Format of the Examination in Forensic Psychiatry - 2023

About the Exam

Purpose

The purpose of the examination is to assess the candidate’s clinical competence and readiness to enter clinical practice. The exam is developed and reviewed by the Forensic Psychiatry examination board, which is made up of practicing Canadian physicians who are recognized content experts. In addition, the exam is reviewed by a quality reviewer, a linguistic reviewer for translation accuracy, and a Royal College editor.

The content of the examination is based on a blueprint that reflects the Competencies in Forensic Psychiatry and the depth of knowledge required for the examination to ensure that the examination reflects relevant clinical practice in Forensic Psychiatry. All candidates are strongly encouraged to read the blueprint and the Competencies thoroughly.

Passing the Exam

The Royal College Examination in Forensic Psychiatry is a written-only examination. The pass score is 70%.

Questions that were overly difficult, fail to distinguish between low and high scoring candidates, or for which new evidence emerged between the time of question writing and exam administration are reviewed. As a result of this review process, some questions may be deleted from the final exam score for all candidates. The exam scores are then reviewed by a panel of subject matter experts in a standard setting process and adjusted, if appropriate, to ensure the exam is set at a proper standard for candidates entering unsupervised practice.

Overall Format of the Examination

The format of the examination is provided in the table below:

Component	Format	Number of Items	Total Test Time
Written	Paper 1: SAQ	~32-45	3 hours

Written Examination

Objective of the Written Examination

The written examination measures knowledge and application of knowledge necessary to function as a competent specialist in Forensic Psychiatry. Most questions will concentrate on the Medical Expert role, but some may also assess the other intrinsic CanMEDS roles (Communicator, Professional, Health Advocate, Leader, Collaborator and Scholar).

Content of the Written Examination

The content of the examination is based on a blueprint that reflects the Competencies in Forensic Psychiatry. The content is balanced to ensure an appropriate representation of the relevant domains. Typical areas of knowledge assessment and a range of percent marks on the examination are included in the table below.

Classification	% Marks*
1. History	0 – 5
2. Ethics	5 – 10
3. Criminal Forensic Psychiatry	10 – 15
4. Special Populations	5 – 15
5. Expert Witness	5 – 15
6. Risk Assessment	5 – 15
7. Correctional	5 – 10
8. Malingering	5 – 15
9. Review Board	5 – 10
10. Civil	5 – 15
11. Violence	10 – 15
12. Research	0 – 5
13. Administration	0 – 5
14. Landmark cases	0 – 5
15. Other	0 – 5

*The ranges are approximate and may vary slightly

The subjects covered in this examination will be related to:

The history of forensic psychiatry, knowledge of the Canadian legal system pertaining to forensic psychiatry, and familiarity with landmark cases in forensic psychiatry;
Ethics issues, including issues of patient confidentiality and consent, including (with reference to) CMA, CAPL and AAPL guidelines;
Civil forensic psychiatry, including personal injury, fitness to work, disability, and mental competency for various tasks and professions;
Criminal forensic psychiatry, including pre-trial (not criminally responsible [NCR] and fitness to stand trial), Dangerous Offenders and pre-sentencing examinations;
Assessment and treatment of special patient populations, including violent offenders, sexual offenders, youth offenders, geriatric offenders, and stalkers;
The role of the expert witness in criminal and civil arenas, forensic assessment, report-writing, and testifying in court and tribunals;
Risk assessment, including risk instruments and guides;
Issues regarding malingering; and
Issues pertaining to all aspects of Criminal Code Review Board assessments.

Scoring of the Written Examination

Each short-answer question is created with a list of model answers. This list is used to guide the markers as to the value of the responses when scoring the question. Partial marks may be allocated for some responses. Members of the Examination Board score short-answer questions, and discuss with their colleagues to ensure that any correct responses outside of the anticipated model answers are given appropriate marks. If a candidate provides more responses than requested, only the first responses corresponding to the number of answers required will be considered in marking. Marks are only awarded for correct answers; no marks are deducted for incorrect responses. Be as brief and direct as possible.

Sample Questions from the Written Examination

SAMPLE WRITTEN EXAM

Additional Information

To access examination dates, view Deadlines, dates and locations.

To access information on online exams, how exams are developed, exam format, pass rates, and tips on how to study for the exam, view Prepare for exams.

To access information on what to expect on exam day: FAQs, identification requirements, conflicts of interest, candidate conduct, and more, view Exam day.

To access information on results dates, how to access your results, data verification, and more, view Results.

Terminology used in the Examination

All candidates should be aware that regional differences in terminology may not be reflected in the exam. The terminology used in the exam has been vetted by the Royal College’s team of language professionals in close collaboration with a linguistic reviewer, who is a physician. It reflects standard terminology appropriate for your specialty.

