Training In Forensic Psychiatry Research Articles

La formation des professionnels en psychiatrie légale : résultats d’une enquête en Occitanie

ObjectivesSince the enactment of the French law of 4 March 2002, patients’ rights have been the subject of constant legislative evolution and particular attention from many independent administrative authorities. In psychiatry, these have led to numerous legal reforms over the years. Moreover, psychiatry is a medical specialty with abundant, long-standing and more than ever topical interactions with the judicial system (psychiatric care without consent, isolation and restraint, court-ordered care, psychiatric care in prisons, treatment of perpetrators of sexual violence, judicial expertise or the question of lack of criminal responsibility due to a mental disorder). In response to the many legal questions asked by medical and paramedical teams, and to the growing interest in research in forensic psychiatry, a unit called EPL (Espace de Psychiatrie Légale) was created, composed of a multidisciplinary team, based in the department of Haute-Garonne, France. In order to adjust its scope of intervention, a questionnaire was distributed to mental health professionals to assess their training needs in forensic psychiatry. In this article, we aim to present and discuss the results of this survey. MethodsWe used a self-assessment survey designed by the multidisciplinary team of the EPL and which was filled out online by the respondents. The target population was all the professionals working in mental health facilities, members of the FERREPSY Occitanie research federation. The questionnaire consisted of several sections relating to the respondents, the typology of patients under their care, the professionals’ daily practice, and training in and knowledge of forensic psychiatry. We included some open-ended questions on the situations encountered that may have presented difficulties and on the impact of legislative changes on the daily practice of professionals. All responses were analyzed anonymously. ResultsFrom 05/05/21 to 17/07/21, 155 professionals responded. Most of them were psychiatrists (32.3%), healthcare managers (20.6%) or nurses (18.7%). The majority were women (78.7%) and had been working in Haute-Garonne for more than 5 years (74.2%). 56.1% of the professionals worked in outpatient units, 37.4% in inpatient wards and 74.8% in adult psychiatry. This questionnaire revealed a strong need for training in forensic psychiatry. Indeed, 94.8% of respondents wanted to receive training in forensic psychiatry, which contrasts with the number of people who had already received training in this area (15.5% in initial training, 32.3% in continuing education). The results highlighted that the most common forensic situations encountered in daily clinical practice concerned areas where professionals considered their knowledge to be insufficient. In addition, the self-assessment scales used were able to highlight specific training topics that should be developed. ConclusionsThe results of this survey therefore establish a basis for making adjustments to future educational interventions involving forensic psychiatry, which, although it has only recently emerged in France, embraces issues that have always concerned the management of patients receiving psychiatric care.

VReedom: training for authorized leave of absence through virtual reality - a feasibility study.

This study assessed the feasibility, implementation process and outcomes of the VReedom training; a virtual reality (VR)-based intervention designed to prepare forensic psychiatric patients for their first authorized leave. Clinical forensic mental healthcare organization Inforsa, operating at security level 3, introduced the VReedom training for forensic patients eligible for their first authorized leave, between March 1st and November 13th, 2022. Employing a retrospective observational cohort study design with patient dossier data as the primary source, the study also used participant observation, weekly evaluative questionnaires and focus group discussions as data sources. Five objectives were utilized to evaluate the feasibility: recruitment capacity and resulting sample characteristics, data collection and evaluation procedures, acceptability and suitability of the training and protocol, training management and implementation, and preliminary participant results. Despite the lack of a control group, findings align with literature suggesting VR's potential for enhancing treatment motivation and reducing stress in preparation for first authorized leave. Of 13 patients approached, 10 participated without dropouts, and no incidents occurred during training. Emotion elicitation was successful, supporting VR Exposure therapy's efficacy. Findings align with literature, emphasizing VR's value in forensic psychiatry. Establishing favorable implementation conditions was crucial, with positive reception from treatment providers. Also, the need for personalization and additional locations was identified, and the training seemed most suitable for patients with a tbs-measure. Future research with control groups is recommended to further validate the effectiveness of the VReedom training intervention, and further protocol development is necessary to make it suitable for a broader population. Current findings contribute to the refinement and expansion of evidence-based practices in the field of VR-assisted training and treatment in forensic psychiatry.

How could forensic psychiatry be made more attractive?

