FORENSICARE ADVANCED TRAINING MANUAL by l62idC8

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									The Victorian Training
 Program in Forensic
     Psychiatry
Trainees’ Manual
      August 2010 version
                                                              CONTENTS
CONTENTS ............................................................................................................................................ 2
INTRODUCTION .................................................................................................................................. 3
    FORENSIC PSYCHIATRY: WHERE MENTAL HEALTH AND THE LAW COLLIDE ....................................... 3
    TIME MANAGEMENT ............................................................................................................................ 4
TRAINING EXPERIENCES RELEVANT TO ALL REGSITRARS ............................................... 6
    CLINICAL EXPERIENCES ....................................................................................................................... 6
      Acute Forensic Psychiatry .............................................................................................................. 6
      Prison-based Mental Health ........................................................................................................... 6
      Report Writing ................................................................................................................................ 7
      Community Forensic Mental Health ............................................................................................... 7
      Forensic Rehabilitation .................................................................................................................. 8
    TEACHING PROGRAM ........................................................................................................................... 8
      Induction Program .......................................................................................................................... 9
      Wednesday morning Seminars ........................................................................................................ 9
      Trainee Tutorials ............................................................................................................................ 9
      Group Supervision of Psychological Management ......................................................................... 9
      Court Report Peer Review Group ................................................................................................... 9
      Trainee Forum ................................................................................................................................ 9
      Consultant Peer Review Meetings / Medical Advisory Committee / Grand Rounds ..................... 10
    TEACHING RESOURCES ....................................................................................................................... 10
      Library .......................................................................................................................................... 10
      Resource Folder ............................................................................................................................ 10
    SUPERVISION ...................................................................................................................................... 10
TRAINING REQUIREMENTS FOR BASIC TRAINEES .............................................................. 12
    EXAM PREPARATION .......................................................................................................................... 12
    APPROVED BASIC TRAINING IN ADDICTION PSYCHIATRY .................................................................. 12
    APPROVED ACTIVITY ON ETHICAL PRACTICE..................................................................................... 12
    WORKING WITH PEOPLE WITH MENTAL ILLNESS, CARER AND NGO EXPERIENCES............................ 13
TRAINING REQUIREMENTS FOR ADVANCED TRAINEES.................................................... 14
    EXPERIENCE IN PSYCHOLOGICAL ASPECTS OF MANAGEMENT IN PSYCHIATRY .................................. 14
    LEARNING GOALS .............................................................................................................................. 14
    APPLICATION OF CONSULTATIVE SKILLS ........................................................................................... 15
    CME ACTIVITIES ................................................................................................................................ 15
    LEADERSHIP AND MANAGEMENT ....................................................................................................... 15
    BASIC AND/OR ADVANCED TRAINING ACTIVITIES ............................................................................. 15
TRAINING REQUIREMENTS FOR FORENSIC ADVANCED TRAINEES .............................. 17
    FORMAL TEACHING ............................................................................................................................ 18
       Graduate Program in Forensic Behavioural Science ................................................................... 18
       Monash D Psych Seminars ........................................................................................................... 18
    CLINICAL EXPERIENCES ..................................................................................................................... 18
       High Prevalence Disorders ........................................................................................................... 19
       Acute Forensic Psychiatry ............................................................................................................ 19
       Forensic Rehabilitation Psychiatry............................................................................................... 19
    RESEARCH PROJECT ........................................................................................................................... 20
    CROSS-CULTURAL/ INTELLECTUAL DISABILITY / ADDICTIONS CASES ............................................... 20
    SUPERVISED MEDICO-LEGAL REPORTS .............................................................................................. 20
    INVOLVEMENT IN CRIMINAL COURT EXPERT EVIDENCE MATTERS .................................................... 21
    INVOLVEMENT IN CIVIL COURT AND MENTAL HEALTH ACT EVIDENCE ............................................ 21
    OBSERVATIONS OF OTHER ‘FORENSIC CLINICAL SETTINGS’............................................................... 21
    SERVICE DEVELOPMENT PROJECTS .................................................................................................... 22



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                                          INTRODUCTION

      Forensic Psychiatry: Where Mental Health and the Law Collide
Forensic psychiatry represents the interface of the law and psychiatry. This
interface is often controversial, occasionally frustrating, but seldom dull.

Although there have been practitioners in forensic psychiatry for many years
in Australasia, it is only recently that formal training programs in the
subspecialty have been developed under the auspices of the Royal Australian
and New Zealand College of Psychiatrists. Forensicare (the Victorian Institute
of Forensic Mental Health) in conjunction with the Centre for Forensic
Behavioural Science (a centre for research, teaching and practice
development within Monash University) is responsible for one such program:
the Victorian Advanced Training Program in Forensic Psychiatry.

