Online teaching of forensic medicine and pathology during the COVID-19 pandemic: A course evaluation.

As the COVID-19 pandemic progressed in early 2020, social distancing rules and 'lockdowns' brought face-to-face teaching in universities in the UK, and globally, to a halt, leading to an abrupt move to online teaching and learning. This article details student feedback to a course on applied forensic medicine and pathology - framed as 'safeguarding vulnerable patients' - which was adapted for delivery online in response to restrictions imposed by the pandemic. That feedback indicated that the adapted online course was well-received and, overall, it compared favourably with pervious iterations of the blended learning course, which had included a substantial face-to-face teaching component. Students remained engaged with the teaching, and they continued to see the relevance of forensic medicine to their future clinical practice.

Application of photogrammetry in forensic pathology education of medical students in response to COVID-19.

As the coronavirus disease 2019 (COVID-19) pandemic forced universities to switch to distance online education, there was an urgent need to find some virtual/digital alternatives in order to continue teaching. Opportunities such as watching pre-recorded autopsy videos or creating and analyzing post-mortem computed tomography or magnetic resonance imaging with various 3D surface imaging techniques are usually time-consuming and cost-intensive. Photogrammetry, which allows the creation of 3D textured surface models from a series of overlapping photographs taken from varying viewpoints, is a less common approach compared with post-mortem imaging. We created 3D autopsy case models for a special online forensic pathology course in which students could try the models. Then, formal feedback was requested regarding the possible application of this method in education. Most of the students were satisfied with the new method and ranked photogrammetry higher than the other available methods. Our results indicate that photogrammetry has a high potential in undergraduate education, especially in the case of distance education or in those countries where declining autopsy rates have resulted in a decline in the use of the autopsy as an educational tool. Photogrammetry can also be used as a supplementary tool in traditional autopsy-based education and has potential applications in various fields of medical education.

European Forensic Veterinary Pathology Comes of Age.

During the mid-1700s, development of the veterinary profession was largely focussed on equine medicine and surgery. Subsequently, rather erratic development encompassed other species and eventually led to specialization in different disciplines. Teaching of veterinary pathology was well established in Europe and North America by the late 19th century. Specialization in this discipline was boosted in the 1940s by the formation, in the USA, of the Register of Veterinary Pathology and American College of Veterinary Pathologists. National societies followed soon afterwards in Europe. The European Society of Veterinary Pathology evolved during this period and the European College of Veterinary Pathologists (ECVP) was created in 1995 to promote high standards in the discipline. As an accrediting body, its emphasis is on training and harmonization across Europe. There is an increasing demand for high-grade forensic veterinary pathology reports which address the requirements of the legal system, but so far only a few countries have defined protocols for these reports. In recognition of the need for a specific qualification that benchmarks the competences and experience expected of forensic veterinary pathologists, the ECVP recently launched the Certificate in Forensic Veterinary Pathology.

Reclaiming the Autopsy as the Practice of Medicine: A Pathway to Remediation of the Forensic Pathology Workforce Shortage?

The historically constricted forensic pathology workforce pipeline is facing an existential crisis. Pathology residents are exposed to forensic pathology through the American Council of Graduate Medical Education autopsy requirement. In 1950, autopsies were conducted in one half of the patients dying in American hospitals and 90% in teaching hospitals, but they have dwindled to fewer than 5%. Elimination of funding for autopsies is a major contributor to the lack of support for autopsies in departments of pathology. Funding may require reclaiming the autopsy as the practice of medicine. Funding of autopsies would rekindle interest in hospital autopsies and strengthen the forensic pathology workforce pipeline.

Teaching forensic pathology to undergraduates at Zhongshan School of Medicine.

Producing qualified forensic pathological practitioners is a common difficulty around the world. In China, forensic pathology is one of the required major subspecialties for undergraduates majoring in forensic medicine, in contrast to forensic education in Western countries where forensic pathology is often optional. The enduring predicament is that the professional qualities and abilities of forensic students from different institutions vary due to the lack of an efficient forensic pedagogical model. The purpose of this article is to describe the new pedagogical model of forensic pathology at Zhongshan School of Medicine, Sun Yat-sen University, which is characterised by: (a) imparting a broad view of forensic pathology and basic knowledge of duties and tasks in future careers to students; (b) educating students in primary skills on legal and medical issues, as well as advanced forensic pathological techniques; (c) providing students with resources to broaden their professional minds, and opportunities to improve their professional qualities and abilities; and (d) mentoring students on occupational preparation and further forensic education. In the past few years, this model has resulted in numerous notable forensic students accomplishing achievements in forensic practice and forensic scientific research. We therefore expect this pedagogical model to establish the foundation for forensic pathological education and other subspecialties of forensic medicine in China and abroad.

Diagnóstico diferencial entre especies durante un levantamiento de dos cerebros. ¿Es fácil? ¿Es suficiente con un examen macroscópico? / Differential diagnosis of species during a recovery of two brains. Is it easy? Is a gross examination enough?

