Top forensic programs?

[reca]

As forensic application season is going to begin soon, I'm curious what the "top" forensic programs in the country are?

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[MisterKitty]

Da Baby’s asylum of sophisticated ratchet hoes

 

[Bartelby]

Ones that come to mind (in no particular order):

Case Western
U Cincinnati
UC Davis
UCSF
Columbia
UMass
Yale

 

[romanticscience]

The "top" programs are usually run by the "top academic forensic psychiatrists."

I would add SUNY Update to the list because of Dr. Knoll.

 

[ArdorAyurveda]

How bout Oregon Health Sciences University, Emory, Medical College of Wisconsin, Northwestern, and University of Minnesota?

 

[freudianslipp]

SUNY Upstate with Dr. Knoll!

 

[BrownForensicPsychiatry]

Great question! I am posting this response as a current fellow in forensic psychiatry at Brown University. This is our program account where we will try to answer forensic psychiatry fellowship related questions. (We will make sure to say whether a current fellow or the Program Director is the one responding.)

Any list of “top” forensic psychiatry fellowship programs is largely subjective. As you can see from previous responses to this thread (and other SDN threads), different people will have their own lists of “top” programs. Take every list with a grain of salt. What the aforementioned lists seem to have in common is current (or previous) Program Directors or key faculty members that are well-known in the forensic psychiatry world. These Program Directors may have been past AAPL presidents, write a ton of articles/chapters/books, be involved in APA or AMA, or simply be well-respected by their peers.

But just having a “big name” Program Director isn’t always going to be best for every fellow. As you look around for “top” programs, consider the level of 1-on-1 direct supervision and teaching you will get from these “top” faculty members.

For example (and of course, I am biased), here at Brown University we have Barry Wall, MD as our Program Director. My co-fellow and I work directly with Dr. Wall on cases 3 days per week (Mon, Wed, Fri). These 3 days/week we have direct, 1-on-1 supervision with him. In addition, we have several other excellent faculty members at Brown that are available to us for 1-on-1 time. This direct work can get watered down at other programs, so be sure to ask exactly how much direct supervision and work you will do with the faculty members.

It is also important to have multiple faculty members associated with a fellowship program who do different types of forensic psychiatry work. Look for a program that has faculty members with experience and interests in civil, criminal, correctional, academic, child, etc. forensic psychiatry. This can help you when you have a specific question regarding a case/evaluation, a specific research interest, or are looking to focus your career on a particular area of forensic psychiatry.

Something else to consider is geography. Some people want to stay within a geographic region, which is totally up to the individual. Family needs, weather preferences, etc all go into this decision. You likely had to think about this when applying to residency.

Some forensic psychiatrists will tell you that you HAVE TO train where you eventually want to practice. Personally, I think this is overblown. My preference was to receive the best training possible in a place where I fit in. Good training travels anywhere. If you move somewhere and produce good work, it will not matter that you didn’t train there. Of course, each state is different in terms of laws, statutes, etc. so you may have to do some additional reading/learning if you move to a different state.

Hopefully this information is helpful to those applying to a forensic psychiatry fellowship. Feel free to post more questions or to reach out directly if you want more information regarding our program at Brown!

 

[whopper]

I wrote quite a bit about this but years ago when I was a forensic fellow and a fresh graduate.
This was years ago but the word among several NYC fellowships was Albert Einstein was the one they thought was the best whether or not they were in the program. All of the NYC fellows go to many of the same lectures and rotations. What distinguished Albert Einstein was the fellows would state that their program director (Merrill Rotter?) Forgot the name) was one of those guys who loved to teach, was very personable, and developed great relationships with his students. The fellows at NYU, Columbia, and Einstein were all saying Einstein was the best one. Things may have changed.

Agree with many of the things written above. A program director may have a "big name" but not be a good teacher.

I'd recommend looking for the following:

1-Will you get along with the PD? Remember it's only you, the PD, and maybe 1-3 other fellows tops. Being in a residency with over a dozen residents vs just 2, those 2 will work with the PD very closely. I won't name the program but there's one where the PD is very difficult to get along with despite having the big name. I knew fellows that hated going to work every day seeing this guy.
2-Does the program offer training in psychological testing? When I was a fellow most didn't. The ones that did stood out. In court you may have a psychologist with very significant psychological test results that could very much undermine your position. If you don't have any training in it, well then you are at a significant disadvantage.
3-Many programs will have you work in a jail that is hours away from the program's base location. Many of them had you driving over 40 hours a week. That is not an exaggeration. One program even had an apartment so you could sleep at that location and come back to work at the hospital the next. The reason for this is most jails or prisons aren't in the middle of the city with most of them strategically placed a long distance away from populated areas. E.g. Sing Sing Prison is hours way from NYC.
There are a small handful of jails and prisons right smack next to the program. I worked at U of Cincinnati and the jail was only about a 10 minute drive away from the university and the forensic hospital.
4. How high will the program train you in serious cases? Like surgeries there's different severities of forensic work. A competency to stand trial is like an equivalent to suturing a patient, while a not guilty by reason of insanity case (NGRI) is kind of like an AAA surgery. Many programs will only allow fellows to do the light work, and then you graduate you still won't know how to the serious work.

