A Comparison of Coronary Artery Stenosis Estimates Made by Forensic Pathologists and Medical Students

Previous studies suggest cardiovascular pathologists are less accurate than noncardiovascular pathologists (e.g., clinical pathologists) in estimating the degree of coronary artery stenosis. To further investigate the effect of training on accurate estimation of coronary artery stenosis, we designed a study to compare the accuracy of estimates made by forensic pathologists versus medical students. Six forensic pathologists and twelve medical students each independently examined 24 images of coronary artery cross sections and gave an estimate of the degree of stenosis. When comparing all 24 images, the forensic pathologists had a median difference between the estimated percentage of stenosis and actual percentage of stenosis of −12.380 and the medical students had a median difference of −16.50 (p-value of 0.08542). In estimating the percentage of stenosis, training in forensic pathology does not guarantee significantly improved accuracy compared with medical students. Our study showed no consistent statistically significant difference between estimates given by forensic pathologists and by medical students.     

Forensic pathology--the hidden specialty: A survey of forensic pathology training available to medical students and residents

It is no wonder that some people refer to forensic pathology as the "hidden specialty." This paper shows evidence that the only exposure given to most medical students is a brief, all-too-explicit demonstration ("horror show") of interesting cases that can only attract the bizarre of mind into the field. It is further pointed out that even residents in pathology receive scanty, if any, formal training in most medical school residency programs, in spite of the fact that two thirds of the medical schools responding have one or more forensic pathologists on their faculty. The obvious answer is a change in the curriculum if this increasingly important subspecialty is to be saved.     

The modern concepts of placental pathology and its role in perinatal mortality in the context of forensic medical practice

The modern concepts of placental pathology are considered and analysed in the context of forensic medical practice. The most promising approaches to the application of fundamental knowledge of placental pathology (including morphometric methods) for the purpose of forensic medical expertise are discussed.     

医学生认知医疗损害法律制度的干预研究

为了提高医学生对医疗损害法律制度的认知水平，对学生进行针对性的医学法学教育。本文以《侵权责任法》医疗损害责任制度及相关卫生法规为切入点，采取专题讲座、开设医学法学选修课、编写《医学生医疗纠纷防范手册》、链接临床案例等综合手段干预学生的认知。结果提示，学生医学法学的认知水平干预前后存在显著差异，P〈0.01。本研究表明，有效的干预手段能极大地提高学生对医疗损害法律制度的认知水平，在学时有限情况下，案例式的医学法学教育、专题讲座、专业课与医学法学课程资源的整合交叉可以达到事半功倍的效果。建议在新一轮专业课教材的编写中，尝试链接相关的法律制度和案例，使学生医学教育与法学教育同步提高。     

医学生对病历书写基本规范的认知差异及干预研究

为提高医学生病历书写技能、掌握病历书写要求和法律规定,本研究以《侵权责任法》第七章医疗损害责任和《病历书写规范》为依据,评估、干预、提高医学生的病历书写技能和法律意识。结果显示,实习生与在校生有统计学差异,干预前后的在校生对病历书写规范及医疗损害法律制度的认知有统计学差异。研究认为,在校生经针对性、综合性、规范化的病历书写规范培训后,能有效掌握病历书写规范的要求和法律制度。建议病历书写规范的培训应该常规化、制度化、规范化,纳入教学计划,提高医学生的病历书写技能和法律意识,减少病历记录不良和记录瑕疵,防范医疗纠纷。     

医学生对医疗损害法律制度的认知现状调研

为了提高医学生的法律意识,谨慎地对待患者的生命权与健康权,防范医疗纠纷和医疗事故的发生。本文以《侵权责任法》医疗损害责任制度及相关卫生法规为切入点,评估医学院校学生对医疗损害法律制度的认知现状,对学生进行医学法学知识测评和问卷调查,结果表明,学生对法律条文的理解与临床实践存在很大差异,在校生与实习生、西医类专业与中医类专业学生医学法学成绩存在显著差异,实习可有效提高学生的认知。本研究提示,学生对医疗损害法律制度的认知不足与教师卫生法学知识的不足、学时有限、医学与法学课程缺乏学科间的交叉整合、缺少复合型师资、专业类别等密切相关。     

The effects of the (fentanyl-fueled) drug overdose epidemic on medicolegal death investigation in the United States

