A Pilot Curriculum for Teaching Social Justice in Forensic Psychiatry Fellowships

Curriculum Development and Implementation

Knowledge of social justice concerns and their intersection with forensic psychiatry is imperative to competent and ethical practice.¹⁰ To ignore the impact of class, race, gender, sexuality, culture, and other aspects of identity on an individual’s behavior can lead a forensic psychiatrist or psychologist to erroneous conclusions about diagnosis, risk assessment, and criminal behavior.^19,20 Forensic evaluators who misapply cultural norms cross-culturally often distort key interpretations of behavior and motives, which can have disastrous effects.²¹ Relatedly, cultural knowledge is pivotal for evaluators to effectively navigate forensic interactions to maximize the information they receive, recognize nonverbal cues, and pace interviews appropriately.²² In addition, an understanding of the fraught historical relationship between minoritized communities and the criminal-legal system provides important context for forensic work.²³ It is essential that forensic evaluators who work in complex medical, legal, and carceral systems understand the historical ways that these systems have been shaped and appreciate how members of minoritized groups might behave within them.

After several years of debate, there was consensus within the authors’ fellowship program that additional focus on social justice was needed for forensic psychiatry training and practice. This conclusion was based on guidance from national professional organizations but also on the faculty’s anecdotal experience of having residents, fellowship applicants, and fellows more often asking questions like, “As a forensic psychiatrist, aren’t you lending your professional credibility to fundamentally unjust systems, thereby perpetuating inequities rather than ameliorating them?” In 2019, the forensic psychiatry fellowship program formed a working group composed of six faculty members, five psychiatrists, and one psychologist to develop a course that addressed disparities arising from multiple aspects of identity, including race, ethnicity, culture, gender, sexual orientation, ability, nationality, religion, age, and socioeconomic status.

Needs Assessment

As the working group considered forensic fellows’ needs in their internal review of trainee didactics, it became clear that fellows’ prior exposure to social justice concepts varied widely. For example, some fellows had been taught in medical school or residency that an individual’s race should not be mentioned during case presentations, whereas others believed this was a vital piece of information needed to provide context and understanding of an evaluee. Some fellows were quite knowledgeable about mass incarceration and outcome disparities in the criminal-legal system,²⁴ whereas others had little knowledge about these topics. Some trainees came to the fellowship with sophisticated knowledge of the impact of the school-to-prison pipeline,²⁵ whereas others had never heard of it. Faculty asked incoming fellows each year about their exposure to social justice concepts and their confidence applying this knowledge to forensic evaluations, finding significant variability among the experiences of the different cohorts. These disparities in foundational knowledge, confidence, and skill suggested that fellows could benefit from an enhanced emphasis on social justice topics during their year of subspecialty training.

The decision to create a new curriculum was also influenced by research showing that pairing learners with differing levels of knowledge (heterogeneous grouping) enhances learning²⁶ and social cohesion.²⁷ Social cohesion has repeatedly been found to be a significant factor in academic performance, with learners who have strong relationships with their peers and instructors engaging more actively and developing a deeper understanding of the subject matter.^28,29 Similarly, small-group learning creates opportunities for cooperative exploration, further bolstering learners’ confidence, communication skills, and desire to verbally engage with the material.³⁰ After reviewing this evidence, the working group concluded that a relatively small but heterogeneous group of forensic psychiatry fellows and faculty participating in the new course would be ideal to enhance fellows’ learning.

Another consideration was whether an entirely separate course was necessary or whether key social justice concepts could be incorporated into existing didactic seminars. The working group concluded that, although fellows were already taught about concepts like bias in violence risk assessment, there was not enough time or flexibility in existing curricula to do justice to such complex topics as racial disparities in criminal-legal outcomes, controversies regarding police practices, or the disparate experiences of forensic professionals based on race or gender. The faculty group did not want trainees to perceive social justice topics as last-minute additions to other forensic lectures, thereby diminishing their importance. Furthermore, the rotating attendance at most of the fellowship’s didactic seminars, including visiting medical students, residents, and other trainees, made it difficult to achieve the type of intimate group cohesion necessary to facilitate open dialogue about sensitive topics. Given the importance of the subject matter, the need for cohesion and psychological safety, and the gaps in the fellowship’s existing curriculum, the working group decided to create a stand-alone course.