This manual is designed to assist psychiatric trainees at Forensicare to make
the most of their time with us. We have designed it with the needs of
generalist (GSAT) and forensic subspecialty advanced trainees (FATs), and
Basic Trainees (BTs) in mind. In general, Dr Andrew Carroll has responsibility
for the training needs of ATs at Forensicare, while Dr Kevin Ong, can be of
assistance to BTs (including arranging exam practice, both mock OCIs and
ECEs). In addition, the ‘lead registrar’ can provide peer support and answer
queries about operational issues such as on-call rosters. The lead registrar
position is filled by a different person every 6 months; from August 2010, Dr
Hemlata Ranga is the lead registrar.

We have avoided repeating information which can be found elsewhere. In
particular, we encourage you to read this manual in conjunction with two very
important online sources of information:
    The Psychiatrist Training Folder on the F drive of the Forensicare
       intranet. This is a subset of the “Education and Training” folder of the
       Thomas Embling Hospital F drive and contains various folders of
       relevance to psychiatrists’ training at Forensicare. We make references
       to the relevant folders throughout this manual. We strongly advise you
       to acquaint yourself with this resource early on in your training with us.
       The timetable for the weekly Wednesday morning training program,
       which is the ‘core’ of the formal Training Program is available on the F
       drive at :
       \\Vifmh10\data\Education & Training\Psychiatrist Training\Calendar.
    The ‘Education and Training’ tab on the Forensicare intranet home
       page, which will keep yopu up to date with service-wide resources.
    The RANZCP website at www.ranzcp.org. In particular, the training
       part of the website which can be accessed under the “Pre-Fellowship”
       tab at the top of the homepage contains a wealth of useful information.

For Generalist ATs or BTs, a placement for six or twelve months in forensic
psychiatry is a very useful, perhaps even essential, part of a fully rounded

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portfolio for training as a general psychiatrist. We therefore take their training
requirements very seriously and endeavour to meet their needs throughout
their time with us. Please note that interested GSATs, IMGs and BTs are
welcome to attend any and all of the meetings and training events which are
open to forensic advanced trainees. GSATs and BTs should remain in close
contact with their local Director of Training with respect to College
requirements, including documentation. We are also happy to meet with you
periodically as required throughout your time with us. Please note however
that your local Director of Training remains your central point of coordination
with respect to the College. Whilst we will attempt to ensure that you are
complying with College requirements with respect to paperwork and meeting
training requirements as you progress, it remains your responsibility to ensure
that these things are completed.

We are happy to meet with you at any time to discuss concerns that you may
have about your training experiences or to hear ideas about how the training
program can be improved. Please feel free to email either of us and we can
set up a time to meet.

                                          Time Management
A key to success in professional training is time management. Forward
planning and careful management of your diary are essential to ensure that
important tasks are not neglected in what will inevitably be a busy period of
your life. Inevitably a balance has to be struck between service provision
responsibilities for junior doctors and their need to meet their training
requirements. Forensicare permits each trainee to spend 0.2 FTE (i.e. 8
hours) of the working week carrying out training activities. This includes,
but is not limited to:
    Attendance at seminars
    Attendance at peer review groups
    Studying in university courses such as the MPM or the Graduate
        Certificate / Diploma in Forensic Behavioural Science
    Site visits
    Visits to civil forensic psychiatrists
    Work on your forensic psychiatry research project
    RANZCP Psychotherapy cases
    Mandatory experiences such as visits to NGOs or ATSI (indigenous)
        services.

You may need to be selective in order to ensure that you do not exceed the
eight hour limit. For advanced trainees in forensic psychiatry spending two
years or more with us, then you certainly should be able to avail yourself of
the full range of training opportunities available whist still sticking to this limit.

It is essential that during your first week you meet with your supervising
consultant psychiatrist and determine exactly how your working week
will be structured in terms of clinical responsibilities and training
opportunities. If at any stage you feel that your training experiences are

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being compromised by pressure to fulfil service delivery requirements, then do
not hesitate to let us know and we will attempt to assist.


The training program is overseen by the Victorian Training Program in
Forensic Psychiatry Committee. The committee has places for trainee
members and meets approximately every two months. Please let me know if
you wish to attend. Agendas and minutes will be circulated to you in any case.
The program itself is accredited with the Victorian Psychiatric Training
Committee and with the RANZCP Subcommittee for Advanced Training in
Forensic Psychiatry, and both periodically carry out site visits for accreditation
purposes.

Although there are inevitably many hurdles to be achieved throughout
psychiatric training and many ‘boxes to be ticked’, we strongly encourage you
not to see this aspect as the ‘be all and end all’ of your forensic psychiatry
experience. The most critical aspect of your training is the clinical
‘apprenticeship’ itself: your immersion within a busy forensic mental health
service and your frequent contact and discourse with patients, peers and
multidisciplinary team members. Forensic psychiatry can be confronting at
times. By its very nature, you will find yourself managing patients who form
one of the most marginalised sections of society. However, it also provides
the opportunity for a rewarding experience that will only enhance your clinical
skills. In particular, you should be able to take away from this rotation an
understanding of the interface between psychiatry and the law, the writing of
court reports, structured risk assessment, and a reasoned approach to ethical
practice in this area. Whilst inevitably your time will have its challenges,
overall the experience should be rewarding and enjoyable.

