Forensic Medicine

Forensic medicine is an unfortunate misnomer in Turkish discipline instead of forensic sciences (Fig. 1) which is rooted from the Latin word “forēnsis” meaning pertaining to the public discussion. As a part of this societal group, you have a right and responsibility for speaking up. This elective will be the tool to direct your inner speech to the outer world via the forensic psychiatry cases. Students who desire to have this election are to be provided a foundation of forensic psychiatry notion. There will be no limitation per student on which main aspects of interest -clinical, research, and/or case analyses- she wishes to work. So that, the course has more of a self-paced curriculum shaped around the globally accepted forensic psychiatry learning objectives as Türkiye fails yet to provide a proper education in this topic. Heat-map of the student activities are predicted to be denser in the Forensics Medicine. In order to keep the bridge intact between the forensic medicine and psychiatry clerkships, students are highly encouraged to have a balance on density of this heat-map as well as in the psychiatry clinics. “Learning Objectives” are listed solely as a sketch of elective’s roadmap. Students are encouraged to shape this curriculum and fine tune it to the exact area they are keen on. Brief: As Türkiye has not established a national curriculum for Forensic Psychiatry as well as most of other subgroups of forensic sciences, this curriculum you are reading is formed around globally applied and accredited curricula of several schools and departments of psychiatry and forensic psychiatry. From a general perspective, the roadmap of this elective is outlined in Figure 1. Figure 1. Subgroups of Forensic Sciences According to the American Academy of Forensic Sciences (Left) and Main Forensic Psychiatry Learning Objectives Covered by Accreditation Council for Graduate Medical Education According to the University of Cincinnati (Right) Specific objectives: Specific objectives are also listed not as a walkthrough but for a way through the science you may walk on (from the accredited curriculum of the Royal College of Psychiatry): Describe the links between psychopathology, victimization, mental disorder, behavior, and crime Outline the criminology of offences relevant to forensic psychiatry and diversity list the services for special groups of forensic patients Outline safety policies and procedures relating to patient consultation Appropriately obtain and document patient informed consent Offer psychiatric expertise to other practitioners to enhance the value of clinical assessments (e.g., through clinical supervision) to which the psychiatrist has not directly contributed Elicit information required for each component of a psychiatric history; in situations of urgency, prioritize what is immediately needed; and gather this information in difficult or complicated situations Demonstrate a knowledge of the principles of clinical supervision and their practical application (NB this competency applies across all the intended learning outcomes and subjects of this domain) Display willingness and availability to give clinical supervision to colleagues at all times Tailor the examination to the purpose, setting and context Make an assessment of safety of environment for patient consultation and examination Identify psychopathology in all clinical situations, including those that are urgent and/or complex Assess and diagnose patients with multiple and complicated pathologies Able to elicit psychopathology and phenomenology relating to risk Undertake mental state and physical examination and investigations sensitively in accordance with patients’ diversity needs Understand the impact of legal context on patient evaluation Understand the balance between the primary duty of care to patients and protecting public safety and take proper account of this in professional decision-making Understand the philosophy of retribution, incapacitation, deterrence Collate and integrate of information from clinical, risk and legal evaluation into a detailed formulation Develop a biopsychosocial formulation including psychodynamics Elicit a full mental state examination and undertake relevant investigations from a forensic patient across a variety of settings Undertake appropriate investigation in forensic settings Describe the policies and procedures relating to the care program approach and effective care coordination Apply legislation relating to interagency working e.g., MAPPA framework, child protection Describe the roles and responsibilities of other agencies, such as police, social work probation and the prison service Outline the statutory care requirements of detained and restricted patients and the role of the RMO Understand the impact of secure institutions Demonstrate competence in the management of violence Direct the therapeutic use of security to meet patients’ needs Utilize relational, procedural, and physical aspects of security to manage patients Mitigate against the negative effects of institutionalization on patient rehabilitation Contribute to psychological understanding of the patient in the context of secure psychiatric institutions Work therapeutically in non-clinical settings (prisons, police stations, courts etc) Seek and respond to legal advice Manage patients in least restrictive setting Assess and manage a patient at risk in conjunction with multidisciplinary team Formulate detailed risk management plan arising from risk assessment with multidisciplinary team Implement risk management plans with multidisciplinary team Knows about principles underlying management and prevention of violence, hostage taking, self-harm, suicide, absconsion, escape and recall of a restricted patient Demonstrate practical knowledge of the relevant mental health legislation, guidelines, local policies, procedures, codes of practice and guidance relating to: mental health, capacity, confidentiality, data protection, freedom of information, disability and discrimination, consent, bullying and harassment, human rights, public protection Demonstrate practical knowledge of criminal, civil and case law relating to forensic patients Demonstrate practical knowledge of other legislation relating to patient care in forensic settings Self-assessment is more prone to yield in concrete success. Thus, observations -not evaluations- , made throughout the elective, of students’ knowledge; communication skills both with patients and with colleagues; ethical thought process; professionalism; and practice skills will be shared with the related students. The sense of self-fulfillment would suffice for a completed elective both on the faculties’ and the students’ perspectives. Are there not very important things which can only reveal themselves, under certain conditions and at certain times, by quite feeble indications? – Freud, Introductory Lectures on Psychoanalysis This elective is a chance to see if this could be that certain time for an entrance to the art of synthesis