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The 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.

The 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.

Even 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.

This 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.

Mental health providers will be increasingly called on to lead psychiatric efforts to improve care and care redesign. The Accreditation Council for Graduate Medical Education (ACGME) in the USA requires residency programs to teach quality improvement (QI) and systems-based practice (SBP) to all trainees as part of training requirements. However, teaching QI and SBP concepts without a clinical context can be challenging with low trainee engagement. The paper aims to discuss these issues.

The authors describe curricular redesign with a specialized educator faculty task force that aimed to create a longitudinal curriculum that integrated abstract QI concepts into clinical practice settings, and helped trainees apply SBP concepts throughout residency. In addition, the authors describe the utilization of resident prescriber profiles to contextualize clinical practice habits, and the implementation of an educational case conference series with emphasis on QI-specific educational tools such as root cause analysis (RCA).

Formal resident feedback from 2016 to 2018 has demonstrated improved trainee satisfaction. The resulting curricular change has also led to a new chief resident role and sustained engagement in QI and SBP education by trainees.

The faculty task force and curricular design changes described in this paper were implemented at one large academic institution. Thus, additional assessment and research is necessary to address the generalizability of the interventions described.

Since QI and SBP are becoming more prominent requirements for medical education accrediting bodies such as the ACGME, the innovative curricular design can benefit other residency and medical student education programs that attempt to integrate clinical practice with education incorporating QI and SBP concepts.