Community support programs are becoming a major priority in community mental health centers throughout the country. The authors present a training design that integrates principles and skills associated with this model into a 4-year residency training program. The aim of such programs is to keep young psychiatrists involved and in the forefront of the newer approaches to the treatment of chronically mentally ill persons.

Training psychiatrists to work with community support systems for chronically mentally ill persons.

Objective: The Accreditation Council on Graduate Medical Education (ACGME) requires that general psychiatry residency training programs provide trainees with exposure to forensic psychiatry. Limited information is available on how to develop a core curriculum in forensic psychiatry for general psychiatry residents and few articles have been published on the topic. Methods: The objective of this article is to provide an overview of forensic psychiatry topics likely to be of benefit to general psychiatry residents. Results: The article is intended to be a springboard for future development of forensic curricula suitable for residents rather than a blueprint for an educational program. Conclusion: Although most general psychiatry residents will not specialize in forensic psychiatry, a working knowledge of basic concepts in forensic psychiatry should be considered an important component of general psychiatry education.

Teaching Forensic Psychiatry to General Psychiatry Residents

The authors review four approaches chairmen of departments of psychiatry have used to attempt to ensure quality resident education in CMHCs they do not control. Several examples are presented of administrative problems that may develop in this type of relationship. Based on this material and the authors' experience, a four stage administrative process is presented which emphasizes clear identification of goals and objectives, negotiation of a relationship that is beneficial to both the department and the CMHC, development of a written contract, and careful monitoring and evaluation of its progress. Designing a relationship in this fashion offers maximum opportunity for programmatic success.

The CMHC as a setting for residency education.

As an official subspecialty of psychiatry, forensic psychiatry residency training must meet the requirements established by the Accreditation Council of Graduate Medical Education. Attendant to these requirements is the expectation that graduates demonstrate core competencies in general areas common to all medical training programs but delineated for each specialty. In forensic psychiatry, trainees must learn to move from the role of healer to objective evaluator on behalf of third parties, a task that differs from general medical care and treatment. Thus, it is important for educators to maintain awareness of the experience of trainees as they adapt to forensic psychiatry, while understanding core competency requirements. This article outlines stages of development of forensic psychiatry fellows as a model for characterizing learning objectives and for supervising trainees in forensic psychiatry fellowship programs. These stages of development include (1) transformation, (2) growth of confidence and adaptation, and (3) identification and realization. Training directors and trainees can utilize this theoretical framework as a basis on which to establish parameters for core competency attainment and supervisory and assessment methods for forensic psychiatry training.

http://jaapl.org/content/jaapl/33/3/317.full.pdf

Forensic psychiatry fellowship training: developmental stages as an educational framework.

The task of evaluating psychiatric disability poses several ethics-related and practical challenges for psychiatrists, especially when they are responding to a request from a third party for a disability evaluation on their own patient. This study sought to evaluate the differences in how forensic and nonforensic psychiatrists approach and view evaluations for Social Security disability benefits. Thirty-two forensic and 75 nonforensic psychiatrists were surveyed on their practice patterns and perceptions of role, objectivity, and dual agency in the disability evaluation process. Significant differences were found between forensic and nonforensic psychiatrists' perceptions of the dual-agency conflict, beliefs about who should perform evaluations, and beliefs about the weight given to different opinions when decisions of whether to award disability benefits are made. A minority of respondents in both groups reported having identified a patient as disabled, despite believing otherwise. The implications of these findings are discussed.

http://jaapl.org/content/jaapl/39/2/183.full.pdf

Evaluating psychiatric disability: differences by forensic expertise

Community psychiatry is an essential requirement of approved residency training. The authors present a format of required educational objectives for this experience. They feel that recent attempts to limit psychiatric consultation to the consultation-liaison model are restrictive and incomplete. In their view of the psychiatrist's role, community consultation techniques are essential skills for the psychiatric practitioner.

Required educational objectives in community psychiatry.

The authors describe the development of a curriculum in forensic psychiatry in a general psychiatric residency training program. Educational objectives for both knowledge and skills are presented. The authors detail training experiences at each level of psychiatric residency, including electives available for fourth-year residents. They encourage other training programs to share similar reports with a view toward the development of standards in the training of residents in forensic psychiatry.

Kinzie Jd

Papers

Required educational objectives in community psychiatry.

Residency curriculum in forensic psychiatry.