Responding to sexual violence: critical issues for healthcare providers

Sexual violence is a monumental problem in Kentucky and elsewhere, and healthcare providers play a critical role in its identification, treatment, and prevention. This article provides essential information for physicians treating survivors of sexual violence, including treatment options, protocol for medical-forensic examinations, tips for documentation, and information about community resources that can facilitate treatment outcomes and proide follow-up services.

[Training and research in forensic medicine: present situation and future challenges for medical schools in Chile]

BACKGROUND

Lawyers need some medical knowledge and physicians must know about forensics.

AIM

To explore training and research programs in forensic medicine in Chilean universities.

MATERIAL AND METHODS

Deans of all Medicine Faculties in Chile were contacted by e-mail and invited to answer a questionnaire containing 21 questions. A survey of Chilean publications on forensic medicine was performed in Medline, Lilacs and SciELO databases.

RESULTS

Fourteen deans answered the questionnaire. In all the responding faculties, forensic medicine is an obligatory course, generally during the fifth year and mostly combining theory with practice. In seven faculties, forensic medicine concepts are included in other courses. Forensics is taught in only two of 10 dental schools, two of 17 nursing schools, one of nine midwives schools and one of nine medical technology schools. It is not taught in phonoaudiology, kinesiology and nutrition schools. There are 74 physicians that teach the specialty but only 10 are certified by the National Board of Medical Specialty Certification (CONACEM). Treatment of most topics on forensics is insufficient. Thanatology is the strongest topic and forensic dentistry is the weakest. There are 52 publications in the area, mostly on "medical law".

CONCLUSIONS

Forensic medicine is taught in medical schools mostly as thanatology. The knowledge of forensics among medical students is limited and must be improved.

The role of Victorian emergency nurses in the collection and preservation of forensic evidence: a review of the literature

Emergency Departments (ED) are providing care for increasing numbers of patients who present as a result of criminal or interpersonal violence and patients may be victims, suspects or perpetrators. As a result, the role of emergency nurses in the recognition, collection and preservation of forensic evidence is increasing. There is little published literature about the role and responsibilities of emergency nurses regarding the collection and preservation of evidence in the state of Victoria and this is complicated by a lack of department and organisation policy and the need for more specific educational preparation of emergency nurses in this area. While it is well accepted that the primary focus of nursing care will always be the physical and emotional care of the patient, the increasing importance of the role of emergency nurses in the recognition and collection of forensic evidence in Victoria is now being recognized and the need for education of emergency nurses in this area understood. This paper reviews the literature related to the recognition, collection and preservation, of forensic materials in EDs by emergency nurses in the state of Victoria and discusses the role of emergency nurses in Victoria in caring for patients who present as victims of violence and in whom the collection and preservation of forensic evidence is required.

A postgraduate sexual assault forensic medicine program: sexual assault medicine from scratch

A government-funded service to provide forensic and medical care to survivors of sexual assault was established in the Australian Capital Territory (ACT) in 2001. Doctors employed by the service lacked the specific skills required to care comprehensively for survivors. Our aim was to develop, implement and evaluate a sexual assault medical education program. It consisted of an 'in-house' education program, and external university course and incorporated team-building, networking activities and protocol development. Core elements were: forensic evidence collection, assessment and management of injuries, prevention of sexually transmissible infections and pregnancy, counselling and emotional support. Participant satisfaction and knowledge acquisition were evaluated using a semi-structured interview and a questionnaire. Seven doctors participated in a 16-session program conducted by the director and nurse coordinator with help from local forensic, legal and medical experts. All doctors successfully completed the Certificate in Forensic Medicine, and reported satisfaction with the program and their increased knowledge, particularly associated with collection of forensic evidence and court procedures. A compete set of protocols was developed and cohesive networks established. We have designed an effective education program for doctors working in the field of sexual assault and offer it as a template to other health professionals working in this area.

