Table 1.

Core Forensic Psychiatry Competencies in General Psychiatry

Clinical Rotation or ExperienceForensic Training TopicsDidactic LearningExperiential LearningGeneral Psychiatry Milestone
Postgraduate Year 1
    Inpatient PsychiatryIntroduction to forensic psychiatryPrinciples and practice of psychiatryApplying basic principles of consent, capacity and commitment
Suicide risk assessmentSuicide risk tools, suicide risk management and documentationInpatient supervision of care of suicidal patients, level of precautions, disposition planPC3, MK2
Violence risk assessmentViolence risk tools, violence risk management and documentation, evaluation of psychopathyInpatient supervision of care of violent patients, level of precautions, disposition planPC3, MK2
Civil commitmentVoluntary and involuntary commitment, outpatient commitmentCivil commitment court filings and proceedings, opportunity to testify
LiabilityMalpractice and other forms of liabilityStandard of care; documentation in medical recordSBP1
Postgraduate Year 2
    Emergency PsychiatryMalingeringHow to detect malingeringAssessment and documentation of suspected malingeringICS2
Suicide risk assessmentSuicide risk tools, suicide risk management and documentationEmergency care of suicidal patients, disposition planPC3, MK2, ICS2
Violence risk assessmentViolence risk tools, violence risk management and documentationEmergency care of violent patients, disposition planPC3, MK2, ICS2
    Psychosomatic MedicineCapacityMedical decision makingClinical evaluation of medical capacityMK6, SBP4, PROF1
Informed consentCompetency, consent and substituted decision makingObtaining informed consent for medical proceduresMK6, SBP4, PROF1
Substituted decision makingCompetency, consent and substituted decision makingIssues of medical guardianship, medical power of attorney, advance directivesSBP4, PROF1
End of life careWithdrawal or refusal of care, advance directives, POLST/MOLST laws, death determinationsPsychiatric consultation of palliative care patientsSBP4
Right to and right to refuse treatmentRefusing medical treatment in competent patientsAdvance directives, medical power of attorneySBP4
Postgraduate Year 3
    Outpatient PsychiatryLiabilityMalpractice and other forms of liabilityEstablishing and terminating care; standard of carePROF2
Forensic referral & consultationWhen to consult a forensic expertreferrals for forensic evaluationsMK6
Patient privacy regulations, HIPAAConfidentiality and privilegeLimits of confidentiality in clinical treatment; release of information; collateral informantsMK6
DisabilityDisability evaluationsClinical evaluation of disability applications
Duty to warn, duty to protectTarasoff lawsRisk assessment
    Outpatient Child and Adolescent PsychiatryConsent and medical guardianshipMature minor, assent/dissent in adolescent healthcareClinical treatment of child and adolescent patients
Child abuseChild abuse reporting lawsMaking a child abuse report
Consent and medical guardianshipCompetency, consent and substituted decision makingClinical treatment of geriatric patients, elder abuse
    Addiction PsychiatryDrug laws and regulationsDecriminalization of addictionTreatment of addiction patientsMK2
    Forensic EvaluationCriminal responsibilityIntroduction to forensic psychiatry, M'NaghtenEvaluation of criminal responsibility of criminal defendantsSPB4
    Treatment of incarcerated populationsCorrectional psychiatryPrinciples of treating incarcerated patientsTreatment of incarcerated patients, accreditation standards, prisoners' rights, correctional cultureSPB2
Postgraduate Year 4, Elective/General
    Forensic Unit of State Psychiatric HospitalCompetency to stand trialIntroduction to forensic psychiatryRestoration of competency/sanitySBP2
    Mock TrialCivil/criminal case scenariosExpert witness qualificationsMock court testimony
    ABPN Board PrepPRITE/general psychiatry board
    Forensic Electives/Independent StudyLandmark cases in psychiatry
  • PC, Patient Care; MK, Medical Knowledge; PROF, Professionalism; SBP, Systems-Based Practice; ICS, Interpersonal and Communication Skills; POLST, Provider Orders for Life-Sustaining Treatment; MOLST, Medical Orders for Life-Sustaining Treatment; HIPAA, Health Insurance Portability and Accountability Act of 1996; ABPN, American Board of Psychiatry and Neurology; PRITE, Psychiatry Resident-In-Training Examination.