Most of the information you'll need will be in the top threads that were separated due their content being the most talked about on this forum.

 

[splik]

Some thoughts I will add are that fellowship is only one year and it is not possible for a program to train you in everything during that time. The most important things are that you are comfortable with report preparation and get as much testimony experience as possible. It is also important that you feel comfortable working with attorneys and the courts, know how to practice ethically (e.g. turn down crappy cases, not feel pressured into an opinion you don't support), and how to manage a forensic practice (e.g. knowing how to bill for work, get paid, dealing with tricky situations etc.) There was at one time a proposal to have fellowships move to a competency based procedural system but because it is a crapshoot what cases you actually get this is not feasible and the idea was dropped. I never got any NGRI cases as a fellow (which was just due to randomness) however I have done a good number of NGI cases including high profile ones since that time. I did not get training in sex offender evaluations but trained in using the Static-99R and STABLE and ACUTE afterwards. One does not need a forensic fellowship to be an expert witness or do medico-legal work so you want to make sure you get strong training in a diversity of cases and get a good grounding in the practice of forensic psychiatry and specialized training if you are going this route. A lot of programs do not offer any value.

That said, some things to get a sense of include:
- case mix
- opportunities for testimony and deposition
- formal training in risk assessment tools (e.g. HCR-20, VRAG, Static-99R, STABLE-2007, PCL-R)
- formal training in malingering instruments (e.g. SIMS, SIRS, M-FAST TOMM, b-test, dot counting test, ILK)
- exposure to civil cases including malpractice, personal injury, harassment/discrimination, civil competencies. Most programs are very heavy on criminal cases so it is important to get as much exposure to these kinds of cases.
- exposure to fitness for duty evaluations and psychiatric disability
- having a good grounding in civil commitment, conservatorship/guardianship laws
- all fellowships have to have a substantial clinical component (usually in corrections or a state hospital, occasionally outpatient community forensics or VA) which pays the salary and is an ACGME requirement for forensics to be considered a specialty but this should not take away from the medicolegal evaluation part. Working in a jail or prison is not a specialty though it is certainly an interesting experience.

 

[whopper]

You won't be able to do many serious cases like an NGRI during your 1 year as a fellow. Those cases are few and far between even for big name forensic psychiatrists. IF you develop a good relationship with your fellowship they can further train and foster your growth after graduation. While I was at U of Cincinnati even after I graduated they continued to nurture me for serious cases. The relationship was beneficial not only professionally but personally. The guys that trained me were good people, the types where I enjoyed working with them, and took the ethics of the profession very seriously.

 

[psyguru]

How bout Oregon Health Sciences University, Emory, Medical College of Wisconsin, Northwestern, and University of Minnesota?

I recommend OHSU. Pm me.

 

[Stagg737]

Some forensic psychiatrists will tell you that you HAVE TO train where you eventually want to practice. Personally, I think this is overblown. My preference was to receive the best training possible in a place where I fit in. Good training travels anywhere. If you move somewhere and produce good work, it will not matter that you didn’t train there. Of course, each state is different in terms of laws, statutes, etc. so you may have to do some additional reading/learning if you move to a different state.

Thank you for bringing this up. For those who are forensics trained and practiced in multiple states like @whopper , how much do you feel is state dependent vs. applicable nationally? For example, I realized that the foundations of performing a solid forensic interview will be relatively uniform, but how much do state-specific laws effect the direction or goals of interviews? I'd imagine practicing somewhere like California or Oregon is going to be dramatically different than a location like Texas. How much does this actually matter when looking into fellowship training?

 

[mdwpsyd]

Superb advice splik! (I'm a forensic psychologist, but I've worked with plenty of forensic psychiatrists over the years to recognize wise counsel when I see it. )

- formal training in risk assessment tools (e.g. HCR-20, VRAG, Static-99R, STABLE-2007, PCL-R)
- formal training in malingering instruments (e.g. SIMS, SIRS, M-FAST TOMM, b-test, dot counting test, ILK)

I am impressed when I meet forensic psychiatrists who take the time to learn how to administer instruments like the above. You don't have to slough off the assessment work to us psychologists.

