GOALS AND OBJECTIVES FORFORENSICPATHOLOGY

BACKGROUND

  • Bythe end of their residencyprogram,anatomical pathologyresidents willhave completed:
  • Three (3)autopsyblockswithin theirPGY2year (2 hospital autopsyblocksat theCivic Campus followed by1 forensic autopsyblockwith theDivision of Forensic Pathology at TheGeneral Campus)
  • Two (2) forensic autopsyblocks within their PGY3/4year with the Division of Forensic Pathologyat theGeneral Campus
  • Anumberofmedicolegalpost mortem examinationduringscheduledSaturdayduties.

AIMS AND OBJECTIVES

GENERAL

Duringthewhole oftheautopsycomponent oftheAPresidencyprogram,the APresident is expected to:

  1. Perform a minimumof 50 routine (postmortemexaminations including hospital and medicolegal coroner’s cases)post mortem examinations on adults.
  2. When permitted bythe supervisor, takeownershipof anypost mortem examination performed in terms ofthetimelypreparation ofadraft report(with conclusions) and timely submission of the case fileto theadministrativesecretary(Kim MacDonald) for processing.
  3. Reviewthe histological findings of thecasewith thesupervisor.
  4. Review and interpret toxicologyfindings.
  5. Maintain alogbook ofall medicolegal postmortem examinations whichtheyperformed under supervision and observed. Foreachcase, this willbe recorded bydateperformed, casenumber, causeof death/casetypeand supervisor.
  6. Provide asummaryof the cases performed undersupervision and observed.
  7. Maintain alogbook ofall special autopsytechniques employed bydate performed, case number, natureof special technique and supervisor.

PGY2 ROTATION

Theoverallaims ofthe fourthautopsyblock of the PGY2 rotation are to:

  1. Introducethe AP residenttothe performanceof themedicolegalpost mortem examination
  2. Reinforcethe basicknowledge and skillsofthe post mortem examinationlearnt in the previous threeattachmentblocks of hospital autopsyat theCivicCampus.
  3. Provide an introduction to theperformanceand requisite skill setsneeded to approachand undertakeforensic postmortem examinations in criminallysuspicious deathsthrough direct observation ofstaff forensic pathologists who conduct these examinations.
  4. Provide opportunities tofoster and developinterests in forensic pathology.
  5. Provide support and careerguidance forthoseAP residents who areinterestedin a career in forensic pathology.

PGY3/4 ROTATION

ThePGY3/4 rotations willbuild furtheron the knowledge and skillsets ofthemedicolegal post mortem examination acquired in thePGY2 rotationwith greateremphasisplaced on the types of cases encountered in criminallysuspicious deaths that will include thehomicidal asphyxias, gunshot wounds, blunt forceinjury, sharp forceinjuryand fatal child abuse.

TheCanMEDs objectiveswillbe as follows:

MEDICAL EXPERT

GENERAL REQUIREMENTS
  • Be ableto identifyan awareness of anylimitations of knowledge and skillsets which willpreclude theundertakingof anyparticular post mortem examination.
  • Demonstrate anawareness of biosafetyconsiderations and risk minimization prior to the performance of postmortem examinationsin infectious casesegtuberculosis, HCV, HIV.
  • Identifythose cases in which radiological imagingof thebodyegskeletal surveys is applicable prior to thepost mortem examination eg gunshot wound cases, severely burnt bodies, sudden unexpected death in infancy,
  • Appreciate an understandingof and needforthe collection ofvarious trace evidenceexhibits in thecriminallysuspicious deaths at the start ofthe postmortem examination.
  • Demonstrate theabilityto gather andenquireintoallrelevant information (medical and circumstantial) beforebeginning apost mortem examination. Be ableto interrogate theclinical and laboratoryrecordsandunderstand the utilityand limitations associated with various types of investigation includingimaging, microbiologyand biochemistry.
  • Exhibitan understanding of theuse ofclinical information and thehealth recordin autopsyexamination and be able to identifyanyclinicalissues to be addressedand resolved bythe autopsyexamination.
  • Demonstrate anawareness of the need to considerand reviewthe findings of the sceneof death/discoveryofabodypriorto startingapost mortemexaminationin communitydeaths.
  • Demonstrate andapplyknowledgeof normalanatomy, physiologyand biochemistry.
  • Anticipate and discuss with the coroner the need for and appropriate retention of wholeorgans in case-specific scenarios egretention ofthe heart in asudden death in ayoungperson with anegative autopsy.
  • Seek appropriate case-specific consultations eg cardiacpathology, neuropathology.
  • Describeand applycommonmethods of evisceration and organdissection techniques relevant toroutine autopsypractice.
  • Be ableto describethe special techniques utilized in forensic pathologyeg vertebral arteryexploration.
  • Understand andapplythe differencebetween cause and manner ofdeath.
  • Understand the basic principles of cellbiology, immunologyand pathogenesisand the changes that occurindiseasestates.
  • Confidentlyandcorrectlyidentifythe macroscopic features of themajor disease processesencountered inroutine autopsypractice.
  • Demonstrate theknowledgeof proceduresrequired forthe identification of an unknown decedent.
  • Befamiliar with the effects of time, heat, cold, dryingand humidityon body tissues.
  • Learn the technique for removing abrainafterthe skull has been opened.
  • Learn how to takevitreous/ introduced to technique to removeeyes via posterior approach.
  • Learn about special needs ofcertainreligions.
SPECIFIC REQUIREMENTS
  • Understand the Ontariomedicolegalsystem of death investigation andcompare and contrast with other medicolegal systems in Canada.
  • Read and understand theCoroner’s Act.
  • Be ableto confirm identityof thebodyjustpriorto autopsyfrom identification ofthe coroner’s identification tagand record the mannerof identification.
  • Appreciatethe need to consider and procurethe various relevant traceevidence samples from thebodyincriminallysuspicious deaths in an uncontaminated manner at theverystart of thepost mortem examination.
  • Appreciatethe need to establish and guarantee chains of custodyof thespecimens obtained.
  • Demonstrate theabilityto perform anddocumentthe significantpositive and negative findings on external examination ofabodyat postmortem through the useofbody diagrams, descriptions and photographs.
  • Be ableto appropriatelyclassify,describe and documentinjuries on external examination (written descriptions, bodydiagramsand photographs).
  • Ensurethat satisfactoryphotographsof external and internal injuries/othersignificant findings at autopsyaretaken duringthe post mortem examination, either bythe resident, technical staff orthe police personnelin attendance.
  • Demonstrate anawareness of thevaried methodsoforgan evisceration andan appreciation oftheir application in case-specificcircumstances.
  • Be ableto perform athorough andsystematicdissectionofthe organs and record the findings (descriptions, diagrams and photographs).
  • Be ableto identifyand correctlyinterpret thepositive anatomical findings on organ dissection.
  • Demonstrate asuperiorand detailed knowledgeofthe normal gross and light microscopic appearanceoftissues.
  • Be ableto recognizethe microscopic appearanceofnormal and diseased tissues appropriate to theexperienceofageneralanatomical pathologist.
  • Demonstrate theabilityto consider, applyknowledgeof and procure appropriate samples forthe relevantancillarypost mortem investigations as indicated (histopathology, toxicology, biochemistry, microbiology,molecularstudies, electron microscopyand other studies).
  • Identifypost mortem changesandartifactsduetodecomposition and animal predation.
  • Demonstrate theabilityto interpret postmortem findings in light of theclinical history and/or sceneinvestigation and be able toarriveata cause of death statementin accordancewith theWHO format.