Andrew Carroll (andrew.carroll@forensicare.vic.gov.au)
Director of Advanced Training in Forensic Psychiatry

Kevin Ong (kevin.ong@forensicare.vic.gov.au)
Consultant with responsibility for Basic Trainees
February 2010




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  TRAINING EXPERIENCES RELEVANT TO ALL REGSITRARS

                                        Clinical Experiences
Each of the registrar posts at Forensicare impose a particular set of demands
and provide a particular set of learning opportunities for you. The learning
objectives listed below have been developed as broad guidelines to help you
to plan your learning during your time with us. It may or may not be possible
to meet absolutely all of these objectives in any given placement.

Acute Forensic Psychiatry
1. Understanding of the assessment and management of acute risks of
   violence and self harm in acute inpatient settings including ethical,
   pharmacotherapeutic and psychotherapeutic aspects.
2. Understanding of the security aspects of forensic inpatient services
   including relational, environmental and procedural aspects of secure care.
3. Appreciation of the epidemiological evidence for links between mental
   illness, substance use disorders and offending behaviour.
4. Understanding of the various reasons for the links between mental illness
   and substance use and knowledge of appropriate psychological and
   pharmacological intervention management strategies.
5. Understanding of management issues at the interface between forensic
   inpatient services, general mental health services and prison services.
6. Understanding of the various pathways followed by mentally disordered
   offenders from offence and rest onwards through the criminal justice
   system including the range of services available to them and their
   respective limitations.
7. Understanding of the Victorian Legislation in relation to mentally
   disordered offenders with special emphasis on the relevant sections of the
   Mental Health Act and Sentencing Act including interface with the Mental
   Health Review Board. Ideally this should be compared and contrasted
   with options available to mentally disordered offenders in other
   jurisdictions throughout the developed world.
8. Development of leadership skills with special emphasis on leading the
   inpatient multidisciplinary team responsible for an acute forensic inpatient
   unit.
9. Understanding of the impact of cultural factors on acute psychiatric
   presentations and adjustments to forensic settings, with particular
   emphasis on ATSI populations.


Prison-based Mental Health
1. Development of skills in assessment and management of self harm and
   violence risk in the correctional context with particular emphasis on ethical
   and systemic aspects.
2. Development of leadership skills with special reference to leadership of
   multidisciplinary mental health teams in a prison setting.


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3. Knowledge of epidemiological evidence relating to levels of mental
   disorder and substance use in prison settings throughout the developed
   world.
4. Understanding of cultural aspects of impacting on mental health in the
   prison setting with particular emphasis on the ATSI population.
5. Awareness of possible pathways from initial incarceration followed by
   prisoners with a mental disorder including limitations on resources
   available.
6. Understanding of legislation as for inpatient.
7. Awareness of the particular issues involved in prescribing psychotropic
   medicines in a prison setting.
8. Development of a working knowledge of the range of services available in
   prison settings in Victoria for incarcerated persons or to assist with
   problems with mental disorder, substance use and offending behaviours,
   including the limitations on such services and comparisons with services
   available elsewhere in the developed world.


Report Writing
1. Development of an ability to formulate opinions in a medical/legal context.
   This includes the development of skills to produce readable succinct
   reports for bodies such as the Courts, the Office of Public Prosecutions
   and the Adult Parole Board in a timely and efficient manner.
2. Development of an ability to produce reports that are ethically grounded
   and clearly demonstrate the basis for the expert opinions provided.


Community Forensic Mental Health
1. Demonstrate an understanding of the role of community forensic mental
   health services as part of the broader general mental health system. This
   should include an appreciation of the various models adopted by such
   services in different jurisdictions such as parallel and integrated models
   and an appreciation of the advantages and disadvantages of each.
2. An appreciation of the broader social and political context in which forensic
   patients are managed in a community setting, with particular emphasis on
   those with a history of homicide.
3. Development of skills in providing effective consultation liaison advice to
   general mental health providers around forensic issues. This should
   include an ability to ground such advice in empirical research.
4. Development of skills in the assessment and management of violence and
   other problem behaviours in the community setting. This should include
   knowledge of the psychological and pharmacotherapeutical approaches to
   the management of aggression and of sexual offending in the long term.
5. Knowledge of legal framework in which patients with a forensic history are
   managed in the community, with particular emphasis on the Crimes
   (Mental Impairment and Unfitness To Be Tried Act) (Victoria) and its
   functioning in the community. This should include an appreciation of how
   this legislation compares and contrasts with that available in other
   jurisdictions.

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6. Development of an appreciation of the roles and functioning of the
   multidisciplinary team in the community forensic mental health setting.
   This should include specific knowledge around roles of: Case Manager;
   Psychologists; Psychiatrists; Social Workers; Occupational Therapists;
   Court Liaison Officer.
7. An appreciation of the role of social and other contextual risk factors on
   likelihood of such behaviours in the community.
8. Knowledge of the array of community services available to assist with the
   management of mentally disordered offenders in the community, including
   some awareness of the strengths and limitations. This should include, for
   example, an understanding of the various elements of general mental
   health services, specialist substance use services, community correctional
   services and non-governmental agencies, particularly those with a specific
   remit for mentally disordered offenders.