~ Mark

slough, transitive verb … 2 a : to get rid of or discard as irksome, objectionable, or disadvantageous — usually used with off

 

[nexus73]

I agree with everything written above. My fellowship was very good in criminal exposure with numerous competency evals and 3 NGRI evals. Also was able to do some immigration assessments for people seeking asylum. My time working in the prison and jail were interesting. And didactics covered all the information needed to pass the boards.

If anything exposure to civil cases and testifying would have been helpful.

 

[splik]

Thank you for bringing this up. For those who are forensics trained and practiced in multiple states like @whopper , how much do you feel is state dependent vs. applicable nationally? For example, I realized that the foundations of performing a solid forensic interview will be relatively uniform, but how much do state-specific laws effect the direction or goals of interviews? I'd imagine practicing somewhere like California or Oregon is going to be dramatically different than a location like Texas. How much does this actually matter when looking into fellowship training?

To be clear, the reason it is recommended to train where you intend to practice is related to networking and referral sources. It is so much not related to the vagaries of the law. While most forensic practice is local, it is not uncommon to consult or do work in other states. I just finished up a case in another state and consult several times per year with attorneys out of state. The important thing is the attorneys give you the information you need to know pertaining to the letter of the law as is relevant to the psycholegal question at issue.

 

[psyguru]

I developed a forensic practice no where near where I did my fellowship. It may have taken a bit longer. My marketing strategy is Nationwide and maybe 20% of my work is outside my state. Although I may have had a 1 year lead by starting out where I did my fellowship, i think if you have an aggressive marketing plan, you can overcome the move. Most of my business is still from new attorneys from directory listings, active social media outreach and SEO rather than old fashioned word of mouth. The one strategy that I have to do more of is CLE talks.

 

[whopper]

For those who are forensics trained and practiced in multiple states like @whopper , how much do you feel is state dependent vs. applicable nationally?

Unfortunately the locality can heavily make up the results and not because of the laws but due to ignorance.

Local yokel judge for example is doing something completely inappropriate, doesn't know it, no one wants to say it cause they don't want to risk the judge's ire.

E.g. the patient is ordered by the court for an NGRI evaluation and a competency evaluation at the same time. You can't do an NGRI evaluation until it's already been determined that the patient has the capacity, and then competency by the court to give an NGRI decision for a defense. Turns out the idiot local forensic psychologist (or psychiatrist) does it this way so she can double-bill for the same amount of work and told the local yokel judge this is completely appropriate.

So I'm called in the case, am asked to do both the NGRI and competency evaluations at once and I say this goes against the professional ethics without trying to say this actually violates legal procedure to save the judge face. Judge mutters to lawyers "but we've been doing it this way for years and Dr. Joanna Quack told me so!"

And this was in a locality that was only minutes away from Hamilton County, OH where from my experience the judges are the most on top of the legal/medicine interface more so than I've ever seen in any other place I've worked. In large part because Ohio had 3 power-house forensic psychiatrists (Phil Resnick, Doug Mossman, and Steve Noffsinger) not only work in this state but heavily guide the state towards the light with forensic psychiatry.

I had a local judge who did not know mental health law at all preside over a forensic psychiatric case and the guy every few minutes declared this was his first mental-health related case and triple checked the case law and did everything appropriately. I was very impressed. I could tell he must've spent at least a dozen hours reading the case law, and during the case he specifically said comments like, "I'm basing my decision on the precedent established in the case of X v Y for future-reference," while the local-yokel judge I mentioned above I could tell tried to cut every corner, do the least amount of work possible, and wasn't aware of the landmark cases that already determined the norms of practice his court was not following.

A forensic psychiatrist could write a 50 page report and some judges only read the last paragraph where you give the thumbs up vs down to the specific legal question.

The bottom line is a lot of this depends on the judge. The lawyer working with you may know the judge's thought process. Of course know the state and local laws but guess what? Depending on the judge none of this, despite being important ethically, legally, everythingally you can think of, bad judge-doesn't matter. If he doesn't know the law, it won't much if you follow the established precedent that he's not for this specific case. All you can do is do your best so you can walk out of there with your self-respect intact, and on the chance the case is appealed you can claim you did what you were supposed to do while others were not.

 

[psyguru]

How bout Oregon Health Sciences University, Emory, Medical College of Wisconsin, Northwestern, and University of Minnesota?

OHSU is a great program. It may not be regarded as top tier but the training and experience are solid. Some of the attendings are from top tier programs and felt the training at OHSU was solid. You do about 50 cases with supervision and 2 didactic a week.