Ethical and legal aspects in teaching students of medicine

Due to the rapid advances in medical technology, medical students are now being faced with increasingly complex and unparalleled ethical and practical dilemmas during their training. The new and future challenges of high-tech medicine demand improvements in current medical education, not only by meeting the needs of students through humanized training programs, but also by involving them in finding solutions to the ethical and legal quandaries they encounter. Today's students of medical universities must acquire knowledge and understanding of the ethical and legal issues relevant to the practice of medicine, and we have to do everything possible to introduce these students to the current discussions on more or less controversial ethical and legal topics. Although final answers may not be found, the very discussion, argumentation, and awakening of students' interest should become an essential part of the core curriculum of every doctor.

Forensic medicine in Tunisia

Tunisia is an Arab northern African country which counts 10 millions citizens. In Tunisia, there is a small number of forensic practitioners (20) distributed over four University and two regional Hospitals. Forensic activity is under the supervision of Tunisian Ministry of Public Health. The first forensic medicine department was set up in the Faculty of Medicine of Tunis (the capital) in the sixties, after which three other departments were founded in medical faculties and in their respective university hospitals (Sfax, Sousse and Monastir). These departments provide forensic medical education and research beside their daily practice. Forensic medical practice is divided in forensic pathology and clinical forensic medicine. In forensic pathology, we have to deal with violent or suspected deaths beside natural deaths. The clinical forensic medicine activity covers mainly forensic traumatology. Other fields of forensic sciences are in progress and ought to be developed all over the country. A forensic medical curriculum is provided in the four Tunisian Faculties of Medicine and in their University Hospitals. Nevertheless, the number of trainees remains small and could not currently satisfy the country needs.

Specific training in clinical forensic medicine is useful to ACEM trainees

OBJECTIVE

To assess the effectiveness of a 6-month rotation in forensic medicine in developing medicolegal and forensic skills for doctors training for a fellowship with the Australasian College for Emergency Medicine (ACEM).

METHODS

Over a period of 6 years 12 trainees undertook a 6-month rotation with the Victorian Institute of Forensic Medicine (VIFM) as a clinical forensic registrar. These 12 trainees were surveyed and asked structured questions regarding their perception of the usefulness of the training and the impact of the rotation on their professional development.

RESULTS

Twelve replies were received (100% response rate). All respondents felt that the term had a major positive influence on their ability to examine victims of physical and sexual assault, obtain forensic specimens and prepare a medicolegal report.

CONCLUSIONS

A 6-month rotation in clinical forensic medicine improves ACEM trainees perceived ability to perform a number of medicolegal tasks without interfering with other areas of professional development.

Research issues in forensic pathology: a survey of academic institutions employing forensic pathologists

In an effort to characterize research efforts in forensic pathology, a questionnaire was sent to a representative of each of the 14 academic medical centers that employ full-time faculty forensic pathologists. Responses were received from all 14 (100%) of the institutions queried, representing a total of 39 forensic pathology faculty positions; 21 positions were tenure track and 18 positions were clinical or other tracks. Of the 39 positions, 25 positions (64%) at 10 institutions required some degree of research or scholarly output. Of the 25 forensic pathologists with a research imperative, only 3 (12%) were principal investigators or co-investigators on funded forensic pathology-based projects. The major limitation cited by respondents on the performance of forensic pathology research was the lack of protected time from service responsibilities. Fellowship training in forensic pathology was available at 6 of the 14 respondent institutions. Of these institutions, 4 (67%) had a research requirement for trainees, and 4 (67%) provided research training. In conclusion, very few US medical schools currently employ full-time faculty forensic pathologists. Of these, only a small number of institutions prioritize research by these faculty members. Scant federal funds are available to support research in forensic pathology. Few forensic pathology fellowship programs provide research training. To achieve a robust research agenda in forensic pathology that is sufficient to support the needs of the criminal justice and public health systems will require a paradigm shift in the medicolegal death investigative system and investment by federal agencies.

