Bridging to Practice

Frequently Asked Questions and Next Steps

Can I perform forensic medical evaluations?

  • Rules about who is qualified to perform FMEs vary geographically and across different organizations.

  • Generally speaking, any fully trained/licensed/board-eligible clinician who can independently diagnose physical and/or psychological conditions within their scope of practice can perform FMEs.

  • Those who are in training/not yet licensed but will ultimately meet these criteria can perform FMEs under the supervision of a trained clinician. For example, medical students, medical residents, PA students and NP students generally fall into this category, while RN students generally do not.

  • The best way to know is to please contact the organization with which you plan to volunteer directly to discuss your qualifications.

  • If you have the appropriate clinical qualifications, all you need to begin conducting GMEs as an expert witness is (1) your medical training and (2) completion of a specialized training course on torture and its physical and psychological consequences (such as this one!), though mentorship in the early stages is highly recommended (see wording from the Istanbul Protocol at the end of this document).

  • Clinicians who regularly diagnose and treat mental health conditions as part of their scope of practice, including internists, family medicine physicians, and emergency medicine physicians, can perform mental health evaluations (see wording from the Istanbul Protocol at the end of this document), and we strongly encourage this! There are far more requests for mental health FMEs or combined mental health/physical FMEs than for those with only a physical component.

How should I prepare to begin conducting evaluations?

  1. Read and familiarize yourself with the Istanbul Protocol!

    • PDF of revised IP 2022 available here

  2. Get connected with the asylum medicine community

    • Join Society of Asylum Medicine

      1. Highlights include a fantastic resource section; list of national orgs, orgs by state, and members; info on upcoming events

      2. Listserv has very useful discussions; great place to crowdsource

      3. All, including med students, can apply to become a member here

  3. Get connected with a referral source for FMEs

    • Register with the PHR Asylum Network

      1. PHR is a national network, more active in some areas of the country than others

      2. Need the date of completion of this training (AMTI Introductory Curriculum) to register

      3. Med students can participate in PHR-affiliated clinics but can’t register with PHR independently (in other words, can’t register using the form above)

      4. Residents can register only if part of a PHR-affiliated asylum clinic

      5. PHR provides “asynchronous mentorship” including preparatory/review phone calls before/after FMEs & affidavit review, but doesn’t provide real-time mentorship (someone to sit in on cases with you); some of their affiliated clinics may offer real-time mentorship

      6. If PHR isn’t active in your area, you can still email them! They may know of independent clinicians working in asylum medicine near you

    • Register with the Mount Sinai Human Rights Program here 

      1. They have both a clinic in NYC and a Remote Evaluation Network (REN)

      2. The REN conducts remote psychological/mental health FMEs

      3. Seeking volunteer physicians (including internists/generalists/FM docs), psychologists, nurse practitioners, and mental health LCSWs, but must have prior experience doing mental health evals (not necessarily remote ones)

      4. Can provide mentoring on how to do remote evals, but you should be comfortable doing mental health FMEs solo/not require mentorship on how to do a mental health FME

      5. This opportunity is only open to med students/residents if they are at Mount Sinai

    • Register with the Center for Refugee & Gender Studies here

      1. Join their expert witness database and legal colleagues will contact you directly about FME requests

      2. There is much less oversight here- consider registering once you are comfortable vetting your own FME requests and performing FMEs independently

    • Other ways to connect with FME referrals: Search online, ask at academic institutions, ask the SAM listserv for other referral sources/asylum clinics/contacts

  4. Find a mentor

    • This can be tricky if you aren’t at an institution with an academic asylum clinic, which often offer mentorship as part of their training/onboarding

    • Some, but not all, referral networks offer mentorship (i.e. PHR offers asynchronous mentorship, MSHRP offers mentorship for remote mental health FMEs only)- ask!

    • Ask the SAM listserv if anyone is willing to mentor you

    • Med students/residents:

      1. Find an asylum clinic near you

      2. Find clinicians at your institution/in your community who are doing evals independently- PHR/SAM listserv are great resources for this

      3. Join PHR’s National Student Program and/or start your own PHR chapter

      4. Start your own asylum clinic with mentorship from existing PHR-affiliated student run clinics

  5. Be a good mentee!

    • Mentorship is a limited resource in this area- be ready to commit to conducting FMEs in the future and be an active learner

    • Write your own draft of the affidavit every time

    • Ask to contribute to the interview

      1. Can start with non-trauma history, progress to conducting the full eval with mentor present

      2. Student learners can assist by note-taking, asking clarifying questions & drafting the affidavit

    • Fully licensed clinicians can have asynchronous mentorship

      1. Review case in advance

      2. Discuss case & review affidavit/pictures afterwards

  6. Know where to access other resources

From the Source:

Relevant wording from the Istanbul Protocol (IP) regarding clinical qualifications for conducting FMEs

  • “All clinicians who conduct clinical evaluations of alleged or suspected cases of torture or ill-treatment should do so in accordance with the Istanbul Protocol and its Principles. The clinical skills necessary to document physical and psychological evidence of torture and ill-treatment include basic clinical competencies. Conducting evaluations in accordance with the Istanbul Protocol does not require certification as a forensic expert, even though this may be the normative practice in some States and is sometimes used to intentionally exclude the testimony of independent clinicians from court proceedings (IP 2022, paragraph 303).”

  • “Documentation of clinical evidence of torture requires specific knowledge by qualified health practitioners. Knowledge of torture and its physical and psychological consequences can be gained through publications, training courses, professional conferences and experience. In addition, knowledge about regional practices of torture and ill-treatment is important because such information may corroborate an individual’s accounts of these regional practices. Experience interviewing and examining individuals for physical and psychological evidence of torture or ill-treatment and documenting findings under the supervision of experienced clinicians is highly recommended (IP 2022, paragraph 304).”

  • “The most important clinical qualification in conducting an evaluation of an alleged victim is knowledge of how to apply the Istanbul Protocol and its Principles. If clinicians are asked to list their clinical qualifications in judicial proceedings, they may consider listing additional information such as: (a) clinical education and training; (b) psychological/psychiatric training; (c) experience in documenting evidence of torture and ill-treatment and other forms of violence; (d) completion of relevant training courses and seminars, including those specific to the Istanbul Protocol; (e) supervision and mentoring by experienced clinicians; (f) association with a human rights organization or network or a treatment centre for torture survivors; and (g) regional human rights expertise relevant to 405 A/69/387, para. 53. medico-legal evaluations. When possible, clinicians conducting clinical evaluations should have knowledge of prison conditions and torture methods used in the region in which torture and ill-treatment were alleged (IP 2022, paragraph 307).”

  • “Many clinicians including primary care physicians, psychiatrists, psychologists, clinical social workers and nurses may acquire the knowledge and skills to diagnose psychiatric conditions. Some physicians may be able to document both physical and psychological evidence of torture or ill-treatment. Clinicians who are not formally trained in psychiatry and/or psychology may acquire knowledge and skills to identify psychological evidence of torture and ill-treatment, such as symptoms of depression, PTSD and anxiety through training or experience (IP 2022, paragraph 308).”