En un levantamiento nos podemos encontrar que debamos pronunciarnos sobre el origen humano o de otro tipo de animal de una víscera. Presentamos un caso inusual en el que se encontraron dos cerebros en el baño de una hamburguesería. Establecimos un diagnóstico diferencial, en atención a su peso, entre un cerebro de recién nacido o lactante menor de 6 meses y un cerebro de origen animal. La impresión inicial fue que se trataba de dos cerebros de animales, probablemente de vaca, y las pruebas complementarias analíticas confirmaron el diagnóstico. No es suficiente con una impresión de diagnóstico genérico de origen animal ante un cerebro en mal estado. Este diagnóstico tiene que ser certero y argumentado. Incluso patólogos y veterinarios de dilatada experiencia se muestran cautos a la hora de pronunciarse al respecto (AU)

At a recovery of viscera, we need to know the differences between human or another animal origin. We are presenting an unusual case where two brains were found into a burger bar toilet. Considering brain’s weight, a differential diagnosis between the brain of a newborn, a baby less than 6 months old, and an animal brain was made. The initial diagnosis was that both were animal brains, probably from a cow, and this hypothesis was later confirmed by laboratory analysis. Gross examination and the hasty conclusion that it is not human are insufficient when dealing with a brain in bad state. In this case the diagnosis must be highly accurate and thoroughly justified. Even experienced pathologists or veterinarians are cautious about these diagnosis (AU)

Forensic autopsy practice in the Middle East: comparisons with the west.

Autopsies are performed in the majority of Arab, Muslim countries. Several of these countries face social challenges and others do not have well established academic programs to teach the science. In this article we intend to review the history and practice of the forensic part of autopsies in a few Arab, Muslim countries (Egypt, Kingdom of Saudi Arabia (KSA) and Kuwait) and compare it with the United States of America (USA) and the United Kingdom (UK), 2 countries where the practice of forensic science and Forensic pathology is well established. This was achieved by pub med literature search and the distribution of a questionnaire to colleagues in Arab countries. We recommend that Arab countries explore the field of virtual autopsy to overcome some of the social challenges related to dissection of the cadaver. Kuwait can benefit from the introduction of Forensic training given the high workload in the country.

SANE-A-PALOOZA: A Clinical Immersion Experience to Close the Gap for New Sexual Assault Nurse Examiners.

BACKGROUND: Traditional educational methods for new sexual assault nurse examiners (SANEs) have had a gap in time between didactic instruction and the application to forensic nursing practice. In this interval, which can take several months, SANE trainees must locate a preceptor and perform at least 10 pelvic examinations. Only then can they apply their didactic knowledge and pelvic examination skills to actual patients presenting for forensic examinations. In 2011, Kansas City educators developed SANE-A-PALOOZA, a program that eliminated this gap, facilitated a unified educational experience, and ensured rapid integration of knowledge and skills. OBJECTIVES: The aims of this study were to briefly describe an educational method for SANEs based on adult learning principles and constructivist learning theory and to provide preliminary quantitative evaluation data, which are limited in contemporary literature. METHODS: Immediately after the formal 40-hour didactic educational experience, trainees took part in an 8-hour SANE-A-PALOOZA, a clinically focused continuing education course that included standardized pelvic examination patients, skills immersion experience with advanced practice nurses and experienced sexual assault nurses, and a hands-on practicum with a crime scene photographer. Each of the 44 trainees performed 8-10 female pelvic and two male genital examinations on standardized patients and took forensic genital photographs in three of those examinations. Participants completed a variety of preevaluation and postevaluation instruments, including knowledge, clinical skills checklists, and confidence measures. RESULTS: SANE-A-PALOOZA participants' self-evaluations indicate high satisfaction with the educational program. Pretest/posttest scores indicate increased comfort, competence, and confidence after this immersion practicum. CONCLUSION: Skills education via a hands-on immersion experience can address the gap between didactic and hands-on clinical experience for SANEs.

Forensic molecular pathology: its impacts on routine work, education and training.

The major role of forensic pathology is the investigation of human death in relevance to social risk management to determine the cause and process of death, especially in violent and unexpected sudden deaths, which involve social and medicolegal issues of ultimate, personal and public concerns. In addition to the identification of victims and biological materials, forensic molecular pathology contributes to general explanation of the human death process and assessment of individual death on the basis of biological molecular evidence, visualizing dynamic functional changes involved in the dying process that cannot be detected by morphology (pathophysiological or molecular biological vital reactions); the genetic background (genomics), dynamics of gene expression (up-/down-regulation: transcriptomics) and vital phenomena, involving activated biological mediators and degenerative products (proteomics) as well as metabolic deterioration (metabolomics), are detected by DNA analysis, relative quantification of mRNA transcripts using real-time reverse transcription-PCR (RT-PCR), and immunohisto-/immunocytochemistry combined with biochemistry, respectively. Thus, forensic molecular pathology involves the application of omic medical sciences to investigate the genetic basis, and cause and process of death at the biological molecular level in the context of forensic pathology, that is, 'advanced molecular autopsy'. These procedures can be incorporated into routine death investigations as well as guidance, education and training programs in forensic pathology for 'dynamic assessment of the cause and process of death' on the basis of autopsy and laboratory data. Postmortem human data can also contribute to understanding patients' critical conditions in clinical management.