Decrease in the number of forensic psychiatric experts recently reached a critical level. Shortage of forensic experts caused difficulties in the health care as well as in the justice system. Surveying of how the field of forensic psychiatry and the forensic psychiatric expert work can be made more attractive. We performed an online survey among forensic psychiatric experts and specialists in psychiatry. We complied a questionnaire that beside demographic data contained questions in 4 areas. The first 2 areas of the questionnaire - simplifying the forensic psychiatry training (10 items), decreasing the cost of the forensic psychiatry training (5 items) - consisted of simple tatements. Responders had to indicate on a 10-point Likert scale their level of agreement. In the last 2 areas, participants were asked to describe in unstructured format whether they see any circumstance that makes forensic psychiatry attractive or unattractive. The questionnaire was sent out in electronic form to the forensic psychiatric experts on the mailing list of the Hungarian Forensic Expert Chamber, and all specialists in psychiatry on the mailing list of the Hungarian Medical Chamber. Altogether 171 persons filled in the questionnaire with a mean age of 57.26 ± 11.57 years. There were 122 (71.3%) females among the participants. The following proposals received the highest ratings from the forensic psychiatric experts as well as from the specialists in psychiatry: increasing the number of the training institutes; decreasing the costs of the training; making the Hungarian Forensic Expert Chamber course free of charge; and introducing a stipend to cover the costs of the training. Results of the survey indicate that active forensic psychiatric experts and specialists in psychiatry representing a potential professional resource, concur that forensic psychiatry training can be made more attractive mainly with increasing the number of training institutes and decreasing the total costs of the training which is compiled from different constituents. Due to the critical lack of necessary professionals, urgent action is needed to make forensic psychiatry more popular and the forensic psychiatry qualification easier to obtain. Orv Hetil. 2023; 164(35): 1373-1380.

Neurodevelopmental Disorders, Criminality, and Criminal Responsibility.

Although individuals with neurodevelopmental disorders (ND), such as intellectual disability (ID) and autism, are overrepresented in the criminal justice system, most psychiatry training is limited regarding NDs, and forensic psychiatry training tends to focus on psychotic and mood disorders. This article explores the complex interactions between NDs and criminality, including direct etiological explanations and potential mediating variables (e.g., trauma), to address common training gaps. We compare and contrast current laws relevant to assessing NDs in criminal responsibility evaluations. Not guilty by reason of insanity (NGRI) criteria vary by jurisdiction, with some specifying ID as one possible insanity defense prerequisite while most jurisdictions are nonspecific. NDs in the absence of psychosis or mania often involve impaired cognition (e.g., comprehension, reasoning, social cognition) and behavioral dysregulation. This article provides potential scenarios by which those with NDs might be competent to stand trial but qualify for one or more NGRI prongs. Suggestions for assessment methods (including for malingering) are addressed for this unique population.

Forensic psychiatry in Pakistan: Where next following the Supreme Court judgement

IntroductionNo statutory mental health services exist for justice-involved individuals in Pakistan. The lack of expertise in forensic psychiatry serves to deny individuals with mental illness the critical support needed for mental healthcare and adequate court dispositions with serious unintended consequences including capital punishment for those who could otherwise be deemed treatment and not punishment worthy. A landmark judgement by the Supreme Court of Pakistan in February 2021 criticized the lack of forensic psychiatry expertise in Pakistan and directing the development of forensic mental health services and forensic psychiatry training in Pakistan.ObjectivesThe key objectives are: 1. Understanding the timeline of how justice invloved individuals are manged by psychiatric services 2. The importance of the Supreme Court of Pakistan Judgement in affecting change 3. Highlights on how Queen’s University will enhance forensic psychiatry in PakistanMethodsA literature review and personal networking facilitated the collection of important data in how justice invloved individuals are supported in Pakistan. The author has published and presented to Pakistani psychiatrists and the Pakistani judiciary on this topic. Queen’s University is aiming to implement a 3-year plan to develop an online curriculum and certificate course to help train the trainers.ResultsIn the Pakistan’s most populous province, Punjab, prevalence rates for psychotic illnesses (3.7%), major depression (10%), and personality disorders (65%) among men with higher rates for psychotic disorders (4.0%) and major depression (12%) among women.ConclusionsIn conclusion there is a dire need to develop forensic psychiatry in Pakistan and other low/middle income countries.DisclosureNo significant relationships.

Perspectives on Excited Delirium and Ketamine

Perspectives on Excited Delirium and Ketamine

Message from the President.

