Defining the problem

Forensic psychiatry is the branch of psychiatry that studies the relationship between mental disorders and legal principles, particularly in the context of criminal law, criminology, victimology, and psychiatric expertise. Consequently, general psychiatrists should be familiar with its fundamental concepts [1]. However, several reports highlight the challenges of incorporating regular resident rotations in forensic units [2]. The particular nature of these settings often leads to low levels of comfort among residents with limited prior exposure, despite their strong interest in the field [3].

To address this gap, we propose a protocol for an educational intervention focused on psychiatric expertise. We consider that case-based learning—a participatory methodology that employs relevant real or simulated cases to foster the practical application of theoretical knowledge [4]—may be a valuable approach. Furthermore, the integration of film in psychiatric education is recognized for its motivational impact and teaching effectiveness [5]; thus, it was selected as the medium for presenting the case study.

The objectives of the seminar are:

1. To reinforce the acquisition of foundational theoretical knowledge and promote its practical application in forensic psychiatric expertise.

2. To foster interest and facilitate a friendly familiarization with forensic psychiatry for residents in training.

Intervention Design

Target group: Second-year psychiatry residents rotating through the forensic psychiatry assessment unit who provide informed consent.

Requirements: Participating instructors must be proficient in the teaching methodology and distribute the relevant bibliography before practical sessions. A suitable room equipped for audiovisual projection and group discussion is necessary. Residents will be organized into small groups of three to four participants.

Seminar development: The seminar will take place over four consecutive weeks, with weekly sessions lasting ninety minutes each.

During the first session, an introduction to the topic will be provided, followed by an initial assessment. This test will evaluate theoretical knowledge through multiple-choice questions and forensic psychiatry case vignettes. Additionally, instructions regarding the selected case and the working methodology will be presented. Between sessions, residents are expected to engage in asynchronous study of the assigned bibliography.

The second session will focus on viewing the film Repulsion (Roman Polanski, 1965), which depicts a protagonist committing a series of crimes, presumably while experiencing psychiatric pathology. Residents will be required to gather forensic expertise material based on observations from the film, interpreting both the cinematic narrative and the accounts of the patient and third parties. The instructor will supplement any relevant aspects not depicted in the movie and encourage residents to take technical notes within a collaborative and supportive environment. Finally, each group will summarize the key learning outcomes derived from the session.

The expected learning outcomes are:

1. To develop the ability to integrate different sources of information.

2. Differentiate the interviewer’s posture in classical psychiatry and forensic evaluation.

3. To know the questions that the forensic psychiatrist must answer for the court.

4. To develop the ability to formulate hypotheses based on psychopathological findings.

5. Identify the symptoms, risk factors, studies, and treatments in schizophrenia and other psychoses.

6. Identify clinical complications and dangerousness in psychosis.

7. Recognize the comorbidities of psychosis, including sexual dysfunction such as sexual aversion.

8. Comprehensively express reports addressed to non-psychiatric areas, such as courts.

In the third session, the student’s guide will be handed out, indicating the seminar questions according to the case-based learning methodology. The groups should develop this guide with the support of their teacher. Then, they will have to present to the rest of the course teaching each other what they have learned, complemented with visual material congruent with their learning outcomes. The teacher will guide the discussion, encouraging open analysis and comparison between the various learning outcomes.

The seminar questions include the following:

• What background information and additional sources are necessary?

• Which aspects of the mental status examination help address the objectives of the forensic interview?

• What is your diagnostic hypothesis, and what complementary studies would you require?

• How does the pathology relate to the crime under investigation?

• Do you consider the protagonist legally responsible (imputable)?

• What is the risk of self-harm or harm to others?

• What treatment and prognosis are indicated?

• What legal measures would you propose for the care of the defendant?

• Does the defendant possess the capacity to stand trial?

During the fourth session, participants will retake the same theoretical test designed to assess knowledge and application skills.

Finally, a satisfaction survey using a Likert scale will be administered to gather residents’ perceptions of the intervention. The survey will evaluate their interest, comfort, and perceived impact on their learning process.

Evaluation

The impact of the seminar on both theoretical knowledge and its practical application will be assessed using a test-retest design, comparing participants’ scores on written tests administered before and after the intervention. Data will be analyzed using the Wilcoxon signed-rank test for dependent samples, given the expected non-normal distribution. Participants’ reception of the seminar will be evaluated through descriptive statistics derived from the satisfaction survey, providing insight into their subjective experience.

Ethical Considerations

This study requires approval from the ethics committee. By employing simulated cases rather than real patients, the intervention upholds the ethical principles of beneficence, justice, and non-maleficence, ensuring the protection of participants from potential harm.

Conclusions

The purpose of this communication is to protocolize a forensic psychiatry seminar using case-based learning supported by film. Although this approach does not replace in-person rotations, it facilitates an initial exposure to the forensic field, whose impact and engagement will be evaluated.

Future developments should include more rigorous analyses to justify innovative proposals in medical education, aligning with prevailing methodologies [6].