Forensic Rehabilitation
1. An appreciation of the legal context in which forensic patients are
   gradually reintegrated into the community with particular emphasis on the
   role of the Crimes (Mental Impairment and Unfitness To Be Tried Act)
   including the functions of the Forensic Leave Panel. This should be
   compared and contrasted with systems existing in other jurisdictions.
2. Appreciation of the political context in which rehabilitation, including
   graduated leave programs, occur.
3. An understanding of the various pathways to reintegration into the
   community existing for mentally disordered offenders, including those
   under the Crimes (Mental Impairment and Unfitness To Be Tried Act) and
   those under the Mental Health Act. The advantages and limitations of the
   various pathways should be understood.
4. An understanding of the assessment and management of risks in the
   context of mentally disordered offenders who are gradually being
   reintegrated with the community. This should particularly include an
   appreciation of the risks of violence, self harm and absconding. Systemic
   psychological and pharmacotherapeutic approaches to risk assessment
   and management and the ethical implications of these should be
   emphasised.
5. An understanding of the issues involved in the ethical management of
   inpatients who are subject to institutional care for prolonged periods. This
   includes but is not limited to: risks of institutionalisation; lifestyle issues,
   such as risk of obesity and poor diet; issues around contraband, including
   substance misuse; gender issues; sexual functioning.

                                          Teaching Program
There is a busy program of training opportunities for registrars at Forensicare.
Note that it might not be possible in any given six-month placement to attend
absolutely all of these and that the ‘eight hours per week’ rule must be
carefully followed.


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Induction Program
This is a ‘crash course’ in the basics of forensic mental health delivered by
over the first month or so of each rotation. You will only need to attend this
once. It covers certain fundamental issues of relevance to both forensic and
general psychiatrists, such as risk assessment and interface with the law.
Details can be found on the Training Calendar on the F Drive.


Wednesday morning Seminars
This is a weekly seminar series delivered on a Wednesday morning at
9.30a.m., either at Thomas Embling Hospital or at the Centre for Forensic
Behavioural Science. It covers a wide variety of specialist forensic topics and
is delivered by a range of clinicians and academics from various fields. Details
can be found in the Training Calendar on the F Drive.


Trainee Tutorials
Following most seminars, there is a tutorial session, which is led by a Trainee
according to a roster system coordinated by the Lead Registrar. The format
and content are flexible but have included:
    presentation of a journal paper;
    presentation of a topic based on a ‘learning goal’
    presentation of a ‘service development project’
Each tutorial is chaired by a Consultant, but Trainees are responsible for
presentation and leading the discussion. ATs can meet their academic
presentation requirements in this setting.

Group Supervision of Psychological Management
This occurs on a monthly basis after the Wednesday morning seminar. It is
designed to augment your clinical care of patients whom you are seeing to
fulfil the ‘Psychological Management’ requirements of Fellowship.


Court Report Peer Review Group
This occurs on a monthly basis after the Wednesday morning seminar. It is a
new component of the Training Program and will involve a Trainee
(determined according to a roster system coordinated by the Lead Registrar)
presenting a medicolegal report that they have compiled and leading a
discussion of issues arising from the case. It will be chaired by a consultant.


Trainee Forum
This occurs approximately every 2 months after the Wednesday morning
seminar and is organised and led by the Lead Registrar. The forum is an
opportunity for Trainees to discuss issues relating to their training and service
delivery. No consultant will be in attendance but it is expected that matters
arising will be fed back to the consultant body via Dr Carroll.


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Consultant Peer Review Meetings / Medical Advisory Committee /
Grand Rounds
Peer review meetings take place on Mondays at noon and involve
presentation of complex cases or particular topics relevant to the service.
The Medical Advisory Committee meets monthly to discuss administrative
issues. Grand Rounds are held periodically and are open to all Forensicare
staff. These generally cover complex cases in conjunction with a particular
topic.

You are required to attend peer review at least 10 times per year and present
twice per year. You should discuss this in advance with your supervising
consultant.

The timetable for these meetings is in the Psychiatrist Training folder within
the ‘Monday Meeting Timetable’ subfolder.

                                        Teaching Resources
All medical staff have access to the following resources:


Library

There is a small library of texts located at the Centre for Forensic Behavioural
Science in Clifton Hill. I can advise further regarding access to this when we
meet. Also note that you are entitled to membership of the Royal Melbourne
Hospital Health Sciences Library (http://www.mh.org.au) which incorporates
the Victorian Mental Health Library and offers an amazingly useful service,
including online access to many journals.


Resource Folder

See F Drive: \\Vifmh10\data\Education & Training\Psychiatrist
Training\Resources

                                               Supervision
As with any other rotation in your Basic Training years, supervision of clinical
work forms an integral part of the assessment of your clinical progress. Whilst
the rotations themselves are invariably busy, this makes it all the more vital
that you receive the minimum supervisory hours deemed necessary by the
College.

