Forensic Fellowship: Will a Clearer Process Produce More Forensic Fellows?

Abstract

In recent years, general psychiatry residencies have experienced a surge in interest from increasingly qualified applicants [1]. During the same period, overall interest in psychiatric fellowships has remained stable or declined [2]. While it is possible that the increase in general psychiatry applications will later translate to an increase in fellowship applications, fellowship programs must consider multiple methods of garnering interest in subspecialty training as well as potential barriers to fellowship interest. Morris et al. [3] and Michaelsen et al. [4] outlined some challenges facing forensic psychiatry fellowships specifically. In reading these articles and others, the distinction between symptom and cause is not clearly apparent. For example, inconsistent referral streams could reflect limitations of a program’s location (i.e., insufficient cases in the area) or may simply be the product of inconsistent availability of fellows to do the work. Such problems are likely idiosyncratic and unlikely to be resolved by any standardized approach across fellowships. Some of the challenges Morris et al. and Michaelsen et al. describe seem to have workable solutions, assuming training directors can agree upon the problems common to all fellowships. Both articles succeed in providing succinct, data-driven analysis of forensic psychiatry fellowships at both the applications and operations levels. Michaelsen et al. stress the need for empirical studies to better understand the relationship between program-specific offerings and challenges common to forensic fellowships. Morris et al. echo this sentiment, considering the value of a FREIDA-like database in which detailed information about applicants and fellowships could be collected and studied. We agree that without clear data, it is difficult to pinpoint and address the challenges facing forensic psychiatry training programs. Underscoring this point perfectly, the Michaelsen et al. and Morris et al. articles each cite a different number of forensic trainees (51 vs. 65) accepting positions for the same training period (2016–2017). If such basic information is not publicly available, we can only imagine the practical difficulties of conducting more systematic studies. Forensic training directors have repeatedly voted down initiating a match process. While one can debate the merits of a formal match into forensic psychiatry, it is difficult to find fault with calls for a more standardized and transparent application process. The Association of Directors of Forensic Psychiatry Fellowships (ADFPF) is actively in the process of developing a standard application for use by fellowship applicants. That is a first step toward creating a more clear, standardized process. Many of the problems Michaelsen et al. outline are common to all psychiatric fellowships (e.g., sustaining funding, maintaining core training sites, and protected time for faculty). There are no simple solutions to these challenges. Cultivating interest of general psychiatry residents in the field of forensic psychiatry remains a critical goal. For any subspecialty to survive, it must continually demonstrate its value to prospective fellows. Residents may abandon pursuing a fellowship if they perceive that additional training is unnecessary, particularly if they have adequate experiences with psychiatric subspecialties during residency. This is primarily an issue of perception. We doubt that a prospective surgical resident would view general and vascular surgeons as interchangeable. It is less clear, however, how trainees view the psychiatric subspecialties relative to general psychiatry. All things considered, we believe that forensic psychiatry is well positioned to brand itself as a truly specialized branch of psychiatry. Whether psychiatry trainees yet know this, they should all consider completing a forensic psychiatry fellowship. The overlap between psychiatry and the law is ubiquitous—from civil commitment, to malpractice standards, to evaluating * W. J. Newman [email protected]