COMMUNICATOR

GENERAL REQUIREMENTS
  • Establish effectiverelationships with coroners, physicians,morguetechnical staff, police, next-of-kin whereindicated, andforensic scientistsas applicable.
  • Be ableto elicit additional information from thecoroner, police and othermedical practitioners.
  • Verballydiscuss andappropriatelyfeedback the results of thepost mortem examination with the requesting coronerat the end of the post mortem examination.
  • Observethe staffpathologistverballydiscuss andappropriatelyfeedback the results of the post mortem examination with the attendingpoliceofficers at the end of thepost mortem examination.
SPECIFIC REQUIREMENTS
  • Verbal appraisal of thecoroner ofthefindingsand thepathologicallydetermined cause ofdeath at theend ofthepost mortem examination.
  • Completion of the “Summaryof Findings”formofthe OntarioForensic Pathology Service asappropriate.
  • Completion of the “ToxicologySubmission Form”of theCentreforForensic Sciences that accompanies the toxicologyspecimens as appropriate.
  • Completion ofthe Biochemistryanalysissubmission form forvitreous humour as appropriate.
  • Completion ofALLrelevant ancillaryinvestigation request formsas appropriate.
  • Preparation ofthe draft andfinalmedicolegal autopsyreports ofahigh standardforthe coroner.
  • Understand theroleof anexpert witness in thedeliveryofforensic pathologyevidence in court.

COLLABORATOR

GENERAL REQUIREMENTS
  • Consult effectivelywithother medical, pathologyandforensicpathology professionals.
  • Appreciatethe value of teamwork involving experts in other forensic sciences such as anthropology, odontology,police specialistsand firearms/ballistics in the investigation ofsuspicious deaths.
SPECIFIC REQUIREMENTS
  • Utilizesufficient experiencein clinical medicineto adviseon the significanceof pathological findingsat autopsy.
  • Followingpreliminaryfindings at autopsy, must beable to adviseconcerned parties on appropriatefurtherinvestigations.

MANAGER

GENERAL REQUIREMENTS
  • Utilize resources effectivelyfor optimal cost-benefit ratios in forensic pathological practice, but without compromisingqualityof work.
  • Work effectivelyand efficientlyin a health careorganization.
  • Utilizeinformation technologyto optimizelife-longlearningand other activities.
SPECIFIC REQUIREMENTS
  • Demonstrateknowledgeof theprinciples of laboratorymanagement.
  • Demonstrate knowledgeof themethods of qualitycontrol in the laboratory.
  • Demonstrate knowledgeofthe methods of risk managementand professional quality assurance as applied to forensic pathology.

HEALTHADVOCATE

GENERAL REQUIREMENTS
  • Understand the need fornext-of-kin genetic counselingfollowingthe findingof congenital/genetic disorders at autopsy.
  • Understand thecontribution of autopsyresults to overallcommunityhealthand safety.
SPECIFIC REQUIREMENTS
  • As members of an interdisciplinaryteam of forensic professionals, thepathologistwill endeavor toensurethat standards ofautopsypractice areregularlyreviewedto meet communityneeds.
  • Inconjunction with the coroner, reinforceto thepublic, the value oftheautopsyto generalcommunityhealth and well-being.

SCHOLAR

GENERAL REQUIREMENTS

  • Develop,implement andmonitor apersonal continuing education strategy.
  • Criticallyappraise sources of information, medicaland otherwise.
  • Facilitate learningof other professionals in the forensic field.
  • Contributeto development of new knowledge.
SPECIFIC REQUIREMENTS
  • Present cases/autopsytopics during the Mondayresidents’academicday. The resident maybeaskedto carryout a small research proposal, initiated either byhimself/herself orbyasupervisingstaffmember and should be able to criticallyappraise theresults.
  • The resident maybe asked to present the results ofconducted research atalocal, national or internationalmeetingofforensicprofessionals with thesupport ofthe supervisor.

PROFESSIONAL

GENERAL REQUIREMENTS
  • Perform highest qualitywork with integrityand compassion.
  • Exhibit appropriate personal and interpersonal professional behaviors.
  • Practice ethical medicine.
  • Demonstraterespect for allgenders,cultures and ethnicgroups in autopsypractice.
SPECIFIC REQUIREMENTS
  • Act as an appropriaterolemodel forothers.
  • Demonstrate aprofessional attitude to colleagues.
  • Have anappreciation of the crucial roleof theforensic pathologistin judicial matters and in general communityhealth and safety. This will include knowledgeof individual professional limitations and the necessityof seekingappropriatesecond opinions.

Revised April 2014

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