PSYU-XXXX - Forensic Psychiatry

PSYU-XXXX - Forensic Psychiatry

Elective Title: Forensic Psychiatry
Course Number: PSYU-XXXX
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: C-Form required, send to Miranda Stinecipher at . For S3s & 4s who have completed their general psychiatry clerkship
Responsible Faculty Director: Rocksheng Zhong, MD, MHS Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Jessica Prescott Other Faculty:
Location to Report on First Day:
Contact Dr. Zhong on first day for orientation and to receive reading materials

1. Students will understand the ways in which psychiatry can be applied to answer legal questions in administrative, civil, and criminal settings.
2. Students will develop an appreciation for the difference between treating clinicians and forensic evaluators.
3. Students will become familiar with subspecialty topics in forensic psychiatry, such as competence to stand trial, the insanity defense, and suicide and violence risk assessment.

1. Students will be able to conduct a thorough psychiatric interview and integrate their findings with collateral records to answer medicolegal questions.
2. Students will draft forensic psychiatric reports that present their findings, professional opinions, and rationales for those opinions.
3. Students will read and discuss case vignettes, judicial opinions, and academic journal articles relevant to psychiatry and law.
4. Students will conduct a 20-minute presentation about a topic of their choice in forensic psychiatry.

Description of course activities
Forensic psychiatry is the subspecialty of psychiatry that deals with the intersection of psychiatry and the law. Students will participate in forensic evaluations. Most commonly, these will be assessments of competence to stand trial. Other types of evaluations may include insanity and criminal responsibility, guardianship, testamentary capacity, suicide and violence risk assessment, fitness for duty, disability, malpractice, and other topics in forensic psychiatry. Students will initially observe and later lead interviews, obtain information from collateral sources, and review records and documents. They will integrate their findings to formulate forensic opinions. They will assist in drafting forensic reports summarizing their interviews, collateral sources, professional opinions, and rationales. They will complete readings taken from textbooks, journal articles, federal and state statutes, and case law. At the end of the rotation, they will prepare a 20-minute slide presentation about a topic of their choice in forensic psychiatry.

Type of students who would benefit from the course
This course is designed for students who are interested in the intersection of psychiatry and the law, as well as students interested in mental health systems, policy, and ethics. Students will have extensive opportunities to improve their skills in interviewing (especially people with serious mental illness), oral presentation, critical thinking, and writing. Note that this is intended to be a rigorous experience, and there is a significant reading and writing component consistent with the real-world practice of forensic psychiatry.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 9-12 (Obtaining collateral and report preparation) 12-5 (Obtaining collateral and report preparation)
Tuesday 9-12 (Obtaining collateral and report preparation) 12-5 (Obtaining collateral and report preparation)
Wednesday 9-12 (Assigned readings) 12-5 (Assigned readings)
Thursday 9-12 (Interviews) 12-5 (Interviews)
Friday 9-12 (Discussion of cases and readings) 12-5 (Discussion of cases and readings)

 Average number of patients seen per week: Approx 3 evaluations per week
 Call Schedule: N/A

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Interviews will occur one day per week and are conducted in courts, jails/prison, and law offices. Students will also receive extensive feedback and editorial comments on their written reports.
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty supervisor and residents/fellows on service
  B. Frequency / Duration of Presentation(s)?
    Once per week
  C. Format - What guidelines are set for the student's presentation?
    For cases: Standard psychiatric oral presentation with additional components specific to forensic psychiatry. For slide presentation: 20-min slide presentation at the end of the rotation on a topic in forensic psychiatry of the student's choosing.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Weekly forensic reports
  B. Format - What guidelines are set for the student's written work?
    A guide to writing forensic reports will be provided to students on the first day of the elective.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Related to cases
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Students should attend all interviews, complete oral presentations, draft forensic reports, and complete readings and discuss them in seminar or tutorial format. Students should be prepared to explain their thought processes and rationales and defend their medical opinions.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.