You should early on decide with your principal supervisor on a regular weekly
time for one hour of individual supervision. This should be in addition to a
minimum of three clinical contact hours for the rest of the week. Your
supervisor should observe you in clinical interviews, as well as allowing you to
observe them in such situations. Obviously, take the opportunity to clarify
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aspects of forensics that you are not familiar with. Supervision should not
simply be a “ward round” of your current patient load.

Supervisors take their role in training seriously. However, should you feel that,
for whatever reason, there has been a problem with your experience of
supervision, please attempt to address this with your principal supervisor in
the first instance. Should you find the outcome unsatisfactory, please inform
either Dr Andrew Carroll or Dr Kevin Ong.




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          TRAINING REQUIREMENTS FOR BASIC TRAINEES

As far as possible, Forensicare seeks to facilitate access to the various
training opportunities required for basic training. These are discussed in detail
below.
Also, whilst most basic trainees are based at the Hospital or at the Melbourne
Assessment Prison, they are encouraged to take the opportunity to at least
visit other arms of the service such as CFMHS and Marrmak.

                                          Exam Preparation
To the uninitiated, forensic psychiatry can be a somewhat daunting
experience. Trainees often become very anxious when confronted by forensic
cases in their clinical exams. Hopefully your rotation will help to demystify this
sub-specialty.

If you are planning to sit Clinical Exams in the near future, please inform Dr
Kevin Ong as soon as possible so that OCI/ECE practice can be arranged.

If there is sufficient interest expressed, it may be possible that OSCE practice
focussed on forensic cases can also be arranged. This would require a larger
group of interested candidates in order to be viable. The same applies for
written exam practice.

                 Approved Basic Training in Addiction Psychiatry
As part of basic training, it is a requirement to complete approved training in
addiction psychiatry. Given the high prevalence of substance use issues, as
well as gambling, in a forensic population, this rotation should provide the
ideal opportunity to meet this requirement.

You will need to ensure that your principal supervisor is aware of your
intentions so that supervision can be tailored to meet the College
requirements in regards to the Addiction Psychiatry component.

Forensicare is fortunate to have strong multidisciplinary teams, and you are
encouraged to help run groups, perhaps in association with a psychologist or
social worker, that are focussed on addressing drug and alcohol and/or
gambling problems.

                           Approved Activity on Ethical Practice

Potential topics for discussion with your supervisor include confidentiality,
consent/capacity, the role of the psychiatrist in court (particularly “dual
agency” and the “hired gun”), working in the prison system, and involuntary
treatment.


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 Working with People with Mental Illness, Carer and NGO experiences
Previous trainees have used the forensics rotation in order to fulfil these
requirements. This includes, for example, organising Q&A sessions at the
Hospital for friends and relatives of patients.

Also, you may ask the social worker on your Unit regarding the role of
organizations such as ACSO and the Salvation Army. Visits to these
organizations can be arranged during your rotation.




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     TRAINING REQUIREMENTS FOR ADVANCED TRAINEES

All RANZCP Advanced Trainees, whether Generalist or Forensic, must
complete a set of mandatory ‘core’ experiences in order to attain Fellowship.

In essence, for subspecialty advanced trainees their generalist and
subspecialty training occur in parallel: the requirements for the generalist
advanced training are necessary to attain FRANZCP Fellowship; the
requirements of the subspecialty certificate (i.e. forensic) are required in order
to obtain the advanced training certificate. Commonly, the AT certificates are
awarded some time after attainment of fellowship.

This section will briefly outline how the mandatory general training
experiences can be met during your time at Forensicare.

You should also acquaint yourself with the regulations for “Basic Training and
Advanced Training for Fellowship” available on the RANZCP website.

    Experience in Psychological Aspects of Management in Psychiatry
It is a requirement that you spend at least one hour per week throughout the
two yeas of advanced training, for at least forty weeks of each year, in the
provision of formal psychotherapy (of any modality) to patients. All of the
training placements at Forensicare provide access to suitable clinical material
for psychotherapy, although inevitably the precise content, process and
modality of such therapy will vary widely depending on where you are
working. We strongly advise you to discuss this requirement early on in your
placement with your supervising consultant and determine how you will meet
this requirement as part of your clinical work.

Group supervision, which is mandatory for ATs, is provided at Forensicare on
a monthly basis by Dr Douglas Bell. Currently these are part of the
Wednesday morning training program.

                                            Learning Goals
As part of advanced training it is mandatory to identify and achieve three
specific “learning goals” in each of:
    Biological aspects of management
    Social aspects of management
    Cultural aspects of management

Again, you should refer to the RANZCP documentation around these
requirements. In general, the subheadings of biological, social and cultural
can be interpreted fairly broadly and it will not be difficult for you to identify
useful learning goals in conjunction with your consultant supervisor while you
are with Forensicare. The nature of forensic practice particularly facilitates the
achievement of learning goals in all of these domains.