The evolving opioid epidemic in the United States, fueled by illicit fentanyl, has greatly increased deaths from illicit drug use. These nonnatural deaths require formal death investigation. The National Association of Medical Examiners states in its Forensic Autopsy Performance Standards that autopsy remains a necessary component for proper investigation of suspected acute overdose deaths. If a death investigation office lacks adequate resources to investigate all deaths under its jurisdiction while meeting expected standards, then that office may be forced to consider altering its protocols for investigation by changing the types of deaths investigated or the extent of its investigations. Drug death investigations take longer to complete because novel illicit drugs and mixtures of drugs complicate toxicological analyses, prolonging a family's wait for completion of a death certificate and autopsy report. Public health agencies must also wait for results, but some agencies have developed mechanisms for rapid notification of preliminary results to allow timely deployment of public health resources. The increased deaths have strained the resources of medicolegal death investigation systems throughout the United States. Given the significant workforce shortage of forensic pathologists, newly trained forensic pathologists are too few to meet the demand. Nevertheless, forensic pathologists (and all pathologists) must make time to present their work and themselves to medical students and pathology trainees to encourage an understanding of the importance of quality medicolegal death investigation and autopsy pathology and to provide a model that can encourage interest in a career in forensic pathology.     

Discrimination between functions of an expert bureau and a burial firm (topic for discussion)

The authors suggest measures aimed at discrimination of the functions performed by forensic medical experts and the services rendered by burial firms. The responsibilities of pathology departments of hospitals and bureaus of forensic medical expert evaluations, which should be reflected in official documents, should be confined to manipulations needed to solve the professional problems and removal of sections. Cases when utilization of certain chemicals or manipulations aimed at restoration of the body are prohibited should be listed in detail. The order of transfer of the body from pathology department or forensic medical bureau to the burial firm and to relatives should be regulated with consideration for the results of autopsy. The moment of the end of autopsy studies is to be determined.     

Potentially dangerous behavior in the mentally ill: attitudes of journalists and medical students toward compulsory admission

Compulsory admission is a critical measure that may lead to stigmatization of patients. The authors investigated what medical students and journalists consider legitimate conditions for compulsory admission. The most frequently quoted conditions in both groups were violent attempts against others. About one third of each group considered continuous neglect as a reason. Students significantly more often than journalists advocated for civil commitment in the case of suicide attempts and violent attempts. Medical students with personal contact with mentally disordered persons advocated significantly more often for coercive measures in the case of suicide attempts. Comparing journalists and medical students having personal contact with mentally disordered persons revealed that medical students significantly more often supported commitment. Journalists displayed a more liberal attitude toward the mentally ill than did medical students.     

Analysis of Forensic Autopsy in 120 Cases of Medical Disputes Among Different Levels of Institutional Settings

Despite advances in medical science, the causes of death can sometimes only be determined by pathologists after a complete autopsy. Few studies have investigated the importance of forensic autopsy in medically disputed cases among different levels of institutional settings. Our study aimed to analyze forensic autopsy in 120 cases of medical disputes among five levels of institutional settings between 2001 and 2012 in Wenzhou, China. The results showed an overall concordance rate of 55%. Of the 39% of clinically missed diagnosis, cardiovascular pathology comprises 55.32%, while respiratory pathology accounts for the remaining 44. 68%. Factors that increase the likelihood of missed diagnoses were private clinics, community settings, and county hospitals. These results support that autopsy remains an important tool in establishing causes of death in medically disputed case, which may directly determine or exclude the fault of medical care and therefore in helping in resolving these cases.     

The forensic or medicolegal autopsy. Friend or foe?

The major issue in questioning the performance of general pathologists doing medicolegal or forensic autopsies is that they are very often without a firm basis for performing this task. With minimal training in medical school and minimal exposure during their residency, practicing general pathologists, although expected or even forced to do these cases, may face criticism after their performance in a case. The necessity for teaching forensic medicine and pathology in medical schools is obvious, and the necessity of there being more forensic pathology exposure in residency training programs in the United States and overseas is also obvious. Medical educators are responsible for all phases of medicine being taught to medical undergraduates and graduates and must be pressured to support the practice of all kinds of medicine in American communities, including legal or forensic medicine, in those cases in which questions arise that lead to the performance of postmortem examination.     

医学生临床法律意识和能力的调查及分析

2008年教育部、卫生部联合印发了《本科医学教育标准——临床医学专业（试行）》（教高[2008]9号）文件,指出本科临床医学专业毕业生必须树立依法行医的法律观念,学会用法律保护病人和自身的权益。本文通过对250名在校医学生的法律意识和能力的调查统计,反映出现在医学院校中医学法律教育存在的问题,并针对问题提出了应加强医学生在校基础理论教育阶段、准备临床实习前期、临床实习阶段三个重要阶段的医学法律教育。     

