Three-session psychiatric malpractice curriculum for senior psychiatry residents

Received September 5, 2007; revised November 13 and December 22, 2007, and February 25, 2008; accepted March 26, 2008. The authors are affiliated with the Department of Psychiatry and Behavioral Health at the Medical College of Wisconsin in Milwaukee. Address correspondence to Carol I. Ping Tsao, M.D., Medical College of Wisconsin, Psychiatry and Behavioral Health, 5000 W. National Ave, Milwaukee, WI 53295; ctsao@mcw.edu (e-mail). Copyright 2009 Academic Psychiatry Psychiatrists are among the least frequently sued of all physicians, but in recent years malpractice claims have become more common against psychiatrists, and corresponding judgments have increased (1). Few events in a physician’s professional life cause as much anxiety as being sued in a medical malpractice action. However, U.S. general psychiatry residencies do not routinely instruct trainees about medical malpractice. Though there are many papers on psychiatric malpractice, including “Malpractice and the Psychiatrist: A Primer for Residents” (2), we are not aware of any papers on malpractice curricula in medical education. Furthermore, the Accreditation Council on Graduate Medical Education does not require any specific training on medical malpractice (3). Given the importance of psychiatric malpractice in psychiatrists’ professional lives, psychiatric residency training programs could benefit from a brief course of study on the basics of medical malpractice as applied to psychiatry. At a minimum, increasing awareness of higher risk clinical situations and demystifying the legal process are anticipated to enhance residents’ sense of control and reduce their anxieties. Though the practice of medicine can never be entirely risk-free for patient or physician, instruction about malpractice may also serve a preventive goal when residents adopt some practices that make their future work more lawsuit-proof. Here we propose a curriculum for PGY-3 or PGY-4 residents that consists of two 90-minute didactic seminars, facilitated by a faculty psychiatrist, followed by a 3-hour mock trial on psychiatric malpractice. Session 1 presents a basic overview of tort law as applied to psychiatric medical negligence. Session 2 delves more specifically into the reasons psychiatrists are sued and what legal responses are available to psychiatrists. Finally, session 3 consolidates and places the learned material in the courtroom context. Resident physicians will need to research the literature to fully engage in some of the discussion questions. They might begin their investigation with one of two forensic psychiatry textbooks, such as Rosner’s Principles and Practice of Forensic Psychiatry (4) or Appelbaum and Gutheil’s Clinical Handbook of Psychiatry and the Law (5). The time spent in seminar sessions is built on the expectation of some outside preparation and designed to be interactive. Candid discourse about past clinical experiences and current or possible future conundrums is invited to contain residents’ undue anxiety about being sued and to assure residents that they are in the supportive company of others who very likely share similar concerns. This curriculum anticipates that lecture-style instruction will be minimal and the majority of each seminar will be devoted to discussion. Relatively long sessions, 90 minutes instead of 60 or 45, are suggested in the hope that there will be time for adequate discussion. Some questions designed to initiate discussion are suggested for sessions 1 and 2.