The Benefits of Required Forensic Clinical Experiences in Residency.

OBJECTIVE: The growth of forensic psychiatry has spurred efforts to improve forensic psychiatry training in general psychiatry residency. The Accreditation Council for Graduate Medical Education requires that residencies provide an experience that "exposes" residents to forensic issues, but leaves the specifics to individual programs. However, there is growing need for psychiatrists to understand the unique circumstances of individuals with mental illness involved in the criminal justice system. METHODS: The authors developed a new mandatory forensic rotation for general psychiatry residents and conducted a pilot study to assess its impact on residents' interest and comfort working with criminal justice-involved patients, interest in forensic fellowship, and knowledge of available resources for consultation and supervision. RESULTS: Rotation completion was associated with a significantly increased interest in working with forensic populations and pursuing forensic fellowship, but no changes in residents' level of comfort or knowledge of supervisory and consultative resources. CONCLUSIONS: This study adds to the growing body of literature describing the benefits of expanding forensic education for residents.

A Multi-Site Survey of General Psychiatry Residents' Forensic Training.

The authors surveyed general psychiatry residents across the United States to better understand residents' experiences with forensic training and to identify variables with the greatest impact on residents' exposure to, comfort with, and desire to learn more about forensic populations and settings. The survey inquired about these topics and the forensic psychiatry resources available at residents' training institutions. Respondents (n = 129) spanned eight of ten U.S. census regions. Residents' comfort with forensic psychiatry was low, whereas desire to learn was high. Residents' number of exposures and comfort increased with greater forensic experience in residency. Fewer than half of residents had completed a forensic rotation, were required to complete a forensic rotation, or had robust forensic resources available to them. Residents who had completed a dedicated forensic rotation had significantly greater forensic exposures and comfort; a finding that remained significant even after controlling for participants' PGY status. Among residents pursuing fellowship training, residents interested in forensic fellowship had more exposures during residency. This study represents the first published effort to survey general psychiatry residents from multiple residency programs regarding their forensic experiences in training. These results have implications for educators interested in developing broader exposure to and comfort with forensic psychiatry.

A Hierarchical Bayesian Implementation of the Experience-Weighted Attraction Model.

Social and decision-making deficits are often the first symptoms of neuropsychiatric disorders. In recent years, economic games, together with computational models of strategic learning, have been increasingly applied to the characterization of individual differences in social behavior, as well as their changes across time due to disease progression, treatment, or other factors. At the same time, the high dimensionality of these data poses an important challenge to statistical estimation of these models, potentially limiting the adoption of such approaches in patients and special populations. We introduce a hierarchical Bayesian implementation of a class of strategic learning models, experience-weighted attraction (EWA), that is widely used in behavioral game theory. Importantly, this approach provides a unified framework for capturing between- and within-participant variation, including changes associated with disease progression, comorbidity, and treatment status. We show using simulated data that our hierarchical Bayesian approach outperforms representative agent and individual-level estimation methods that are commonly used in extant literature, with respect to parameter estimation and uncertainty quantification. Furthermore, using an empirical dataset, we demonstrate the value of our approach over competing methods with respect to balancing model fit and complexity. Consistent with the success of hierarchical Bayesian approaches in other areas of behavioral science, our hierarchical Bayesian EWA model represents a powerful and flexible tool to apply to a wide range of behavioral paradigms for studying the interplay between complex human behavior and biological factors.