Dear Members and Fellows of the Indian Psychiatric Society, Greetings to you from the Desk of the President! Indian Psychiatric Society has for many years been at the helm of publishing Clinical Practice Guidelines (CPG) in many important clinical disorders. This year sees another outstanding contribution from our CPG Committee on Forensic Psychiatry led by Prof. Shiv Gautam (Chairperson, CPG Committee), Prof. Jhanavi Kedare (Co-Chairperson, CPG Committee), Prof. Sandeep Grover (EC Coordinator, CPG Committee), and Dr. Siddharth Sarkar (Convener, CPG Committee). I am indebted to the team for their tremendous contribution and dedication. I extend my deepest gratitude to Prof. Ajit Avasthi for his selfless contribution to this Committee in the past and to Prof. O. P. Singh for his excellent leadership as the Editor of the Indian Journal of Psychiatry in bringing out the Supplement with the CPG. American Board of Forensic Psychiatry and the American Academy of Psychiatry and Law define Forensic Psychiatry as “a subspecialty of psychiatry in which scientific and clinical expertise is applied to legal issues in legal context, embracing civil, criminal, correctional, or legislative matters.” Forensic psychiatry is comparatively a new upcoming and developing field in India and should be practiced in accordance with guidelines and ethical principles enunciated by the profession of Psychiatry. The World Health Organization and the International Guiding Principles for Mental Health Care mandate that all human rights, including the right to privacy, informed consent, confidentiality, freedom from cruel and unusual treatment, and nondiscrimination, should be guaranteed through mental health legislation. It is important to remember the history of Forensic Psychiatry to fully appreciate why we need to immensely focus on this specialty. Law relating to custody of lunatics and management of their estates was introduced in India through three separate Acts: (1) the Lunacy (Supreme Court) Act, 1858 relating to judicial inquisition as to lunacy in presidency towns, (2) the Lunacy (District Courts) Act, 1858 relating to proceedings outside presidency towns, and (3) the Lunatic Asylum Act, 1858 relating to confinement of lunatics in asylums. The English Acts of 1853 after frequent amendments were replaced by the Lunacy Act, 1890 and amended by the Lunacy Act, 1891. The Indian Lunacy Bill, 1911 was enacted within 1 year as the Indian Lunacy Act, 1912 (Act IV of 1912), and much later, we had the Mental Health Act of 1987 and The Mental Health Care Act, 2017. Not all practicing Psychiatrists and Postgraduates (PGs) in Psychiatry have adequate practical knowledge of Forensic Psychiatry. Most private and government medical college psychiatry units do not have much exposure to Forensic Psychiatry, except a few. Hence, teaching and training in Forensic Psychiatry are not adequate for Psychiatry PGs throughout the country. Many practicing psychiatrists, especially youngsters, find it difficult to handle cases related to psychiatry and law. Today’s psychiatry is involved in very, many spheres of our day-to-day life and not only restricted to criminology. I am very confident that the CPG in Forensic Medicine will provide us with the necessary guidelines to provide our patients with evidence-based treatment while at the same time being sensitive and compassionate toward their issues. I congratulate and thank all members for their sterling contribution and request all members of our society to refer to the guidelines in their clinical practice. With best wishes to all!

Ethics and Law.

Ethics and Law.

