Rotation Schedule
Rotation Schedule
Click the link for a full schedule for the fellowship. The details below list out the various rotations that will take place during the fellowship.
The forensic psychiatry fellows will provide court-ordered evaluations primarily through the Bexar County Magistrate Court. The fellows will evaluate defendants for their competency to stand trial in the Bexar County Adult Detention Center (BCADC), at the in-jail competency restoration program (JBCR), at the outpatient competency restoration (OCR) program and individuals on bond at UT Health San Antonio. Fellows will also perform supervised telepsychiatry evaluations in surrounding county jails through UT Health San Antonio. In addition, the fellows will also evaluate individuals for their appropriateness for Assisted Outpatient Treatment (AOT) and learn to write effective Certified Medical Examinations (CME). The fellows will spend two half days weekly performing court-ordered evaluations.
In Quarter 3, the fellows will spend one half day per week doing Juvenile court ordered evaluations at the Juvenile Detention Center (JDC). The fellows will have the option to continue this half-day change into Quarter 4 in lieu of changing back to adult court ordered evaluations.
Fellows will be assigned competency to stand trial evaluations, criminal responsibility evaluations, presentence evaluations, and dangerousness assessments. The majority of evaluations will be focused on competency and criminal responsibility evaluations to gain proficiency in these evaluations across multiple settings.
The forensic psychiatry fellows will provide forensic consultation and evaluations of forensic patients admitted to the State Hospital. This program is uniquely located between two state hospitals in the area. The fellow will alternate between San Antonio State Hospital (SASH) and Kerrville State Hospital (KSH) for one day every week for 12 months. The schedule of the location typically will be once every other week at each location to get a variety of exposure to forensic cases at each hospital. The schedule is subject to change at the discretion of the Program Director based on the availability of cases.
At SASH, fellows will be assigned competency to stand trial evaluations and criminal responsibility evaluations and will learn the use of psychological and neuropsychological instruments in forensic evaluations. Fellows will learn to administer, score, interpret, and summarize relevant tests and assessment instruments to assess malingering, violence risk assessments, and future sexual recidivism. The fellows will provide consultation to forensic hospital treatment teams to provide risk assessment and treatment recommendations to manage barriers to release. At KSH, the fellows have unique experience with the risk assessments for NGRI community transition and dangerousness evaluations of maximum security patients.
The forensic psychiatry fellows receive training regarding the clinical management of detainees in a jail setting at the Bexar County Adult Detention Center (BCADC). For six months, the fellows will provide longitudinal treatment to detainees one half-day per week. The treatment will include new intakes to the detention center and psychiatric patients in the general population. The fellow will continue to follow the patients on whom they perform an initial psychiatric evaluation.
Fellows will provide medication management for inmates who are referred for psychiatric evaluations. The fellows will have indirect supervision initially in order to orient the fellows into the jail system. By the end of the rotation, the fellows will demonstrate progression in their clinical skills to have the supervisor provide oversight for the fellow working in a correctional facility.
The forensic psychiatry fellows will rotate with practicing forensic psychiatrists. They will spend at least two hours every other week observing and participating in private practice cases.
Fellows will be provided mentorship in the transition to independent forensic practice. Fellows will discuss active cases and observe depositions or testimony as they occur. Fellows will prepare parallel reports and discuss essential elements of a well-supported opinion for commonly encountered civil forensic issues. Evaluations may include topics such as personal injury litigation, psychiatric disability determinations, psychiatric malpractice, guardianship, and testamentary capacity.
The fellows will take the general psychiatry boards in September during their fellowship. The fellows will have dedicated time during Quarter 1 to study for the boards which will also be important for becoming an expert in the field. This is listed as scholarly activity. After September this unscheduled scholarly activity can be used for further research on a quality improvement project, looking up information for an evaluation or treatment case, or as unscheduled time to read over landmark cases.
The electives are integrated into the schedule to provide opportunities to fellows to experience a variety of forensic evaluations. These experiences can include:
(A) Juvenile Evaluations,
(B) Military Evaluations,
(C) Veteran Evaluations,
(D) Geriatric Evaluations (Guardianship Cases),
(E) Auditing a law school course.
The elective time is not intended to be used as unscheduled time to work on reports, however, can be changed to unscheduled time at the direction of the Program Director based on the workload of the fellow. The goal of the elective block is to further enhance and diversify the number of experiences the fellow has during the program.
Fellows should refer to the Elective Course Catalog. (Separate document, available on the fellowship’s SharePoint site) for descriptions of established elective rotations; however, this is not comprehensive as fellows are encouraged to develop their own elective experiences. Fellows are responsible for their elective time and must complete an elective description form (Appendix 5: Elective Description Form) and submit it to the Program Director for approval at least two weeks prior to beginning the elective. Fellows are strongly encouraged to plan and coordinate their elective experiences several months in advance of their anticipated start date due to constraints with credentialing, staff schedules, etc.
All such electives must demonstrate compliance with the requirements in forensic psychiatry and be submitted to the Program Director prior to implementation for review and approval. Fellows failing to submit an elective plan prior to their assigned elective time will be assigned to a core rotation or another established elective per the discretion of the Program Director.
The future goal of the program will be to have specific tracks have rotations geared towards the fellow’s background experience or future career plans. The incoming fellow will discuss these tracks with the Program Director for prior approval. If the fellow wishes to pursue a track, they must let the Program Director know prior to October. If the fellow does not wish to pursue a specialty track, they will still pursue elective opportunities in these specialty areas.
- Military Track: This specific track would be available to those fellows who are currently in the military or are planning to join the VA after graduation. The fellow would work with Airforce forensic psychiatrists on military-specific cases and at the VA on forensic cases. There would be elective time for fellows to work on these evaluations without having to be on the specific track.
- CAP Forensic Track: This specific track would be available to those fellows who have completed a child and adolescent psychiatry (CAP) fellowship prior to the start of this program. The Jail Psychiatric Services treatment location will be changed from the Bexar County Adult Detention Center to the Bexar County Juvenile Detention Center. The fellow will also perform more child and adolescent forensic cases within the juvenile justice system that includes minors under the age of 14.
- Forensic Psychiatry Treatment Track: This optional track is available to all fellows who want more experience in the treatment with the forensic psychiatry patient population. The fellows will have one of the court clinic days changed to treatment of Jail-Based competency restoration (JBCR) patients who have been found incompetent to stand trial (IST). They will continue the treatment of inmates in the Bexar County Adult Detention Center for the year rather than the minimum required six months. Finally, the fellow will work more with the treatment teams at SASH where they will sit in on treatment team meetings for patients they are not assigned to evaluate. However, due to the length of stay at the state hospital and the acuity of their care, the fellows will not be assigned patients to directly treat. There will be elective time that the fellow can take to explore the treatment options without specifically deciding on this optional track.