Survey of forensic pathologists

A survey of board-certified forensic pathologists (from a list of board-certified forensic pathologists supplied by the American Board of Pathology) was conducted to determine their current practice situations. The purpose of the survey was to provide information useful to the public in general and to those organizations that represent forensic pathologists in particular to better understand and meet the needs of the forensic pathology community. A total of 773 surveys were mailed, and 18 were returned as undeliverable. There were 337 replies (45%). Responses were as follows: In terms of age, 7% were in their 30s; 32% were in their 40s; 29% were in their 50s; 19% were in their 60s; and 13% were 70 years of age or older. In terms of gender, 79% were male and 21% were female. For pathology practice status, 72% worked more than 30 hours per week; 11% between 5 and 30 hours per week; 5% less than 5 hours per week; and 12% no longer practice pathology. For percentage of pathology practice that is forensic pathology, 69% of respondents were more than 80%; 6% were 50%-80%; 5% were 25%-50%; 8% were 5%-25%; and 12% were less than 5%. In terms of forensic pathology practice setting, 54% were employed by medical examiner or coroner systems; 13% worked under contract to medical examiner or coroner systems; 27% worked in private practice or consultation; and 6% responded as "other."     

Teaching post-mortem external examination in undergraduate medical education--the formal and the informal curriculum

In undergraduate medical education, the training of post-mortem external examination on dead bodies might evoke strong emotional reactions in medical students that could counteract the intended learning goals. We evaluated student perception of a forensic medicine course, their perceived learning outcome (via self-assessment) and possible tutor-dependent influences on the overall evaluation of the course by a questionnaire-based survey among 150 medical students in Hamburg, Germany. The majority of students identified post-mortem external examination as an important learning objective in undergraduate medical education and did not feel that the dignity of the deceased was offended by the course procedures. After the course, more than 70% of the students felt able to perform an external examination and to fill in a death certificate. Respectful behavior of course tutors towards the deceased entailed better overall course ratings by students (p<0.001). Our findings highlight the importance of factors such as clearly defined learning goals and course standardization (formal curriculum) as well as tutor behavior (informal curriculum) in undergraduate education in forensic medicine. Furthermore, we suggest embedding teaching in forensic medicine in longitudinal curricula on death and dying and on the health consequences of interpersonal violence.     

Integrating the Accreditation Council for Graduate Medical Education general competencies into forensic pathology fellowship training

Since July 2004, forensic pathology fellowships have been required to provide training in 6 general competencies: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. In anticipation of this movement, beginning in 2002 the Office of the Medical Investigator (OMI) of the state of New Mexico began incorporating specific training in the general competencies into the fellowship program. Our experience has shown that the additional instruction and evaluation have proven to be valuable in preparing fellows for a successful forensic pathology career, did not detract from the more traditional aspects of forensic pathology training, and in many instances improved our training and assessment procedures.     

Forensic medical aspects of bone tissue injuries and pathology

This paper reports the results of a number of investigations into forensic medical aspects of bone tissue injuries and pathology that may be of value, both theoretical and practical, for the further studies in this field. The data obtained shed light on the influence of bone porosity on the mechanism of fractures and processes of reparation in the bone tissue. Moreover, they can be used for the purpose of forensic medical expertise.     

Expert systems for medical diagnosis: A study in technology transfer

Expert systems continue to evolve for specific applications in medical diagnosis. This is necessary because the influx of new information is so massive that the expert systems must be specialized. The research methodology for this study was based on the usage patterns of expert systems in clinical pathology with data obtained at 94 US medical schools from 202 medical-school-based clinical pathologists. The study showed the link between the use of expert systems in medical schools and within the professional medical community. Initial education in medical schools and ongoing communications through residency programs, post-doctoral fellowships and clinical usage at university hospitals with the goal of technology transfer between medical schools and physicians, seem to represent the future for this valuable diagnostic technique.     

Telemedicine and the law

The delivery of medical services through the use of modern technology is proving of significant benefit, particularly in remote communities where transportation of patients and medical practitioners is problematic. Technical systems supporting telemedicine-based consultations have been available for some years and more recently diagnostic services such as pathology and radiology have embraced this new technology. While teleradiology and telepathology allow medical services to be delivered across vast distances from highly populated areas to regions of low population density, the same technology can also deliver services across national and international boundaries. Where the patient and medical practitioner are located in different jurisdictions, issues arise regarding the regulation of medical service provision and this has an impact on the registration of medical practitioners, mutual recognition of training and specialisation and the administration of medical service provision. The increasing specialisation of medical practice and manpower shortages in key practice areas would suggest that there will be ongoing expansion of telemedicine services in the years to come. This will require greater standardisation of medical education, together with an improvement in arrangements for mutual recognition of medical practitioners across national boundaries.     

History of environmental pathology

Environmental pathology provides the opportunity for the pathologist to enter the mainstream of medical diagnosis and treatment through the application of his special skills and knowledge to the problems of the patient as created by his exposure to the environment.