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                              Application of Consultative Skills
It is an essential part of advanced training that you learn how to clearly
communicate assessments and management plans to other health
professionals such as GPs. Again, at Forensicare there will be ample
opportunity to meet this training requirement. Note that it is also essential that
you spend time with your consultant supervisor, reflecting on interactions with
non-psychiatric health professionals on at least eight occasions each year.

It is your responsibility to ensure that this requirement is met and you will
need to be proactive in discussing it with your consultant supervisor.

                                             CME Activities
As discussed in detail below under ‘Forensic Advanced Training’, you will find
no shortage of continuing professional development opportunities at
Forensicare and the Centre for Forensic Behavioural Science. Again, be sure
to acquaint yourself with the College requirements and ensure that the
documentation is filled in. This will be good practice for your time as a
consultant. CME is now a mandatory requirement for ongoing registration as a
medical practitioner in Australia.

                                 Leadership and Management
Forensicare does not deliver a formal leadership and management training
program. You should discuss with your Director of Training regarding local
opportunities for this. Attendance will be facilitated as part of your allowed
training time at Forensicare.

For ATs at Forensicare we encourage an apprenticeship model whereby a
combination of observation and observed practice in conjunction with your
supervising consultant allows you to gradually enhance and develop skills in
multidisciplinary team leadership and management. In addition, ATs at
Forensicare attend the Medical Advisory Committee at which management
and administrative issues are regularly discussed by the consultant body.

As you progress in your advanced training, you will be acting in roles involving
a substantial degree of clinical responsibility, albeit always with oversight and
supervision from a responsible consultant.

                       Basic and/or Advanced Training Activities
An annual activity on ‘ethical practice’ is required for each year of both basic
and advanced training. This requirement is interpreted fairly broadly and, as
you might imagine, there is no shortage of ethical dilemmas in forensic work
upon which you can reflect in conjunction with your supervisor. In addition,
depending on which academic opportunities you take up, there may be other
opportunities to meet this requirement.

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Currently “continuity of care” and “rural mental health” are requirements for
training that can be completed as an AT if they have not been completed as a
basic trainee. Most ATs will in fact have already completed these before
coming to Forensicare. If this is not the case however, you should advise us
of this fact early on in your placement.




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     TRAINING REQUIREMENTS FOR FORENSIC ADVANCED
                       TRAINEES

As noted above, although Generalist ATs do not need to meet any of the
requirements of the advanced training certificate in forensic psychiatry, they
may well wish to avail themselves of many of the training opportunities
detailed below during their time at Forensicare.

With respect to international medical graduates working as registrars,
although not formally enrolled as ATs in forensic psychiatry, they should
nonetheless endeavour to meet all of the requirements of the advanced
training certificate in forensic psychiatry and also fill in the forensic psychiatry
training logbook as they go along. Documentation of training is always a good
idea and it is possible that retrospective accreditation will be granted for such
experiences should the registrar enrol in forensic subspecialty training
subsequently.

ATs in forensic psychiatry (FATs) should meet with Dr Carroll in the first
month of their training and develop a written proposal outline using the
appropriate College documentation for their initial year of forensic training. He
will meet with FATs at least six monthly thereafter and another proposal will
be required at the start of year two. Obviously he is available to meet more
frequently as the need arises. In addition, a formal application to start
Advanced Training in forensic psychiatry will need to be completed on the
appropriate paperwork at the start of your time as a FAT.

Please note that you will need to complete the College formative and
summative assessment forms in conjunction with your consultant supervisor
and provide these to the College via your Regional Director of Training at the
required intervals. It is strongly recommended that you fill in your logbook as
you go along. Please remember that you also need to meet all of the
requirements of the GSAT program detailed above in order to attain
Fellowship as well as your advanced training certificate, unless exemptions
have been granted.

As ever, it is your responsibility to ensure that your documentation is provided
to the College in a timely manner and you will not necessarily be chased up
regarding these issues.

At the end of your Advanced Training you will need to provide a final written
qualitative report and a completed logbook signed off by myself, for
consideration by the Binational Subcommittee in Advanced Training in
Forensic Psychiatry for recommendation for the award of the an Advanced
Training Certificate in Forensic Psychiatry.

Obviously you need to familiarise yourself with the logbook, regulations and
curriculum pertaining to forensic psychiatry subspecialty training. The
curriculum and requirements were recently subject to a minor review and
some changes were introduced in July 2009. You should ensure therefore
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that you are familiar with the most up-to-date version on the RANZCP
website.

The following section will advise in general terms on how each of the
subspecialty requirements can be met during your time with us at
Forensicare.

                                           Formal teaching
The requirement in the regulations is to attend at least eighty hours of formal
teaching over the two years. In reality, you will have the opportunity to attend
considerably more than eighty hours and so should have no problem in
meeting this requirement. There is an additional requirement to “attend thirty
hours of academic presentations”, but there is no sharp distinction between
formal teaching and academic presentations. In addition, you are required to
deliver two academic presentations in suitable fora.
As well as the training opportunities open to all registrars (see above),
advanced trainees may wish to consider the following opportunities:

Graduate Program in Forensic Behavioural Science
Monash University, through the Centre for Forensic Behavioural Science,
delivers the Graduate Certificate / Diploma in Forensic Behavioural Science
via distance education. FATs are encouraged, although not mandated, to
study this course. It is a multidisciplinary course which mainly involves private
study but also includes two days of interactive workshop every semester. For
FATs and for certain IMGs (agreed by direct negotiation), Forensicare will
fund 50% of the course fees by retrospective reimbursement. Further details
on the course can be found at www.med.monash.edu.au/spppm/pgrad.