Reflections on Psychiatric Training

Back to table of contents Next article EditorialFull AccessReflections on Psychiatric TrainingMatthew L. Edwards, M.D.Matthew L. EdwardsSearch for more papers by this author, M.D.Published Online:11 Jun 2021https://doi.org/10.1176/appi.ajp-rj.2021.160401AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail One morning during medical school, I eagerly approached my senior resident during rounds on the medicine wards. Dressed in a short white coat, clipboard in hand, and with lapels flanked by a penlight on the left side and Snellen card on the right, I began to describe a patient with chronic pain who believed that the medical equipment used to manage her pain was sending signals. Even as our adjustments to her regimen yielded some improvement in her presenting condition, I could not stop contemplating the impact of the patient's mental disorder on her pain.Now, closing my final year of general psychiatry training, embarking on specialty training in forensic psychiatry, and marking the end of my tenure as Editor-in-Chief of the Residents' Journal (RJ), I am still committed to better understanding the extent to which mental health affects our lived experiences. Charged with curating a journal of perspectives ranging from arts and culture to psychopharmacology, from medical history to interventional psychiatry, and from medical ethics to psychotherapy, I have relied on this curiosity to help shape a journal with perspectives as diverse as the people who contribute to and support it.As I reflect on the past 3 years of professional training, I recognize the steady pulse that the RJ has provided in the background of my own professional life. The RJ's authors are reflective, patient-centered trainees, continually exploring how our field can better treat people with mental suffering. Our editors are respectful and engaging thought leaders in their fields, sharpening the articles and podcasts published each quarter while elevating the authors' voices throughout our pages.We continue to benefit from the RJ's growth over the years. The journal now boasts a growing geographic reach, aided in part by a widening social media footprint. Its timely articles and podcasts, produced by psychiatrists-in-training around the country, are carefully shaped and molded by a thoughtful editorial board. I thank our media editors, Drs. Barrington Hwang, Priya Gearin, and Bharat Sampathi, for managing and showcasing the breadth and depth of our media initiatives. Our social media and podcasts are as vital to the RJ and its readership as are our published articles.Although the members of the editorial board come from varied backgrounds, stages of training, and perspectives, we are united by a desire to cultivate this resident-led, academic journal dedicated to elevating the voices of trainees and future leaders in psychiatry. I am especially grateful to the following deputy and associate editors who have contributed to the RJ: Drs. Rachel Dillinger, Fiona Fonseca, Shirin Vartak, Danielle Lowe, Matthew Yung, Colin Wendt, Christopher Magoon, Amanda Calhoun, Jennifer Kim, Shixie Jiang, and Richard Hadi. They were supported by dedicated ad hoc reviewers Drs. Brent Schnipke, Julian Raffoul, and Amanda Mihalik-Wenger. Even amidst a deadly global pandemic that claimed the lives of millions around the world, redeployed trainees to the far reaches of medical services, and separated many from friends and family, these physicians-in-training continued to support our mission to foster a space for learners to share their ideas and perspectives, triumphs and failures, and hopes for the future of psychiatry.I am proud to announce that my colleague Dr. Austin Blum is the RJ's new Editor-in-Chief. A skilled writer, lawyer, and future forensic psychiatrist, Dr. Blum will continue the tradition of compassion, humility, and service to the RJ—values that my predecessors, Drs. Shapir Rosenberg and Oliver Glass, instilled in me.Dr. Edwards is Chief Resident in Psychiatry, Stanford University School of Medicine, Stanford, Calif., and Editor-in-Chief, American Journal of Psychiatry Residents' Journal (2020–2021). FiguresReferencesCited byDetailsCited ByNone Volume 16Issue 4 June 11, 2021Pages 2-2 PDF download History Published online 11 June 2021 Published in print 11 June 2021

Toward a New Model of Training in Canadian Forensic Psychiatry.

The Royal College of Physicians and Surgeons of Canada has recently introduced a new model of training for residents and fellows in all specialties and subspecialties, including forensic psychiatry. This model, Competence by Design, is intended to improve the training of residents with the goal of increasing the competence of practicing specialists. In the Competence by Design model, training is broken down into four distinct phases. Residents prompt their supervisor proactively when they are ready to be assessed on a specific task, and the feedback is specific and corrective. A resident's performance of each designated task is reviewed by a competency committee, which decides when the trainee is ready to move on to the next phase. In this article, we review some of the problems with the current model of training and explore how this new model will improve upon this training. We anticipate that this model will prove effective at improving training in forensic psychiatry.

Jonas R. Rappeport, forensic psychiatry pioneer, dies

Jonas R. Rappeport, M.D., founder and first president of the American Academy of Psychiatry and the Law and a pioneer in forensic psychiatry, died Sept. 8 at the age of 95, the National Association of State Mental Health Program Directors Weekly Update reported Sept. 11. Rappeport, a psychiatrist and former chief medical officer for the Circuit Court for Baltimore City, was integral to the development of forensic psychiatry in the United States, serving as the first court psychiatrist in Baltimore County before becoming the first medical officer for the Baltimore City Circuit Court. He was a consultant in the cases of the attempted assassinations of presidential candidate George Wallace and Presidents Gerald Ford and Ronald Reagan. He ran a forensic psychiatry training program and taught at the University of Maryland Medical School and the Johns Hopkins School of Medicine.

