Forensic pathology

Forensic pathologists must be trained in several fields to succeed at their job. They utilize a wide variety of methods such as conducting autopsies which in itself has a variety of methods. When conducting an autopsy a forensic pathologist may take X-Rays, samples of bodily fluids, samples of tissues, and samples of bacterial culture found within the body.[5] While conducting the autopsy the forensic pathologist uses the stages of death as another method to inspect both the time of death and the amount of time the body has been deceased. Using the Information received during the autopsy paired with evidence provided by law enforcement provides the basis for the determination of the cause of death.

In some jurisdictions, the title of "Medical Examiner" is used by a non-physician, elected official involved in a medicolegal death investigation. In others, the law requires the medical examiner to be a physician, pathologist, or forensic pathologist.

Similarly, the title "coroner" is applied to both physicians and non-physicians. Historically, coroners were not all physicians (most often serving primarily as the town mortician). However, in some jurisdictions, the topic of "Coroner" is exclusively used by physicians.

In Canada, there was a mix of coroner and medical examiner systems, depending on the province or territory. In Ontario, coroners are licensed physicians, usually but not exclusively family physicians. In Quebec, there is a mix of medical and non-medical coroners, whereas, in British Columbia, there is predominantly a non-physician coroner system. Alberta and Nova Scotia are examples of ME systems[6][7]

In the United States, a coroner is typically an elected public official in a particular geographic jurisdiction who investigates and certifies deaths. The vast majority of coroners lack a Doctor of Medicine degree and the amount of medical training that they have received is highly variable, depending on their profession (e.g. law enforcement, judges, funeral directors, emergency medical technicians, nurses).

In contrast, a medical examiner is typically a physician who holds the degree of Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.). Ideally, a medical examiner has completed both a pathology residency and a fellowship in forensic pathology. In some jurisdictions, a medical examiner must be both a doctor and a lawyer, with additional training in forensic pathology.

There are currently three paths to qualify as a forensic pathologist in Australia. The first is to train solely in forensic pathology (although a significant amount of anatomical pathology knowledge is still required) and pass two examinations for forensic pathology only. The second is to commence training in anatomical pathology, and complete an initial anatomical pathology examination, which takes a minimum of three years; then go on to train solely in forensic pathology and complete a forensic pathology examination, which takes a minimum of two years. The third is to complete a minimum 5 years' training in anatomical pathology to qualify as a fellow in anatomical pathology, then complete a post-fellowship year in forensic pathology (a minimum twelve months further training plus successful completion of an examination).

In Canada,[17] individuals must complete an undergraduate science degree, followed by a doctor of medicine degree from one of the seven medical schools in Canada. After these are completed individuals may enter the Royal College of Physicians and Surgeons (RCPSC) which requires the completion of residency training.[18] Anatomical pathology is a five-year residency. Residents who wish to become forensic pathologists must then complete a one-year fellowship in forensic pathology. Forensic pathology is a sub-specialty by the RCPSC. As of 2022, there are three schools in Canada that offer the forensic pathology training program. These schools are the University of Alberta, the University of Ottawa[19] and the University of Toronto. McMaster University ceased their training program in 2019.

Once students have acquired the "Abitur" diploma and completed all the requirements, they can study medicine at a university. Within the medical education system, there are four subdivisions individuals must partake in prior to moving into a specialization.

The first section is a two year preclinical study period where individuals are introduced to the basics. A two month work period at a hospital must be completed between each semester in order to become familiar with everyday life in a hospital. A final exam on the basics concludes this portion.

The second section is a one year clinical period to familiarize the students with the basics of clinical practice. The students complete the first part of the physician's exam at the end of this period.

The third section is another clinical period which lasts for two years, which practices non-surgical, surgical, neurological, ecological and general medicine domains. Here is where forensic medicine is first introduced. Between the first and second clinical sections, four months of medical clerkship are required, which consists of two months in a hospital and two months at any other medical institution. Students complete the second part of the physician's exam at the end of this period.

The final section is a one year practical period where students partake in three 4 month practicums: four months of internal medicine, four months of surgery and four months of clinical practical study of their choice. Students write the final part of the physician's exam at the end of this period.

After completing the previous sections, students are considered "physicians under supervision" and must complete 18 months of training at a medical institution of their choice under supervision from another physician. This is where students can begin their specialization and work in an institution of interest.

Once individuals have completed their medical studies, there is a minimum of six extra years of specialization training for forensic pathology. During this training individuals must complete at least three years and six months working for a legal medicine institution, focusing on clinical forensic pathology training. Then, at least one year of pathology work at a specialized institute is required partaking in autopsy technical training. As well, a minimum of 6 months working with forensic psychiatrists is also required. Finally, a single year of work in any field of medicine or legal medicine must be completed. During these work periods, it is required that these physicians write a number of opinions on their post-mortem examinations, crime scene investigations, crime scene reconstructions and insurance medical cases. There is also a minimum number of reports consisting of their own autopsies, police inquiries, histological investigation and other investigative results. Finally, the practicing physician must complete a certain number of oral court proceedings. Once all of this has been completed, an oral examination, overseen by the Chamber of Physicians (also known as the German Medical Association) is to be completed which allows individuals to officially become a forensic pathologist upon completion.[20]

In India, the specialty is commonly referred to as Forensic Medicine and Toxicology, or Legal Medicine. After completion of medical graduation (MBBS), one has to complete three years of study and training including thesis research, which leads to the award of a degree of MD (Forensic Medicine). One can also alternately pass the board examination conducted by the National Board of Examinations, leading to awarding of Diplomate of National Board (DNB).

