Education and training in forensic medicine in United Kingdom: Fit for purpose?

It would not be unreasonable to conclude that the development of forensic medicine in the United Kingdom to the present day owes more to serendipity rather than to structure when compared to other European countries such as France, Germany and Italy. The probable explanation partly lies in the differences in legal systems and practice between Europe and most of the UK. The approach in continental Europe of Roman canon law to legal decision making in contrast to English common law encouraged the development of forensic medicine in a more formal manner. One of the main reasons for this is that all decisions in Roman canon proceedings were made by judges, and therefore technical evidence could be incorporated more fully into the process of adjudication. On the other hand, this was less possible in common law trials, where the use of juries tended to discourage testimony that could not be readily understood by lay people. ¹

One of the consequences of such an evolution in the UK has been the fragmentation of forensic medicine into a number of sub-specialties, incorporating both part-time and full-time forensic medical practitioners. In addition, the very multidisciplinary nature of forensic medical practice, both in the UK and the rest of Europe, has created difficulties in achieving mono-specialty status, although this problem is close to being resolved through the efforts of the European Council of Legal Medicine ² which was founded for the purposes of harmonising forensic medical practice.

Furthermore, and particularly in the UK, there has been some reluctance in appreciating the value of a unitary approach to forensic medicine, rather believing that each should be regarded as a sub-specialty within larger medical specialities. As a consequence of such a view, forensic medicine has been regarded as playing only a minor part in the health and welfare of the nation compared to other specialties. For this and other reasons, there has been a serious decline in the teaching of the subject generally in medical schools, losing out to the major traditional subjects in the undergraduate curriculum, receiving serious consideration only when introduced as a postgraduate subject. Resources are scarce when competing with other subjects which are seen as mainstream. In the case of forensic pathology, this has been pointed out by a number of eminent practitioners.^3–5 Its function has mostly been regarded in the past in existing university forensic departments as providing a medico-legal service with little clinical or academic benefit and only suffered because of the income generated from casework. As a result of forensic medicine being held in such low regard as an academic subject, it is not surprising therefore that most doctors do not consider the specialty as a career option.

Despite this resistance from universities, the General Medical Council’s seminal document on medical education, first published in 1993, ⁶ emphasised the importance of teaching legal medicine and ethics to medical students to prepare them for understanding their medico-legal duties as doctors in promoting the well-being of their patients. Such duties, for example, would include knowledge on how to recognise and differentiate accidental from deliberate injury, particularly important when examining children, and such common tasks as providing death and cremation certificates, which if completed incorrectly and then rejected by registrars can cause distress to families when funerals are delayed. As a result of such clear support from the General Medical Council, we are at last beginning to see the re-emergence of undergraduate teaching in forensic and legal medicine, particularly in the form of student selective component modules which are offered as an option to undergraduates, within the curriculum.^7,8

Turning to the training of forensic doctors and scientists for those who wish to follow a career in the specialty, despite the decline and closure of many university departments over the last 50 years, there has been encouraging steady progress over the last few years with the establishment of the Faculty of Forensic and Legal Medicine in 2006 and with the continuing support of the Royal College of Pathologists and Home Office Pathology Delivery Board. The aims of theses bodies are to provide training programmes for forensic medical practitioners and to ensure the delivery of a high-quality service. Furthermore, in order to ensure that the service provided by all forensic sciences is of the best possible standard required by the justice system, the government created the office of the Forensic Science Regulator, with the first appointment being in 2008. ⁹

With regard to forensic pathology, in a recent review, Professor Hutton reported on its current status and, in the main, found the delivery of service to be of a very high standard. He also commented on the low number of forensic pathologists and the fragility of the specialty unless it was given more support and underwent some necessary reorganisation, citing the Regional Health Authority model ¹⁰ as a possible way forward. I believe that consideration should be given to the development of a number of regional centres which could encompass not just forensic pathology but also other forensic medical disciplines and have firm ties with their respective Royal Colleges and universities for research and teaching. Such a firm multidisciplinary approach would allow collaboration in research and casework between forensic practitioners from different backgrounds such as toxicology, genetics, pathology, odontology, anthropology, medical law and so forth, thus providing a more efficient and streamlined approach to investigations essential to the administration of justice.

As can be readily appreciated, forensic and legal medicine has in the past been looked upon as being of relatively less value compared to other scientific disciplines in terms of endeavour and innovation. Yet, its rigour is just as scientifically important in the pursuit of justice. As I have stated, important strides have been taken place over the last few years to address education and training needs. However, it is also essential that recognition of a necessary unitary approach to the forensic medical sciences should be encouraged and developed further. This is essential for the future progress of the specialty.