The role of client empathy in treatment outcome in a sample of adolescents referred to forensic youth psychiatric services

Starting from the assumption that empathy is crucial in the therapeutic process, the current study explored whether client empathy before treatment relates to treatment outcome, whether client empathy is subject to change in the first six months of treatment, whether such change relates to treatment outcome and whether therapist factors relate to possible changes in client empathy. In total 90 adolescents treated by 31 therapists at forensic psychiatric services participated in the study. Client empathy was assessed with self-report questionnaires of affective and cognitive empathy at intake and again at six months of treatment. Therapeutic change was rated by their therapist. Client empathy before treatment was not systematically related to treatment outcome. Cognitive empathy tended to improve during treatment, stronger in girls than boys, and depending in part on the therapist’s gender: Under conditions of a male (not female) therapist boys reported less improvement in cognitive empathy than girls. The most consistent study result was that improvement in cognitive empathy contributed positively to treatment outcome. The study provides new data on the role of client empathy in the treatment of forensic youth psychiatric patients. If replicated, these findings have important implications for treatment and training in juvenile forensic psychiatry.

Forensic mental health service implications of COVID-19 infection in Nigeria

Forensic mental health services are fledgling in most African countries including Nigeria. The current formulation of such services in Nigeria is correctional psychiatry in addition to some hospital-based services. The COVID-19 pandemic presents significant challenges to the already fragile state of forensic mental health services within the country. Its impact includes limitation of access to and continuity of mental healthcare in prison as well as reduction in referrals from other services within the criminal justice system such as the police and the courts. Further tapering of previously less prominent aspects of forensic mental health service in the country such as the preparation of psychiatric court reports has also been observed. Forensic psychiatry training and research have equally been hampered by the pandemic. The lessons learnt from these challenges should offer practitioners and policy makers insight into strategic developmental objectives for the post-COVID era within services and training programmes.

Examining the Past and Advocating for the Future of Forensic Psychiatry Training.

The American Academy of Psychiatry and the Law (AAPL) has been devoted to the teaching of forensic psychiatry, and as AAPL celebrates its 50th Anniversary, it seems fitting to examine the history and the current status of forensic psychiatry teaching in general psychiatry residencies and forensic psychiatry fellowships. After a brief review of the history of AAPL and forensic psychiatry training, this article explores the current state of graduate medical education (GME) in the United States, the growing popularity of psychiatry as a specialty and forensic psychiatry as a subspecialty, the Accreditation Council for Graduate Medical Education's requirements for forensic training, and the methods currently used to teach forensic psychiatry to general psychiatry residents. This article also examines the current status of forensic psychiatry fellowship training in the United States. Finally, future challenges to forensic training in both residencies and fellowships will be discussed, as well as the need for AAPL and others in the profession to advocate for increased forensic teaching in a manner that leads to the production of both general and forensic psychiatrists who are competent to practice independently and who are sufficient in number to meet the growing demands for forensic expertise.

Enhancing forensic exposures in residency training

PurposeThe purpose of this paper is to review the impact of a new, brief forensic rotation for general psychiatry residents on the variety of residents’ forensic exposures.Design/methodology/approachThe authors surveyed residents who trained before and after the implementation of the new rotation to assess the impact of the rotation on the residents’ forensic experiences during training across a variety of domains.FindingsEven in a highly clinical forensic setting, residents participating in the required rotation reported significantly greater variety of forensic experiences than those who had not completed the required rotation, including types of settings and assessments, Rotation completers 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/valueThis study demonstrates that a brief, mandatory forensic clinical rotation may increase residents’ exposure 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 having these forensic experiences and that even time-limited forensic rotations can enhance the breadth of residents’ forensic exposures. Further, the rotation achieved these outcomes without using typical forensic sites but instead highly clinical sites, which may be particularly encouraging to residency programs 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 residents’ training in clinical forensic psychiatry.

International Journal of Risk and Recovery, beginning of an exciting journey

Sébastien Prat is an Assistant Professor at McMaster University and a Staff Psychiatrist at St. Joseph’s Healthcare Hamilton. His medical training and residency in Psychiatry took place at the University François Rabelais of Tours in France. He underwent a subspecialty training in Forensic Psychiatry at McMaster University. He is the Executive Editor of the International Journal of Risk and Recovery.

