Teaching forensic psychiatry using problem-based learning: A move away from lectures

Dear Sir

Forensic psychiatry is an expanding field. Yet many undergraduates and psychiatric trainees receive little experience or training in the subject. It has been estimated that only half of UK medical schools provide clinical placements, seminars, workshops or special study modules within forensic psychiatry (Reiss & Chamberlain 2001). The majority of psychiatric trainees also lack experience in the forensic setting, with a significant proportion having never visited a prison (Reiss & Famaroti 2004). Therefore we recently developed and implemented a forensic psychiatry problem-based learning (PBL) module to stimulate interest and, it is hoped, future career aspirations. Transferable skills from this programme could also be applied to many aspects of chronic illness management.

As part of the standard model of PBL we developed vignettes to create suitable problem-based tasks. As an example a vignette involving morbid jealousy was used to develop history-taking skills, since a careful history was required to distinguish the condition from a case of true infidelity or domestic violence. Mental state examination skills were evaluated by considering active symptoms such as command hallucinations of a violent nature. Many forensic patients suffer from treatment-resistant schizophrenia and we found that scenarios involving this condition helped improve students’ understanding of the management of chronic conditions.

We encouraged psychiatric trainees to attempt some of the more complex problems within forensic psychiatry. Issues relating to ethics, consent and life-threatening illness were raised by considering prisoners on hunger strike. How to assess and manage a homicidal patient with delusional disorder helped measure skills in risk assessment. Issues relating to fitness to plead, psychiatric defences and hospital treatment orders were explored by tasks involving the preparation of fictional court reports. The forensic sections of the Mental Health Act can appear daunting to some trainees. We hoped scenarios involving their application helped increase awareness regarding their use.

The use of forensic topics within PBL has much to offer both undergraduates and psychiatric trainees. In addition to developing generic skills such as communication and group participation we hope that an increased understanding of forensic psychiatry was achieved. We believe that this fun and self-motivating method of learning could help to inspire medical students and psychiatric trainees towards a career in forensic psychiatry. Such motivation must be required if we are to help meet the demand imposed by this expanding speciality.