Monash D Psych Seminars
The Centre for Forensic Behavioural Science also delivers seminars in
criminal and civil forensic mental health for psychology doctoral students. ATs
may attend these although they must register their interest with Dr Carroll
before doing so. There are two seminar series every year. The series on civil
topics should be of particular interest to FATs since this is not a topic well
covered elsewhere. The interdisciplinary nature of this series has been
particularly valued by past participants.

                                        Clinical Experiences
Your clinical experiences are of course the core of your training in forensic
psychiatry. Although there is a wealth of fascinating academic material
pertaining to the subject, this only really makes sense in the light of
experience gained in the setting of clinical placements involving frequent
patient contact. Your supervising consultant at Forensicare will have
considerable experience in forensic psychiatry and will be a very valuable
learning resource during each of your clinical placements. It is to be expected
that different consultants will have different styles and ways of dealing with the

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problems thrown up by clinical work. You should attempt to learn from each
and develop your own style as your training progresses. Exposure to a wide
variety of supervisors and placements is the key to successful and fulfilling
training and ensuring that you have the confidence to work as an independent
consultant after acquiring your Certificate and Fellowship.

You need to complete two years FTE in total in forensic psychiatry. This
should include at least:
      6 Months FTE Acute
      6 Months FTE Rehabilitation (inpatient or community)
      6 Months FTE Inpatient
      6 Months FTE High Prevalence Disorders, including at least 3 Months
        FTE with prisoners/remandees
It is possible to transfer programs to one of the other forensic training
programs throughout Australasia during your Advanced Training years. If
considering this, please discuss this well in advance with me, in order that
your training needs can be optimally met.


High Prevalence Disorders

In the domain of forensic psychiatry the binational subcommittee has agreed
that this requirement includes the need to spend a minimum of 6 months
equivalent full-time (in total) working with high prevalence disorders such as
depression, adjustment disorders and personality disorders; at least 3 months
of this experience must be in prison/remand settings (where such disorders
are common). There are a number of placements at Forensicare which allow
trainees to meet this requirement, including:
      Acute Assessment Unit at Melbourne Assessment Prison
      Marrmak Unit and Outpatients at Dame Phyllis Frost Centre (women’s
         prison)
      Metropolitan Remand Centre Outpatient Clinic (four sessions per
         week, hence three months’ FTE for a six month placement)


Acute Forensic Psychiatry

There are a number of placements which can meet this requirement:
    Acute Assessment Unit at Melbourne Assessment Prison (note that
      two requirements can be met simultaneously here i.e. this is both high
      prevalence and acute work)
    Marrmak Unit and Outpatients at Dame Phyllis Frost Centre (note that
      three requirements can be met simultaneously here i.e. this is high
      prevalence, rehabilitation and acute work)
    Atherton, Argyle and Barossa Units at Thomas Embling Hospital


Forensic Rehabilitation Psychiatry

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This can be met in a number of settings at Forensicare:
    Thomas Embling Hospital: Bass Unit , Barossa Unit, Canning Unit,
       Daintree Unit and Jardine Unit
    Community Forensic Mental Health Service: Mental Health Program,
       Problem Behaviour Program and/or Non-Custodial Supervision Order
       Consultation Liaison Program
    Marrmak Unit and Outpatients at Dame Phyllis Frost Centre (women’s
       prison)

                                           Research Project
The guidelines pertaining to meeting the requirement to “complete relevant
clinical research in forensic psychiatry” are available on the RANZCP website
and allow for a broad range of academic projects to count as meeting this
requirement. We recognise that different trainees have different levels of
interest and expertise in the area of research. You should discuss with me
early on in your training how you may best meet this requirement. There are
opportunities to both take part in established research projects and develop
small research projects of your own. There are also resources in terms of
supervision, both within Forensicare and at the Centre for Forensic
Behavioural Science to assist with this area.

The ‘Forensic Fellow’ registrar position is intended for those in the final stages
of subspecialty training who have a particular interest in research. Only one
such position exists and it is filled after an annual competitive selection
process.

            Cross-Cultural/ Intellectual Disability / Addictions Cases
Six cases from each category need to be documented in your logbook. There
will be no shortage of relevant material in both assessment and treatment
cases throughout your time with us. You should discuss how you will meet
this requirement with your supervising consultant.

                              Supervised Medico-legal Reports
The requirement for fifty supervised medico-legal reports over the two year
period might initially seem daunting. However, there will be no problem in your
meeting this target. There is a major emphasis on refining your report writing
skills throughout your training and you will be exposed to a variety of methods
and philosophies throughout your time here. Again, it will be important to learn
from a variety of supervisors as to how to write defensible reports and, if
necessary, deal with cross-examination of your evidence in the witness box.