The majority of the specialists are attached to the Department of Forensic Medicine and Toxicology in various medical colleges. The classification of posts includes Assistant Professor (Lecturer), Associate Professor (Reader), and Professor. The work profile of the specialists includes conducting autopsies and clinical forensic examinations; apart from teaching the medical students. They have to regularly appear in the courts as expert witnesses. A typical department in a government institution conducts 100 to 5,000 autopsies a year depending upon the jurisdiction. Apart from this, clinical forensic examinations constitute a major part of the work and the number of cases can run up to ten thousand a year in an average institution.

The largest association of the specialty is Indian Academy of Forensic Medicine (IAFM), which also publishes its quarterly Journal of Indian Academy of Forensic Medicine regularly. This association has a specialist member strength of more than 1000.

In Indonesia, forensic medicine, also known as legal medicine ("kedokteran kehakiman"), is a 3-year specialty program that can be taken directly after completing medical school. It is separate from anatomical pathology and clinical pathology. Upon completion of the program, a forensic medicine specialist will obtain the title Spesialis Forensik, or Sp.F. He or she may be addressed in public as Dokter Forensik ("forensic doctor"). Note that there is no pre-medicine program, making the total duration of formal education for one to become a forensic specialist 9 years. It was first introduced through the Dutch colonial criminal justice system in the early twentieth century.

Forensic medicine is also a mandatory round during medical school clerkship. Medical students assist the doctors on autopsies, and they may also be allowed to perform an autopsy under supervision, and to witness in the court.

In Japan, the profession of forensic pathology is not commonly pursued compared to other medical professions such as clinicians and doctors. In Japan, there are 33 of 42 universities that have a department of pathology established on their campuses yet, even so, only  21 of the 42 universities offer residency programs pertaining to forensic pathology.[21]

To become a forensic pathologist, it requires individuals to pursue a four year undergraduate degree. After completing their undergraduate career, it is then required for individuals to attend medical school to either earn their Masters or Doctorates degree. After completing medical school, individuals are then required to have 2 years of mandatory postgraduate clinical education where they learn important clinical skills such as communication skills, common laboratory procedures such as Gram’s stain and urinalysis. When the two year mandatory clinical training is completed, another 3-4[21] years of training is needed to focus more on surgical procedures which is especially for forensic pathologists. During these last 3–4 years of training, forensic pathologists will learn more about specified human anatomy and they will also have the chance to interact with real patients as well as interacting with other forensic pathologists as well. The department of Forensic Medicine at Kyoto University in Japan has a legacy that can be traced back to 1899 when the department of forensic was first founded. The department has been active forces in promoting the significance of forensic medicine through its innovative programs, research, and analysis.

When their training is completed, forensic pathologists in Japan will then have the opportunity to receive their certificate of pathology awarded by the Japanese Society of Pathology[22]

In the UK, forensic histopathology is a five-year training programme, consisting of two years of histopathology followed by three years of forensic histopathology. Successful candidates are eligible for inclusion on the specialist register of the General Medical Council (GMC), which is a requirement to work as a consultant forensic pathologist.

Entry to forensic histopathology specialty training requires completion of the UK Foundation Programme, stages A and B of histopathology specialty training, and a pass in the FRCPath Part 1 examination in histopathology. Candidates are in year 3 of specialty training (ST3) when entering forensic histopathology and progress immediately to stage C. Completion of stages C and D (a minimum of 36 months), and a pass in the FRCPath Part 2 examination in forensic histopathology allow the candidate to apply for the Certificate of Completion of Training (CCT).[23]

Another option is to obtain the full FRCPath in general histopathology, followed by another 18–24 months of training in forensic pathology, which will qualify the candidates with either the Diploma of the Royal College of Pathologists in Forensic Pathology (DipRCPath (forensic)) or the Diploma in Medical Jurisprudence (DMJ). In England and Wales, the candidate will also need to be Home Office Accredited, which will require checks of the training portfolio and completion of a security check and the Expert Witness Training Course run by the Forensic Science Service.

Currently approved centers for forensic pathology training include Belfast, Liverpool, Leicester, Cardiff, London, Sheffield, Glasgow, and Dundee. Not all the posts are currently actively training.

Imminent changes as a result of the Tooke report may require two years or more to be fulfilled on general rotational placements before the option of histopathology arises. The Royal College has not yet issued their response to this matter.

In the United States, forensic pathologists typically complete at least one year of additional training (a fellowship) after completing an anatomical pathology residency and having passed the "board" examination administered by The American Board of Pathology or The American Osteopathic Board of Pathology ("board-certified"). Becoming an anatomic pathologist in the United States requires completing a residency in anatomic pathology, which is on-the-job training one must perform upon completing medical school before one may practice unsupervised. Anatomic pathology (as it is called) by itself is a three-year residency. Most U.S. pathologists complete a combined residency in both anatomic and clinical pathology, which requires a total of four years.

In the United States, all told, the education after high school is typically 13–15 years in duration (4 years of undergraduate training + 4 years of medical school + 4–5 years of residency [anatomic and clinical pathology combined] + 1–2 years of forensic pathology fellowship). Generally, the biggest hurdle is gaining admission to medical school, although the pass rate for anatomic and forensic pathology board examinations (in the U.S.) is approximately 80-90 and 90-100 percent, respectively. The courts do not require the American Board of Pathology certification in order for a witness to be qualified as an expert in the field of forensic pathology, and there are several "diploma mills" that give online certificates in the field.[24]