Defining the tasks of clinical reasoning in forensic psychiatric evaluation: Psychomedicolegal analysis competency

Natalia Widiasih Raharjanti; Diantha Soemantri; Tjhin Wiguna; Ardi Findyartini; Agus Purwadianto; Wresti Indriatmi; Elizabeth Kristi Poerwandari; Marlina S Mahajudin; Nadia Rahmadiani Nugrahadi; Aisha Emilirosy Roekman; Ronald Leonardo; Adhitya Sigit Ramadianto; Monika Kristi Levania

doi:10.1016/j.heliyon.2023.e14077

Defining the tasks of clinical reasoning in forensic psychiatric evaluation: Psychomedicolegal analysis competency

Heliyon. 2023 Feb 25;9(3):e14077. doi: 10.1016/j.heliyon.2023.e14077. eCollection 2023 Mar.

Affiliations

¹ Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
² Department of Medical Education, Jakarta, Indonesia.
³ Forensic Department, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
⁴ Dermatology and Venerology Department, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
⁵ Faculty of Psychology, Universitas Indonesia, Jakarta, Indonesia.
⁶ Department of Psychiatry, Airlangga University, Surabaya, East Java, Indonesia.

Abstract

Objective: Inconsistency in the quality of forensic psychiatry report has been criticized for several years. Yet, there are limited guidelines to provide minimally satisfactory forensic psychiatry evaluation conducted by psychiatrists. In addition to the impact towards the forensic psychiatry service, this lack of standardized guidelines may impact the relevant competency development and its various teaching methods of forensic psychiatry among general psychiatrists. Therefore, this study aims to identify components of psychomedicolegal analysis competency as a form of clinical reasoning in forensic psychiatry.

Methods: A comprehensive literature review and expert panel discussions were conducted simultaneously to formulate an initial list of psychomedicolegal analysis competency. A total of fourteen experts were chosen based on their expertise in different disciplines that have intersections with forensic psychiatry and the general psychiatry curriculum (e.g. general psychiatrist, forensic psychiatrists and psychologist, law practitioner, and medical education director). The expert panel were instructed to score and provide feedbacks on the items of the initial list. Four-point Likert scale were used in order for the experts to express the relevancy of the core competence to forensic psychiatry practice until it reached the consensus.

Results: The final 60 items of psychomedicolegal analysis competency were developed after three rounds of Delphi technique and reached a consensus (>70% and medians score of at least 3,25). These competency then categorized into four steps 1) preparing the case (Item 1-11), 2) conducting the evaluation (Item 12-41), 3) writing the report (42-51), and 4) giving expert opinion in court (Item 52-60).

Conclusion: We developed 60 items of psychomedicolegal analysis competency that can be used as a standardized guide for psychiatrists to conduct forensic psychiatry evaluation, write the report and provide expert opinion in court. Implementation of this guideline can be used to shape further forensic psychiatry education for general psychiatrist and psychiatry residency.

Keywords: Clinical reasoning; Core competence; Forensic psychiatry evaluation; General psychiatrists.