You will also need to complete at least five reports in each of mental
impairment, unfitness to stand trial and disposition. In practice, most reports
will be for disposition purposes. However Forensicare do produce a large
number of reports covering mental impairment and/or unfitness to be tried
matters for the Office of Public Prosecutions. You will be given ample

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opportunity to conduct such assessments and write reports throughout your
time with us. You may subsequently have the opportunity to present these
reports and be cross-examined in Court. All such reports must be supervised
(and, unless you are a Fellow-in-Training, countersigned) by an appropriate
Consultant Psychiatrist.


            Involvement in Criminal Court Expert Evidence Matters
‘Involvement’ in criminal court matters goes beyond simply being cross-
examined on one’s own reports. This requirement is to be interpreted broadly
and also involves attendance at Court matters where other psychiatrists are
giving evidence. There will be ample opportunity for this, including attendance
at pre-hearing conferences with barristers. Again, it is important to discuss
this early on with both myself and your supervising consultants. There is a
very useful updated list of court cases pending in the relevant folder in the
Psychiatrist Training folder on the F drive: Vifmh10\data\Education &
Training\Psychiatrist Training\Court cases pending. You should consult this
and contact the relevant consultant if you wish to attend a particular hearing.

         Involvement in Civil Court and Mental Health Act Evidence
This includes presentation at or observation of the Mental Health Review
Board. Whilst working on the Acute Units at Thomas Embling Hospital you
may obtain considerable experience in delivering evidence to the MHRB on
patients under your care. In addition, you may contact the MHRB through Jan
Szuba (Jan.Szuba@mhrb.vic.gov.au) in order to arrange observation of a
session of the MHRB. Note however that most Boards will not allow you to
stay in the room while they deliberate on cases.

Presentations to and observations of the Forensic Leave Panel also comes
under this heading. Your placement at Thomas Embling Hospital will provide
ample opportunity for this.

In addition, you may wish to spend some time working alongside a civil
forensic psychiatrist. In Victoria, this work is carried out in the private sector
rather than at Forensicare. A number of local civil forensic psychiatrists have
kindly assisted in the past by allowing FATs to observe assessments and to
develop ‘mock’ reports on the cases. Dr Nigel Strauss at the Millswyn Clinic
(drnigel@bigpond.net.au) in South Yarra has been especially helpful. Do let
me know if you wish to pursue this option and I will assist with contacts. If you
do pursue this, then you may have the opportunity to observe proceedings at
other civil bodies such as VCAT.

                 Observations of other ‘Forensic Clinical Settings’
It is an important part of your subspecialty training experience that you
observe forensic settings beyond Forensicare. Within Forensicare itself you
should ensure that you attend the Marrmak Unit and the AAU at least once
throughout your time with us. Visits can be arranged through the consultant
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psychiatrists working on those units. Dr Adam Deacon (Forensicare) can
assist with a visit to Malmsbury ‘Youth Training Centre’, a juvenile justice
facility in country Victoria. In addition you are encouraged to liaise with the
Forensicare Court Liaison Service at Melbourne Magistrates’ Court in order to
arrange a visit to observe that service in action. Dr Gunvant Patel can also
arrange a visit to the Intellectual Disability Forensic service (DFATS) in
Fairfield.
The ‘Victim Support Agency’ (auspiced by the Victorian Department of
Justice) present in the Wednesday seminar series on an annual basis. For the
purposes of forensic training, attendance at this seminar will be counted as a
‘visit’ to a victim service.

External to Forensicare, you are also encouraged to arrange visits to the
following:
     Adult Parole Board : This is based in Footscray. You are encouraged
       to contact the Registry Manager, Cheryn Leahy
       (Cheryn.Leahy@justice.vic.gov.au or 03 9094 2111) to arrange a visit.
       You will be required to fill in some paperwork beforehand.
     Mental Health Branch / Office of Chief Psychiatrist: I will arrange these
       on an annual basis.
     Interstate Forensic Services: I can assist in arranging these for you if
       you have a particular interest in seeing services interstate or in New
       Zealand. It can be particularly helpful to see how similar problems are
       dealt with in different jurisdictions.
     If travelling overseas it would be a great idea to visit forensic services
       there; often Forensicare will have details of contact people at such
       services who can assist with facilitating this.

Note that whilst travel to services elsewhere is not reimbursed by Forensicare,
it will be tax deductible if the purpose of the visit was for training. As part of
your award, note that you have some limited CME funds to draw upon.

When carrying out your visits to other settings, it is useful to record your
observations in the form of brief written notes in order to help you to reflect on
what you have learned. I strongly encourage you to take advantage of the
opportunities afforded by your advanced training years to carry out these sorts
of activities, since such opportunities are often thin on the ground once you
start work as a consultant.

                                 Service Development Projects
You are required to carry out two small ‘service development projects’ during
your time with us. These should follow the generally accepted ‘quality
assurance’ format. I suggest that you discuss this requirement with me at
some stage during your first year.




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