Goals and Objectives

Although there are many models for integrating cultural competency and diversity training in medical school and residency,^31,–,34 there are fewer models at the fellowship level. One of the epistemological challenges is that there is no single model for “social justice education.” The term has different meanings in the public and medical education milieus. A review of the medical education literature indicated that, for some authors, “social justice” could mean developing clinical interventions and programs for marginalized populations; for others, it might involve participating in nonclinical advocacy for health-related social concerns.³⁵ Some researchers noted that social justice curricula focused on the social determinants of health as key drivers of outcomes in the populations they treat or evaluate, whereas other scholars called for a transformative curriculum with an orientation toward a critical reflection on power, privilege, and the inequities embedded in medical relationships, with a commitment to activist solutions.^35,36 In medical settings, most social justice topics are often presented as singular lectures, brief electives, or self-directed exploration.³⁷ Efforts to increase medical trainee exposure to social justice topics are ongoing,^38,39 with many psychiatrists urging the field to do more.⁴⁰

The intent of the Fostering Justice course was to create a forum for trainees and faculty that extended beyond theoretical debate of contemporary socio-political controversies; it was essential that the course be centered on forensic psychiatry and psychology practice. First, the faculty working group aimed to provide fellows with a space to grapple with some of the more challenging social justice aspects of forensic practice. Another objective was for fellows to acquire core knowledge about the social determinants of mental health and criminal-legal outcomes in forensic populations, which is vital to understanding the etiology, context, and motivation of behaviors.⁴¹ Third, fellows were to gain an understanding of the lived experiences of minoritized groups in forensic settings, which is vital to case conceptualization and respecting individuals’ dignity.^23,41 Finally, fellows were encouraged to identify and minimize sources of bias in their own practice, acknowledging that evaluator biases can significantly affect the outcome of forensic evaluations⁴² and that awareness of these biases reduces the impact.²⁰ Together, these four objectives formed a pathway to achieving the ultimate course goal of preparing fellows for lifelong engagement with social justice.

Selection of Educational Strategies

The working group chose to pursue a curricular commitment to critical self-reflection without prescribing any particular viewpoints or actions regarding social justice. Although it is impossible to be completely neutral and unbiased in the presentation and discussion of these topics,^43,44 faculty attempted to guide fellows through a balanced curriculum. They reviewed relevant literature, consulted with people with lived experience, and revised the curriculum extensively to identify and reduce areas of biases in selecting and teaching these topics. The group was especially mindful that fellows should review the subject matter and come to their own conclusions rather than adopting a one-sided ideology. Although some factual information that was presented left less room for interpretation (e.g., disproportionate minority confinement rates, policing prevalence in communities of color, results of research conducted on bias), other topics (e.g., standards of care for transgender adolescents, ethics of advocacy) led to more diversity of opinion. Faculty encouraged fellows to engage in a dialogue about these topics and to consider how they might incorporate these ideas into their practice of forensic psychiatry.

Initially, fellows expressed concern that their opinions and perspectives would alter how faculty perceived them. The concepts of cultural safety and power imbalances⁴⁴ were discussed extensively throughout the curriculum, but conversations at the beginning of each year were especially thorough. Every initial class of the course discussed these fears directly and agreed upon group norms. For example, faculty and fellows approached the course with cultural humility and explicitly described extending grace and respect if individuals disagreed or stumbled on their words. The group also discussed the importance of diverse viewpoints in the learning process and actively encouraged fellows to share their opinions, even if they deviated from those of their cofellows or faculty.

