Teaching undergraduate psychiatry in a forensic setting

Typically, medical students do not learn about psychiatry in forensic settings. Depending on their interests and their medical school, they might have access to special study modules or elective placements in their final year. We introduced undergraduate psychiatry placements at our regional forensic service in New Zealand and surveyed the experiences and attitudes of our students over the past 2 years. The placement includes experience of medium-secure in-patients, community, prison and court liaison services.

McGauley & Campbell ¹ asked whether medical students needed to know anything about forensic psychiatry and concluded that forensic psychiatry taught students about managing chronic illness, working with complex patients, understanding stigma and security, learning about personal and organisation dynamics and experiencing multidisciplinary, cross-disciplinary and multi-agency working. Such issues are relevant to all psychiatric specialties and some areas of medicine.

The University of Otago Medical School, Dunedin, was the first to be established in New Zealand. There are about 270 students each year. Students study psychological medicine throughout the 2nd year, and 8-week attachments, divided between two different areas of psychiatry, are compulsory in the 4th year. Students attend placements as part of the clinical team and complete logbooks of experiences, including team working and ethics. They see patients and learn about the assessment, formulation and management of common mental health problems. They regroup for weekly medical school teaching and undertake an examination with written and practical components.

We designed an online survey, which the medical school emailed to our 15 students who had spent their psychiatry placement with our forensic service; 73% (11 students) responded. They were asked about the expectations and experiences they had had, the disorders they had learnt about, what they had enjoyed and what could have been improved.

Interestingly, 27% were anxious about starting their placement. Most students thought that they would be learning mainly about ‘legal issues’ and seeing patients in prison. Some had ‘no idea’ what to expect. All respondents gained experience of seeing patients with schizophrenia, bipolar disorder, drug and alcohol problems and the problems associated with psychological trauma and head injury. Over 70% also gained experience of seeing patients with personality disorders. Depressive and anxiety disorders were less commonly encountered, with around half of students gaining experience of these. We learnt that about 27% of respondents felt unsafe at some point during their placement and subsequently introduced a first-day security and safety induction and distributed a leaflet explaining the nature of forensic services and the placement, which we were told was useful.

All students were positive and stated that they had enjoyed their placements. Over 70% rated the placement as ‘excellent’. They appreciated seeing patients in a variety of settings which included in-patient, community, prison and court, and gained experience of a variety of mental health problems. Some students remarked that the placement was one of the best they had done in their undergraduate training to date. Forensic settings can therefore provide useful and enjoyable experiences to students as they learn about psychiatry as undergraduates.