Royal College exams routinely include abbreviation and acronym definitions. However, abbreviations and acronyms that are common knowledge to clinicians are not spelled out (e.g. MRI, CT, ECG, IV, BMI, HIV, CBC, etc.). The same practice applies for clinical trial names, with exceptions for when candidates are being asked to define or explain the trials themselves.

Below is a table that includes explanations of specific terms used in exam questions.

MOST likely	refers to the response most likely for that clinical scenario
INITIAL	refers to the first step you would take in that specific clinical scenario
NEXT	refers to the next step you would take in that specific clinical scenario
ASSESSMENT	refers to the clinical assessment for that scenario, which would include history, physical examination, bedside point of care testing (but would not include lab investigations)
INVESTIGATIONS	refers to all investigations for that specific clinical scenario, and may include laboratory, diagnostic imaging, ECG, referral to other specialties/ subspecialties, etc.
TREATMENT	refers to all therapies for that specific clinical scenario and may include pharmacological treatments, non-pharmacological treatments, surgical therapies, fluids and electrolytes, nutritional therapies, education, counseling, and follow-up
MANAGEMENT	refers to the steps you would take in the clinical assessment, investigations, and/or treatment for that specific clinical scenario

Reference and Study Materials

For sources with multiple editions, please refer to the most recent edition. In the event that a textbook or guideline has been published in the last 12 months, answers will also be accepted from the previous edition of the textbook.

The Royal College exams follow the Canadian and/or American “standard of care” for clinical practice, and clinical practice guidelines published in Canada and the United States. In the absence of Canadian or American guidelines and when relevant, candidates may reference guidelines from other international organizations.

Study materials include, but are not limited to:

Sample textbooks

Glancy, G., & Regehr, C. (2020). Canadian landmark cases in forensic mental health. Toronto: University of Toronto Press.
Bloom H and Schneider RD. Mental Disorder and the Law: A Primer for Legal and Mental Health Professionals (2006);
L. Gold, R. Frierson, & R. Simon (eds.), APA textbook of forensic psychiatry (3rd edition). The American Psychiatric Publishing Textbook of Forensic Psychiatry, American Psychiatric Publishing, Inc; [2017]
Rosner R and Scott C, eds. Principles and Practice of Forensic Psychiatry, 3rd Edition. Dec 18, 2016.

Sample Journals

Journal of AAPL

Sample Guidelines

Glancy, G. et al (2015). Practice guideline: The forensic assessment. Journal of the American Academy of Psychiatry and the Law, (supp), 43, 263.
Ramshaw L, Wilkie T, Chatterjee S, Glancy G. Canadian Guidelines for Forensic Psychiatry Assessment and Report Writing: General Principles, Canadian Association of Psychiatry and the Law, https://www.capl-acpd.org/publications/guidelines-for-forensic-psychiatry-assessment-and-report-writing/. Accessed June 16^th, 2023
Ramshaw L, Glancy G, Wilkie T, Chatterjee S. Canadian Guidelines for Forensic Psychiatry Assessment and Report Writing; Fitness to Stand Trial, Canadian Association of Psychiatry and the Law, https://www.capl-acpd.org/publications/guidelines-for-forensic-psychiatry-assessment-and-report-writing/. Accessed June 16^th, 2023
Ramshaw L, Wilkie T, Glancy G, Chatterjee S. Canadian Guidelines for Forensic Psychiatry Assessment and Report Writing: Criminal Responsibility, Canadian Association of Psychiatry and the Law, https://www.capl-acpd.org/publications/guidelines-for-forensic-psychiatry-assessment-and-report-writing/. Accessed June 16^th, 2023
Ramshaw L, Chatterjee S, Glancy G, Wilkie T. Canadian Guidelines for Forensic Psychiatry Assessment and Report Writing: Violence Risk Assessment, Canadian Association of Psychiatry and the Law, https://www.capl-acpd.org/publications/guidelines-for-forensic-psychiatry-assessment-and-report-writing/. Accessed June 16^th, 2023 
Ramshaw L, Wilkie T, Chatterjee S, Glancy G. Canadian Guidelines for Forensic Psychiatry Assessment and Report Writing: Dangerous Offender and Long-Term Offender Risk Assessments, Canadian Association of Psychiatry and the Law, https://www.capl-acpd.org/publications/guidelines-for-forensic-psychiatry-assessment-and-report-writing/ Accessed June 16^th, 2023

Other Resources

DSM 5

Questions?

To ensure fairness to all candidates, all of the information that can be shared about the format of the examination is available in this document. If you require clarification on the content of this document, please contact credentials@royalcollege.ca.

Updated June 2023