Faculty acknowledged that some forms of social justice structural action (e.g., protest marches, op-eds, legislative testimony) may carry special risks for forensic evaluators who are expected to remain objective when conducting evaluations and whose participation in such activities could be viewed by courts as evidence of bias. There remain robust conversations regarding the impact of advocacy on the work of forensic evaluators, with some stating that this will obscure objectivity and others maintaining that advocacy is critical to ethical forensic practice.^45,–,50 The goal of the Fostering Justice course was not to sway fellows’ opinions one way or the other; it was to raise fellows’ awareness about social justice concerns while allowing them to choose how best to address these matters in their own careers.

Class length was set at 90 minutes to allow for a combination of interactive presentations, reflection, and discussion. An initial schedule of twice-monthly classes, for a total of 12 sessions, was created. The course began in September of the fellowship year rather than in July to allow fellows time to adjust to the training program and develop trust and rapport with one another and faculty before discussing sensitive topics. Although other learners (e.g., visiting residents, rotating medical students) are often included in fellowship didactics, participation in the Fostering Justice course was initially limited to fellows and core faculty. Fellows’ attendance was mandatory, and faculty were encouraged to attend regularly to create a sense of group cohesion. Over time, as discussions of social justice became more routine in medical education, the need for a closed group of participants lessened and residents and medical students were invited to attend the course during their forensic rotations.

The course’s introductory session reviewed relevant concepts in forensic psychiatry ethics, such as Griffith’s²³ view of ethics centered on cultural formulation of the evaluee, as opposed to Appelbaum’s⁵¹ earlier ideas that truth-telling and justice are foundational to forensic evaluations. Griffith’s cultural formulation advice followed Diamond’s⁵² exhortation of forensic psychiatrists not to discard their role as physicians in the evaluation of psychiatrically ill evaluees, and subsequent scholars shifted their attention to the discrimination against nondominant groups inherent in the U.S. justice system, advancing theories to mitigate bias in forensic work.^42,53,–,55 Norko⁵⁶ proposed compassion as a moral foundation for forensic ethics, Candilis and Martinez⁵⁷ conceived of a robust professionalism that protects vulnerable persons and vulnerable community values, and Buchanan⁵⁸ emphasized respect for human dignity and self-worth of evaluees. All these scholars highlighted the injustices embedded in the criminal-legal system while also acknowledging concerns that advocacy could have negative consequences for forensic psychiatrists. By placing these ideas at the beginning of the Fostering Justice course, instructors encouraged fellows to consider the history and ethics of forensic psychiatry as a foundation for subsequent social justice topics.

Following the introductory session, the course proceeded in three sections, as outlined in Table 1. The curriculum began by broadly reviewing the impact of identity on policing, sentencing, and incarceration. The next section discussed the impact of bias on evaluations, risk assessment, and experience. For sessions focused on explicit and implicit bias, fellows were given resources to explore their own biases before class and were invited to share their experiences of this process during class, if they so desired. For example, facilitators encouraged trainees to access the Harvard Implicit Association Test, a test initially designed to measure automatic and unconscious beliefs about racial differences, which has expanded to include modules including skin-tone, religion, gender, politics, and weight, among others.⁵⁹ Fellows were also encouraged to read and complete privilege checklists regarding disability, socioeconomic status, race, gender, and sexuality prior to class.⁶⁰ Consistent with models regarding forensic evaluators and the impact of certain beliefs about biases,⁶¹ the facilitator provided psychoeducation on heuristics and their role in the development of bias and stereotypes to help dispel common myths among forensic mental health professionals. Faculty also reviewed the impact of the social psychology phenomenon of halo and horn effect on interactions and interpretations of behavior⁶² and led fellows through discussions about how these might affect the way they view evaluees. (The halo and horn effect is a form of cognitive bias in which an observer is unduly influenced by an attribute of another and generalizes that attribute to unrelated areas, for example, believing that someone who is physically attractive is bright and capable, despite the lack of correlation between those characteristics.) The facilitator also discussed affinity bias and encouraged fellows to reflect on how this affects their professional practice.⁶³ Another faculty member led a class on the impact of bias on standardized risk assessment, specifically addressing how different types of bias can affect clinical, actuarial, and structured professional judgment approaches to risk assessment.^64,–,66

