Forensic Medicine" in the undergraduate medical curriculum - the following are some of the main issues that need to be addressed:
I. Medicine split into many separate branches long ago. Doctors who work in one branch do not consider themselves competent in other branches. The same is true of Forensic Medicine and it is not possible for a forensic practitioner to be competent in all its subdisciplines. Yet we persist in the regressive approach of advocating a single subject called "Forensic Medicine". Till now the standard way to get around this problem has been to invite staff from other disciplines to handle the teaching of the forensic aspects of their specialties. This "integration" sounds good in theory but in practice it runs into the following problems:
a) Difficult to co-ordinate - staff are not always available when needed and one is not always able to repeatedly change the undergraduate teaching program to suit all conveniences.
b) The staff tend to teach the MEDICAL aspects of their specialty because that is what they are familiar with. The FORENSIC aspect gets ignored.
c) Because of the present curriculum, which considers Forensic Medicine as a para-clinical subject, the forensic aspects of the various medical disciplines quite often have to be taught to students who are yet to have been introduced to these disciplines. For example they may have to learn forensic psychiatry before ever having had a psychiatry posting and forensic aspects of OG in the absence of an OG posting. This is a highly unsatisfactory state of affairs.d) At the end of the course the evaluation of the students is done only by staff of Forensic departments who may not (for the reason mentioned in the first paragraph) be fully familiar with the way specialists teach their own particular fields. Thus a forensic pathologist may not be fully competent to adequately assess a student's response to a question on forensic psychiatry or toxicology simply because it his not his or her area of routine practice and therefore he or she is likely to be unfamiliar with the latest developments which the specialist will be aware of.
THERE IS AN EASY AND OBVIOUS SOLUTION TO THE ABOVE PROBLEMS - instead of teaching Forensic Medicine as ONE subject, and trying to get input from other departments, it is much better to simply allocate the different aspects of Forensic Medicine to the various concerned departments to be taught at the same time as the regular medical posting in that subject. For example Forensic Pathology (autopsies, death and postmortem changes) can be taught as part of Pathology, Forensic psychiatry can be taught as part of psychiatry, toxicology as part of medicine etc, etc. This means doing away with Forensic Medicine as a separate subject. The advantages of this approach are as follows
1. The students learn the topics alongside the medical posting in that subject and so get a better understanding.
2. There is no need for time consuming and difficult co-ordination between different departments - each department teaches the forensic aspects of their subject whenever the students are posted with them.
3. The staff of each medical specialty are encouraged to take up the forensic aspects of their specialty. This is essential if we wish to keep up with developed countries who have long ago realized that this is the most progressive approach. Only in this way can Forensic Medicine grow. A single person is no longer competent to handle all aspects of Forensic Medicine.4. As far as exams and assessment of the students is concerned, it can be done by the respective departments. Thus the pathology exam can have a separate section on forensic pathology (theory and practical), the OG exam can have a section on forensic aspects like sexual offences, the medicine exam could include general medical jurisprudence, toxicology and drunkenness assessment, surgery and orthopaedics could take up mechanical injuries, the anatomy exam could include forensic osteology and radiology, etc, etc.
II. The observing of 10 medico-legal autopsies is another problem area. Many private colleges do not perform such cases and so have great difficulty in complying with this regulation. Getting students to go to the local government hospital for this purpose is also troublesome because permission for the same is often not granted by the responsible person OR there is lack of co-operation and co-ordination between the two concerned institutions. In theory, the observing of an actual autopsy sounds good but in practice when many students crowd around an autopsy table only the few in front of the group get to properly see the injuries - that too for no more than a few minutes. One also cannot guarantee when a case for autopsy might arrive - it may come when students are not available or not come when the students are ready to see it. A well taken photograph or video of positive autopsy findings is just as good for the student to evaluate and has the added advantage that it can be studied for as long or as often as is required and at the student's convenience. So can this method of recording autopsies also be allowed in the new curriculum?
Dr. Noel Walter,
MD FRCPathHead of Forensic Medicine
Christian Medical College, Vellore
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With due respects to Dr. Noel Walter, I would like to give another more easy solution to the issue of teaching of Forensic Medicine. Instead of the subject being taught in the second professional year when the students are not exposed to the clinical subjects fully, the subject should be taught and the examinations in the subject conducted in the third professional year. In this way, the students understand the importance of the subject and also understand the clinical aspects of the subject. Even if the subject is divided and dealt with by different departments as suggested by Dr. Walter, Medical Jurisprudence still would be left untaught. The only solution, thus would be to change the subject from a para-clinical one to a clinical one.
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