The authors surveyed residents who trained before and after the
implementation of the new rotation to assess the impact of the rotation on the residentsforensic experiences
during training across a variety of domains.
Findings Even in a highly clinical forensic setting, res idents participating in the requi red rotation reported
significantly greater variety of forensic experiences than those who had not completed the required
rotation, including ty pes of settings and assessments, Rotation comple ters reported greater exposure to
various types of settings and assessments, and courtroom-related experiences, as well as the overall
number of forensic exposures. The two groups did not differ in their forensic exposures in general
psychiatry settings, civil-forensic evaluations or diverse forensic populations. Secondary analyses showed
that increased exposure to court-based experiences and multiple forensic settings was associated with
forensic fellowship interest.
Originality/value This study demonstrates that a brief, mandatory forensic clinical rotation may
increase residentsexposure to forensic settings, assessments and courtroom-related experiences and
that increased exposure to courtroom-based experiences in particular may increase interest in
forensic fellowship. While not surprising, the results demonstrate that residents were not otherwise havin g
these forensic experiences and that even time-limited forensic rotations can enhance the breadth of
residentsforensic exposures. F urther, the rotati on achieved these out comes without using ty pical
forensic sites but instead highly clinical sites, which may be particularly encouraging to residency pr ograms
without ready access to classic forensic rotation sites. This study contributes to the small but
expanding body of the literature describing the value of increasing psychiatry residentstr aining in clinical
forensic psychiatry.
Keywords Mental health education, Forensic psychiatry, Psychiatry residency education
Paper type Research paper
In the USA,board certificationin psychiatryrequires completion of four years of psychiatry residency
training. The training is regulated by the Accreditation Council for Graduate Medical Education
(ACGME).Training programsmust provide at least fourmonths of internal medicine, two monthsof
neurology, as well as training in a variety of psychiatry settings and specialty fields, including
inpatient, outpatient and emergency settings and addiction, child/adolescent, consult-liaison,
forensic and geriatric psychiatry specialties (ACGME, 2017).
The ACGME requires that all general psychiatry residency training programs provide an
educational experience in forensic psychiatry that includes evaluating patientspotential to harm
themselves or others, appropriateness for commitment, decisional capacity, disability and
competency (ACGME,2017). However, the ACGME does not specifyfurther requirements for this
forensic experience, such as setting, scope,duration or year in training. This contrastsgreatly with
other areas of psychiatry such as inpatient, outpatient, addiction and geriatric psychiatry, which
have clear requirements regarding the setting and duration of residentsexposure.
As a result of this ambiguous requirement for residentsforensic experiences, residency
programs have taken diverse approaches to forensic training. A 1995 survey of psychiatry
residency training directors found that 82 percent of programs offered forensic rotations, but only
Received 10 April 2019
Revised 27 August 2019
Accepted 25 October 2019
Tobias Wasser is based at the
Department of Psychiatry,
Yale School of Medicine,
New Haven, Connecticut, USA.
Saksham Chandra is Private
Practice Statistician based in
Providence, RI, USA.
Katherine Michaelsen is based
at the Department of Psychiatry
and Behavioral Sciences,
University of Washington
School of Medicine, Seattle,
WA, USA and VA Puget Sound
Health Care System, Seattle,
WA, USA.
DOI 10.1108/JMHTEP-04-2019-0021 VOL. 15 NO. 1 2020, pp.13-19, © Emerald Publishing Limited, ISSN 1755-6228
j
THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
j
PAGE13

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