The concluding section of the course covered a rotating set of topics, identified by fellows’ interests, and relied heavily on lived experience. Fellows were invited to suggest topics about which they wanted further education; most selected topics aligned with their identities or lived experience. For example, women consistently requested classes about navigating forensic evaluations and testimony as a woman, and individuals who identified as queer requested classes about treatment of lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual (LGBTQIA) people in forensic settings. Fellows were each invited to facilitate one of these special population sessions. The fellow-led sessions were well received by the fellows and faculty alike. The fellow facilitators often stated that leading the seminar helped them to expand their knowledge and enhance their conceptualization of forensic cases.

The series also invited presenters from other disciplines, members of the surrounding community, and people with both academic knowledge and lived experiences. For example, one class contemplated the impact of evaluator disability and disability in general in forensic settings. Another session explored testimony challenges, including microaggressions, interpersonal challenges, and the projection of expertise in the courtroom, as experienced by forensic professionals from minoritized groups. One invited presenter facilitated a class that explored the impact of personal identity on forensic evaluations, reflecting that shared identity and culture between evaluator and evaluee can influence the evaluator’s interpretation of behavior.⁶⁷ Another presenter discussed the implementation of a faith community-based early intervention program for adolescents at risk of criminal-legal involvement, highlighting the important role that faith groups can play in helping young people form an identity and cohesive community away from criminal activity.

Adaptation to Remote Learning

The initial stages of the Fostering Justice course occurred during the COVID-19 pandemic, and many of the classes were taught via Zoom during this period. Fellows and faculty both felt the impact of remote learning on the course experience. One benefit was the ability of numerous faculty members to attend the classes regularly, thereby contributing to a richer discussion than otherwise might have been possible. Similarly, faculty were able to secure a wider array of presenters than would have been available in person.

The primary drawback of Zoom was the difficulty in creating group cohesion. Significant effort was needed to nurture a feeling of safety and inclusion between the faculty and fellows. One practice suggested by the fellows during the first class was that they would all keep their cameras on throughout the class, as they believed this would foster group cohesion, inclusion, and respect. Similar to strategies used by other educators during the pandemic,⁶⁸ the faculty requested that fellows mute their microphones unless they were speaking and encouraged them to “raise their hand” via the online platform to ask questions or type their questions into the chat log. Faculty identified a facilitator among the working group for each class, and that facilitator was responsible for monitoring the chat log, relaying questions, and ensuring that there was room for questions and discussion.

Initially, it was difficult to elicit unguarded responses in the online learning environment, where it was difficult to “read the room” and interpret participants’ social cues. Another significant barrier to creating a safe and intimate environment in the inaugural year was that faculty had limited opportunities to meet the fellows in person prior to the start of this curriculum. The relationship between the teacher and learner is pivotal to creating an environment in which learners feel safe to engage with complex material,⁶⁹ but this was not possible because of the pandemic. Although faculty met with fellows via Zoom prior to the implementation of this course, it was evident from the feedback that year that in-person interactions were significantly preferred.

When class was conducted in person in subsequent years, faculty perceived a noticeable shift in fellows’ engagement. Fellows participated more often and offered their thoughts more readily. Additionally, faculty described feeling more comfortable teaching the subject matter, as they were better able to gauge the reactions of fellows in person, felt that they knew the fellows better prior to embarking on this course, and had a year of experience teaching the material. Numerous conversations occurred in the hallways, both before and after class, in which fellows and faculty continued to reflect on the content of the classes, something that had not happened during online learning. Fellows who were in training during the pandemic year specifically said that they missed this type of informal interaction with their peers and faculty, noting that significant learning happens in these unguarded and unscripted moments.

