Asylum medicine is a field that brings together health professionals and human rights advocates to evaluate people seeking protection through the asylum system. Clinicians play a key role by conducting medical and psychological forensic evaluations that help document harm and can strengthen an individual’s legal case. A new Yale-led study, published in BMJ Global Health, introduces a standardized virtual curriculum to train clinicians in performing these forensic medical evaluations (FMEs).
According to Katherine McKenzie, MD, associate professor of medicine (general medicine) at Yale School of Medicine and lead author of this study, there is a shortage of clinicians trained to perform FMEs. “Most of us in asylum medicine are clinicians with full-time jobs—internists, pediatricians, psychiatrists, and social workers—who do this work in our free time,” she says. “While the skills overlap with our clinical training, we still need to be taught how to apply them in a forensic context; we’re not acting as caregivers or advocates but as professionals gathering evidence.”
McKenzie, who directs the Yale Center for Asylum Medicine, worked with other leaders in the field to create the first national curriculum for conducting FMEs that features peer review by experts in medicine, mental health, and human rights. This curriculum is now known as the Asylum Medicine Training Initiative (AMTI).
Studies have shown that access to a forensic medical evaluation can double the likelihood of being granted asylum.
Katherine McKenzie, MD
“We wanted to build on existing training efforts and create something accessible and grounded in expert consensus. The idea was to make the training free and available online. This is especially helpful for clinicians who aren’t near academic centers,” says McKenzie. “Since there’s no formal licensure in asylum medicine, having a recognized curriculum like AMTI helps clinicians build knowledge and strengthen the credibility of their affidavits in court.”
The AMTI was developed through an iterative, structured process using Kern’s six-step approach to curriculum design, an established framework for developing and refining medical education programs. The team focused on building consensus among experts across disciplines and institutions, and aligned the training with international standards outlined in the Istanbul Protocol, the United Nations-endorsed guidelines for documenting torture and ill treatment.
McKenzie highlights the importance that FMEs can play in the trajectory of an asylum seeker’s case and life. “Asylum seekers are usually highly marginalized in society as they flee persecution and danger in search of safety,” she says. “Studies have shown that access to a forensic medical evaluation can double the likelihood of being granted asylum.”
While the full impact of AMTI on clinician knowledge and FME performance is still being studied, McKenzie sees its introduction as meaningful progress. “There’s often strong interest in this work, but turning that interest into practice has been a challenge," she says. "We’re hoping that the AMTI will help bridge that gap and strengthen the workforce that performs these evaluations.”
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