Forensic entomology: implementing quality assurance for expertise work.

The Department of Forensic Entomology (Institut de Recherche Criminelle de la Gendarmerie Nationale, France) was accredited by the French Committee of Accreditation (Cofrac's Healthcare section) in October 2007 on the basis of NF EN ISO/CEI 17025 standard. It was the first accreditation in this specific field of forensic sciences in France and in Europe. The present paper introduces the accreditation process in forensic entomology (FE) through the experience of the Department of Forensic Entomology. Based upon the identification of necrophagous insects and the study of their biology, FE must, as any other expertise work in forensic sciences, demonstrate integrity and good working practice to satisfy both the courts and the scientific community. FE does not, strictly speaking, follow an analytical method. This could explain why, to make up for a lack of appropriate quality reference, a specific documentation was drafted and written by the staff of the Department of Forensic Entomology in order to define working methods complying with quality standards (testing methods). A quality assurance system is laborious to set up and maintain and can be perceived as complex, time-consuming and never-ending. However, a survey performed in 2011 revealed that the accreditation process in the frame of expertise work has led to new well-defined working habits, based on an effort at transparency. It also requires constant questioning and a proactive approach, both profitable for customers (magistrates, investigators) and analysts (forensic entomologists).

Different conditions and strategies to utilize forensic radiology in the cities of Melbourne, Australia and Berlin, Germany.

Forensic radiology has become a common modality in many forensic practices around the world. Here, we report and compare the usage patterns in the cities of Melbourne, Australia, and Berlin, Germany, using 16 multislice scanners in two large forensic facilities with both machines integrated in the mortuary. While in Melbourne all bodies receive a full body computed tomography (CT) scan resulting in nearly 5,000 scans per year, the situation differs in Berlin where approximately 250 state prosecutor sanctioned cases are scanned per year. While in Melbourne the CT scanner is an integral element of the process of determining whether further examinations will follow, in contrast in Berlin all cases proceed to autopsy irrespective of the findings from the CT scan. While pathologists in Berlin receive on site training to use the CT scanner by a highly experienced forensic pathologist who has previously been involved in the Virtopsy(®) program in Switzerland, training of pathologists in Melbourne is multifaceted. A radiologist with extensive experience in the forensic environment is employed part time at the institute in Melbourne and provides radiology lectures including topics such as postmortem artifacts, regional anatomy, and neuroradiology. CT is gaining acceptance as a useful modality for presenting information to the courts and juries, as well as providing an easily accessible platform to review cases and initiated research projects.

Raising future forensic pathologists (first report): results of a preliminary questionnaire survey.

The shortage of future forensic pathologists is a serious problem both in Japan and overseas. In Japan, however, factors such as government budget cuts and increasing the autopsy rates, make the condition even worse. In an attempt to improve this situation, we implemented a questionnaire survey to investigate the particular features necessary when selecting a career in forensic medicine. As a preliminary study, we sent the questionnaire along with an anonymous answer sheet to all forensic pathologists with a degree in medicine M.D., who were affiliated with universities in Hokkaido and the Tohoku district of Japan as of August 2011. Thirteen physicians in nine universities (response rate 77.8%) returned the answer sheet. Characteristics of participants are listed below: years of experience, board specialty and number of years as board certified specialists, percentage of work effort spent on autopsy practice, the time when they decided to work as a forensic pathologist, the time when to best recommend forensic pathologist as a career, and crucial factors in choosing the specialty of forensic medicine. As a result of this research, we've revealed the importance of undergraduate medical education or the effect on the role models. Furthermore, we've also extracted miscellaneous comments, such as standardization of minimum requirements. In our study, we' ve found some clues to increase future candidates in the field forensic medicine. However, we must collect further samples for our questionnaire survey to validate the study, and, as a future project, we must also address this problem at the congress of forensic medicine.

Raising future forensic pathologists (second report): results of a preliminary interview survey.

Fostering the specialists of forensic pathology has become a worldwide problem. In Japan, factors such as government budget cuts, the introduction of initial postgraduate clinical training system, as well as national policy on increasing autopsy rates, may deter young graduates from entering this specialty. The aim of this study was to look for clues to promote the training of young forensic pathologists. We selected and interviewed five forensic pathologists, with each interview lasting approximately 60 minutes, and picked up common views among them. The interviews topic, based on a prior survey, was: "What do you believe forensic pathologists require to promote the training of their successors." We selected common views on the three themes listed below; 1) standardization of minimum requirements to be independent forensic pathologists, 2) balancing forensic pathologists' time among autopsy practice, research, and education, and 3) preparing positions for younger forensic pathologists. These opinions were the same as those of previous studies conducted overseas and must be discussed at academic conferences in the future, where both junior and senior forensic pathologists participate.