 

[ArdorAyurveda]

Ivy League Forensic Psych Fellowship = access to Harvard/Yale/Columbia lawyers when they're students (and access to their mentors) = crazy connections down the road?

Something to be said for suffering through a New England winter for a year...

 

[psyguru]

Ivy League Forensic Psych Fellowship = access to Harvard/Yale/Columbia lawyers when they're students (and access to their mentors) = crazy connections down the road?

Something to be said for suffering through a New England winter for a year...

I did my fellowship in another state. It would have been nice to have connections but not 100% necessary. With optimizing my practice growth, from SEO, directory listings, social media presence, etc. I imagine even I had "top-notch" connections, 90% of my cases would come from new attorneys who found me online. I try to target various markets such as civil, occupational IME, criminal, etc.

 

[splik]

Ivy League Forensic Psych Fellowship = access to Harvard/Yale/Columbia lawyers when they're students (and access to their mentors) = crazy connections down the road?

I don't see how this could possibly be the case. Also these schools tend to churn out people who go into politics, biglaw, or work for the government. most of which don't interact with psychiatry. For those who will end up working in the US attorneys office or as a public defender or DA where forensic psychiatrists are frequently used, they will most likely tap local connections. That said, having lawyer friends or connections is definitely going to help get cases because much of how people are found is through connections. This is infinitely more likely to be from college friends or other people in your social network than from your fellowship. The last case I did, I was retained by the parent of a friend of a friend. >90% of the work I do comes from people who contacted me because someone recommended me or they came across a report I wrote and liked my work. I have never had an attorney contact me through my website alone (usually they hear of me then check out the website) though occasionally insurance companies or workers comp cases contact me through my website alone.

 

[notdeadyet]

I’d vote for training where you intend to practice for forensics. I wouldn’t go to a bad program over a good one for the sake of locale, but I’d go to a great one over a really great one.

Forensics is best done by word of mouth. You develop a reputation over time and can choose which lawyers and cases you work with. Unless you’re a raging narcissist (of which there are no shortage in forensics), the ability to choose the type of case and the type of lawyer are the most important parts of a satisfying practice.

The alternative is registering with forensic placement services, advertising on the web, and taking cold calls from lawyers you’ve never heard of. This is how you get roped into bad relationships with dodgy lawyers. Taking referrals from lawyers referred by lawyers you’ve worked makes for a satisfying practice. And as you get better known, your reputation travels but mostly geographically.

You can do a great psych fellowship in Boston and then move to LA. But you are essentially pretty close to starting over. No one knows you. No one cares about your name dropping. The fact that you have a client list and a depo/testimony history is helpful once you make the first round of selection, but it’s hard to make that first round of selection when no one knows you.

I would think of a forensic fellowship similarly to a clinical practice. You can pick up and move anywhere, and you bring your experience with you, but you are largely starting over (albeit with a lot of wisdom). If you are in a good fellowship, you’ll get lots of referrals from your program, you’ll be a known entity in many local courts/judges, DAs, PDs, and law firms. It’s a much more useful thing to finish fellowship with than choosing another program across the country because you really like their football team or they have a more famous head of didactics.

 

[psyguru]

I do take "cold calls". However, these calls are screenable and are easy to handle (as I only treat patients part-time). I have a few ground rules like I avoid pro se cases. My contract (and perhaps my fee schedule) do screen out many of the dodgy attorneys. Even with dodgy attorneys, I have control over my report and testimony. One way is to ensure control is to review the case early and that makes it easy to drop out if you do not agree with the retainer party. Remember the attorney's interests are different from yours. It is important to obtain an adequate retainer so you will have the time/funding to review material and follow leads that may not be favorable to the retaining party. Even a non-dodgy attorney will be more inclined to benefit his or her client over the whims of an expert.

I agree it's great to be selective. But having a good and diverse supply of referrals allows one to be selective with the case and also over your rate.

In my fellowship, most of the exposure was criminal cases and even if I had stayed there, I am not sure I would have the same variety I do now without listing myself. Also listing yourself opens up other opportunities. For example, I was appointed on a governor's correctional health committee and was found online.

If I waited just on word of mouth, it would have taken me another decade to develop my practice to where it is now. In fellowship, I did about 50 cases and then it dropped to about two a year for several years depending on word of mouth. I then diversified the referrals (and locations from Canada to the USVI) with a website and directory listings. It is hard to grow as an expert witness if you are only testifying once a year or doing about 5 cases a year. I am glad I diversified my referrals and I do enjoy the variety of cases.