Fitness for Duty Assessments: Teaching Forensic Psychiatry Fellows Best Practices in Workplace Safety Consultation
Forensic psychiatrists are commonly called upon to perform fitness for duty (FFD) evaluations in situations where employers have concerns regarding an employee's ability to do the essential functions of their job safely. Referrals for fitness for duty evaluations typically occur when employers notice deficits in an employee's ability to work or observe conflicts or disruptive (i.e. erratic, unusual, disturbing, or aggressive) behavior in the workplace [1, 2] In most state jurisdictions, an employer may require an employee to submit to a medical examination by a physician designated to evaluate the capacity of the employee to perform the work of his or her position. The forensic psychiatrist, familiar with the legal requirements of FFD evaluations as well as with expertise in psychiatric problems, disability, and violence risk assessment, is uniquely poised to be of assistance to employers. Since fitness for duty cases typically involve issues of potential workplace violence and/or danger to public safety, it is imperative that forensic psychiatry fellows have excellent training in conducting these unique and challenging examinations. The importance of developing competency in consultation to non medical systems (i.e. military, schools, businesses, etc. is outlined in the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Psychiatry and Neurology's "The Forensic Psychiatry Milestones Project" [3] In authoring the Forensic Psychiatry Milestones, leading educators in the field of forensic psychiatry identified developmental benchmarks, i.e. "milestones," for the evaluation of forensic psychiatry trainees throughout their progression in ACGME accredited fellowship programs. Published in 2013, each milestone is rated on a scale of one through five, with a score of one being the lowest rating and a score of five being the highest. The Forensic Psychiatry Milestones Project reflects professional consensus on the core components of competency and professionalism for newly graduated board eligible forensic psychiatrists. The Milestone titled "SBP3Consultation to Medical Providers and Non medical systems (e.g. military, schools, businesses, forensic)" outlines the necessary skillset for forensic fellows to develop in training in order to demonstrate competency in making recommendations as a "consultant and collaborator" to non medical systems. Key milestones include: "Provides, under supervision, forensic recommendations through collaboration with health care teams and/or nonmedical stakeholders (e.g. attorneys, courts)" "Manages complicated and challenging consultation requests," and "Provides forensic psychiatric consultations to larger systems." An aspirational milestone is defined as: "Leads a forensic psychiatric consultation team" [3, p. 8] This article outlines recommendations for teaching forensic psychiatry fellows best practices in conducting fitness for duty assessments. By utilizing a combination of both didactic and experiential learning, forensic psychiatry fellows can achieve competency in the relevant milestones and begin developing their expertise in this important area of practice. While many individuals enter forensic psychiatry fellowship with a welldefined interest in criminal law, the intersection of mental health and employment law is often relatively new territory. Since most referrals for FFD come with some degree of urgency due to the workplace safety concerns, the faster pace of FFD cases allow fellows to quickly gain an understanding of the important contributions forensic psychiatrists make in assisting employers and organizations in difficult and/or dangerous situations. Jessica Ferranti JAFerranti@ucdavis.edu
Academic Psychiatry