Curriculum Evaluation

When the course was originally designed in 2019, the working group discussed how to evaluate fellows’ overall learning, but there were no valid, reliable, and objective measures that assessed social justice learning at that time. In 2024, Banas and Gershon⁷⁰ proposed such an instrument, measuring course participants’ self-assessment of their social justice knowledge and attitudes. Fortunately, the fellowship program had been soliciting trainees’ feedback about the Fostering Justice course throughout its implementation, touching upon many of the areas identified by Banas and Gershon, such as fellows’ comfort level in discussing their identity, knowledge of social disparities, and ability to identify sources of bias. Faculty initially solicited weekly oral feedback regarding the structure and content of the course, and trainees were encouraged to e-mail faculty or leave written feedback in their mailboxes if they did not feel comfortable discussing their thoughts in person. Additionally, fellows were given an opportunity to provide anonymous written feedback via the fellowship’s MedHub course review forms and were asked to give their opinions during an oral, year-end review of the course that included both fellows and faculty. Faculty highlighted their appreciation for candid feedback, and fellows expressed gratitude that their feedback, whatever the content, was consistently requested, appreciated, and implemented.

In addition to ongoing fellow feedback, the faculty working group sought other opportunities to assess the impact of the curriculum on trainee learning. Faculty evaluated the fellows’ ability to integrate concepts learned in Fostering Justice into their forensic case presentations (e.g., discussing social factors that might have influenced an evaluee’s alleged criminal conduct, discussing an evaluee’s identity in relationship to their own). In other courses, such as a lecture series on carceral psychiatry, fellows engaged in cross-curricular training to enhance understanding,⁷¹ discussing racial disparities in the prison population, including those in solitary confinement and on death row. Faculty also monitored quarterly written evaluations of fellows by their individual supervisors, which contained prompts to assess the trainees’ knowledge, compassion, and cultural competence.

Lessons Learned

Although the core Fostering Justice curriculum was created by faculty, the course was shaped through formal and informal collaboration with fellows (a total of 25 trainees over the five years of the course). Overall, the fellows enjoyed the experiential activities associated with the class (e.g., case-based learning, mixed media learning), appreciated faculty vulnerability, and felt they learned from hearing about faculty struggles, both personally and professionally. Fellows also described the perception that their input was valued in the development of the curriculum, as they were consistently encouraged to share their opinions and suggestions.

Fellows reported that they struggled in classes where conversations were less structured, describing uncertainty regarding what they should contribute to the discussions. This prompted the faculty to ensure that sessions were more structured and well facilitated to enhance fellow participation. Additionally, when a class was led by someone other than a forensic psychiatrist or psychologist, fellows sometimes wanted the material to be more clinically relevant (e.g., addressing how disparate policing practices apply to their evaluations and treatment). In these cases, faculty prepared lecturers beforehand and intervened during the class to help fellows understand how the information was relevant to their daily practice (e.g., the importance of considering an evaluee’s personal experiences and cultural viewpoint on police when assessing their competence to stand trial).

The importance of faculty members modeling a candid, forthright approach to class discussion cannot be overstated. Researchers have repeatedly found that candidness is imperative for facilitating successful discussions about social justice topics in university settings,⁷² and Fostering Justice was no exception. During the first year of the course, faculty concerns about trainee sensitivities led to overly cautious presentations at times, but the trainees’ feedback helped empower bolder faculty approaches in subsequent years. Strategies derived from Derald Wing Sue’s seminal works on facilitating difficult conversations in small groups were pivotal for structuring the class discussions.^73,74 Faculty explored deeper meanings of topics, ensured that conversations were not sidetracked, modeled vulnerability by discussing their own identities and biases, and thanked fellows for voicing their opinions, whatever those opinions were. Faculty paid special attention to controlling the process, but not the content, of class discussions to ensure that everyone’s voice was respected and that the conversations were not derailed by discomfort in the room.