What does impartiality mean in medico-legal psychiatry? An international survey

Medico-legal psychiatry is the field of forensic psychiatry that consists of reporting to criminal, civil and administrative authorities and testifying in courts of law. As a forensic science, medico-legal psychiatry is based on the principle of impartiality. However, the notion of impartiality is not clearly defined and can be understood in many different ways. The purpose of this study was to explore the meaning that expert psychiatrists attribute to this notion. Members of the forensic sections of the World Psychiatric Association, the European Psychiatric Association and the American Academy of Psychiatry and the Law were surveyed by e-mail using a vignette and a questionnaire. One hundred and thirty-one responses were received. When commenting on the case presented in the vignette, a large majority of respondents considered that the personal moral convictions of the doctor were the main factor likely to cast doubt on the impartiality of the expert, followed by past personal experience and the fact that the expert was the treating doctor of the examinee. In the answers to the questionnaire, 54% of participants considered that the question of impartiality was similar in both the inquisitorial and adversarial systems. Impartiality was considered by most participants as both an ethical and a legal concept. The main factors considered as likely to affect the impartiality of an expert were past personal experience, personal beliefs and perceptions, and the fact that the expert was the treating doctor of the examinee. Training in forensic psychiatry and past professional experience were considered to be the most important factors that could enhance the impartiality of an expert. When asked about their own definition, 70% of respondents defined impartiality as a choice specific to the expert, and 27% of participants defined impartiality as a result of external factors. The term ‘objectivity’ was used in 30% of responses. Results revealed a rather unified view of the issue of impartiality by medico-legal psychiatrists, irrespective of their country and practice conditions. The notions of honesty and striving for objectivity, which are emphasized in several guidelines of forensic psychiatry associations, were cited by many participants. Impartiality appears to be considered as a coherent concept in both normative and consequentialist ethics and represents a useful reference in the practice of medico-legal psychiatry.

Creating a State-Academic Partnership to Advance a Forensic Teaching Service: Benefits and Barriers.

In Washington State, like many states, there is a shortage of forensically trained mental health clinicians to work with criminal justice-involved individuals. At the direction of the state legislature, a collaborative project was undertaken by the University of Washington, the state Department of Social and Health Services, and a state psychiatric hospital to develop a proposal for a jointly sponsored forensic teaching service. The authors reviewed the literature, surveyed and interviewed forensic psychiatry and psychology training directors, and conducted site visits of selected training programs that offer multidisciplinary training or have affiliations with state hospitals. The authors conducted focus groups of additional stakeholders, including clinicians and patients in forensic settings, to better understand the needs in Washington. The authors report on several common benefits and barriers to establishing forensic teaching services. Other states and forensic programs may find this article useful in identifying common considerations for forensic mental health teaching services.

Legislative Advocacy and Forensic Psychiatry Training.

Very few residency and fellowship programs offer mandatory or elective rotations in health advocacy. Where there are formal training opportunities, they are commonly didactic or clinical community rotations, where trainees participate in a clinically oriented project with a local community organization. Fewer programs offer specific training opportunities in legislative advocacy and the legislative process. The University of Washington assembled two task forces to advise the general psychiatry residency program on training needs in the areas of (1) Forensic Psychiatry and (2) Advocacy and Public Policy. Both task forces identified, as an aspirational goal, resident involvement in legislative and regulatory processes as means of advocacy. This article describes a model curriculum in legislation developed at the University of Washington that is suitable for trainees at different stages in their professional development (including residents and fellows), and an explanation of how the curriculum supports training in forensic psychiatry. Challenges in creating the elective training opportunity are also discussed.

The Benefits of Required Forensic Clinical Experiences in Residency.

The growth of forensic psychiatry has spurred efforts to improve forensic psychiatry training in general psychiatry residency. The Accreditation Council for Graduate Medical Education requires that residencies provide an experience that "exposes" residents to forensic issues, but leaves the specifics to individual programs. However, there is growing need for psychiatrists to understand the unique circumstances of individuals with mental illness involved in the criminal justice system. The authors developed a new mandatory forensic rotation for general psychiatry residents and conducted a pilot study to assess its impact on residents' interest and comfort working with criminal justice-involved patients, interest in forensic fellowship, and knowledge of available resources for consultation and supervision. Rotation completion was associated with a significantly increased interest in working with forensic populations and pursuing forensic fellowship, but no changes in residents' level of comfort or knowledge of supervisory and consultative resources. This study adds to the growing body of literature describing the benefits of expanding forensic education for residents.