Of course, such painstaking attention paid to the course by the faculty took significant time and energy. Although it is difficult to quantify the hours devoted to this process, the first year of implementation was certainly more time-intensive than the rest of the course. As is common when building new curricula, faculty initially spent much more time discussing the potential structure of the class, meeting with fellows to elicit feedback, and strategizing about how to implement the feedback. Faculty met for approximately 15 hours to plan the course prior to implementation, and for the first year, each faculty member devoted approximately one additional hour to the course for each hour spent in the class. As Fostering Justice progressed, the course became more streamlined, and less time was needed to ensure that the classes were successful.

Inviting a diverse group of presenters was also essential to the learning experience. It was important to the working group to ensure that presenters were not solely academic scholars with research knowledge of the subject matter and that they were drawn from various disciplines to diversify the viewpoints of presenters. Faculty intentionally selected both scholars and local community members with lived experience of the subject matter, as the impact of lived experience on medical education is crucial for increasing compassion, knowledge, and a person-centered approach to care.⁷⁵ Occasionally, presenters possessed both scholarly knowledge and lived experience; when this happened, those presenters were prioritized over those with only scholarly knowledge.

Finally, flexibility in the curriculum sequencing to meet the fellows’ interests was crucial to a successful course. The implementation of the class concurrently with national conversations on social justice in 2020 was fortuitous, as there were many current events to apply to each session. Although the course had a general structure, there was enough flexibility to allow discussion of important social topics when they arose, such as the resumption of federal executions⁷⁶ or the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization.⁷⁷ Even as the cultural landscape regarding DEI concerns shifted dramatically in subsequent years, conversations continued to explore contemporary trends and led to rich and productive discussions.

Future Directions and Conclusions

Although the Fostering Justice curriculum was well received by the fellows, the instructors identified areas for improvement in subsequent years and worked to address those areas. For example, some guests with lived experience noted the emotional labor and time requirements that such presentations extracted, leading the fellowship program to create an appropriate budget for speakers from the community. Another area for pedagogical refinement involved better tailoring guest speakers’ presentations to forensic psychiatry practice.

Our experience developing and implementing a social justice course for forensic psychiatry fellows in 2020, a time of great upheaval and interest in social justice, posed many theoretical and logistical challenges. In 2025, the curriculum faced new barriers in a political climate that demanded the exclusion of diversity programming from university education, but the subject matter remained just as relevant. Operating the Fostering Justice course in such disparate social contexts has called for cultural humility and an open and educable style that encourages contributions by all participants, including those who might believe that social justice education and advocacy have no place in forensic psychiatry. By taking this nonprescriptive approach, the course has been well received by the trainees and faculty, gradually becoming an expected and valued part of professional training in forensic psychiatry.

It is important to note that, although the Fostering Justice curriculum has been effective within its fellowship program, we offer the course’s framework only as a starting point for other fellowships to develop their own social justice courses. The intention is not to be prescriptive about how programs approach the implementation of this material; the curriculum is flexible and iterative, allowing for local nuance and context. The primary goal of encouraging trainees in forensic psychiatry to examine their relationship with social justice concepts can be accomplished in many ways, and fellowship programs are encouraged to chart their own paths.

Future work in this area aims to refine the course content and format based on additional years of experience and trainee feedback. Fellows have consistently stated and demonstrated that the curriculum enhanced their understanding of core social justice concepts in forensic psychiatry, but the recent development of structured assessment tools for social justice education⁶⁹ allows greater opportunity to demonstrate the curriculum’s efficacy. Faculty plan to utilize validated measures in the upcoming academic year to gather further data about areas of growth and areas of success. Future directions also include assessing whether this knowledge is retained and utilized when the fellows graduate and transition into independent practice.