A survey on the involvement of accident and emergency doctors in medicolegal work in Hong Kong

This study reports the results from a questionnaire survey on the pattern of medico-legal work undertaken by doctors working in Accident & Emergency Departments (ED) and their self-evaluation of competency in forensic medicine. A total of 155 questionnaires were returned with a response rate of 46%. Only 30% (46) respondents were fellows of the Hong Kong College of Emergency Medicine but 46% (71) had more than 6 years of experience working in the ED. Most of the requests for medical report came from police and insurance companies. Fellows had more experience writing reports on homicide, sexual assault and child abuse than non-fellows did. Nearly all fellows and three quarters (74%) of non-fellows had given evidence in courts of law. Physical assault was the commonest and sexual assault the least common experience. Most respondents had experience of attending district court (83%), followed by coroner inquest (67%), magistracy (66%) and high court (45%). Respondents were asked to rate themselves on their competence in various subject areas. It can be seen that respondents were less comfortable in areas like homicide, child abuse and sexual assault. On the job coaching by a senior seems to be the major mode of training. Both fellows (61%) and non-fellows (36%) favored some form of courses with a hands-on workshop element in future.

Dr. Walter McCrone's contributions to microscopy workshops and the certification of criminalists

Walter McCrone was not only a remarkable forensic microscopist, but also a skilled grants man and devoted scientific professional. This article briefly recounts his activities in the 1970s and 80s where he played a major role in securing grant funds to sponsor microscopy training around the country, and in using his considerable professional influence to advance the cause of certification.

Dr. McCrone's teaching methods in forensic microscopy, their nature, history, and durability

The microscopy teaching activities of Walter C. McCrone started long before the McCrone Research Institute (McRI) was incorporated as a not-for-profit research institute in Chicago. McCrone obtained his first microscopy training at Cornell University, with Emile Monnin Chamot, and was shortly thereafter appointed a full instructor in chemical microscopy before obtaining his Ph.D. (in 1941). After leaving Cornell, he had classes at the Armour Research Foundation (now Illinois Institute of Technology Research Institute--IITRI) from 1942-1956 and founded McRI in 1960. The course and student totals from McCrone's educational activities are impressive. As of January, 1, 2002, the cumulative for McRI (1942-2002) is 2,130 courses for 22,557 students. There has been an average of 600 students in an average of 60 classes for the last several years. Nearly all of the courses contain one week of intensive hands-on microscopy training with usually only one instructor for the entire duration of the class, making it a unique teaching experience for both student and Instructor. Thousands of students have successfully completed at least one of McCrone's specialized forensic microscopy (trace evidence) courses and the number will steadily increase as a result of McRI's continued efforts to interest forensic investigators in microscopy.

Crime scene ethics: souvenirs, teaching material, and artifacts

Police and forensic specialists are ethically obliged to preserve the integrity of their investigations and their agencies' reputations. The American Academy of Forensic Sciences and the Canadian Society of Forensic Science provide no guidelines for crime scene ethics, or the retention of items from former crime scenes. Guidelines are necessary to define acceptable behavior relating to removing, keeping, or selling artifacts, souvenirs, or teaching specimens from former crime scenes, where such activities are not illegal, to prevent potential conflicts of interest and the appearance of impropriety. Proposed guidelines permit the retention of objects with educational value, provided they are not of significance to the case, they are not removed until the scene is released, permission has been obtained from the property owner and police investigator, and the item has no significant monetary value. Permission is necessary even if objects appear discarded, or are not typically regarded as property, e.g., animal bones.

Dr. Walter C. McCrone--his contributions to environmental microscopy

This paper briefly highlights Dr. McCrone's contributions to the recently emerging field of forensic environmental microscopy. Few, if any, criminalists are not familiar with Dr. Walter C. McCrone's voluminous contributions to the field of forensic microscopy and the analyses of micro and ultra micro transfer (trace) evidence. Dr. McCrone was renowned for his life long efforts in promoting the application of the Polarized Light Microscope (PLM) to problem solving. It is therefore not surprising that Dr. McCrone would also apply his analytical and deductive skills employing the PLM to problems in environmental analysis. He is well known for his many publications dealing with the analysis of asbestos and asbestos like materials by PLM. His philosophy of presenting intense professional training courses stressing the practical applications of the PLM carried over to a series of courses offered to students requiring education in other areas of microscopical analysis. Through McCrone Research Institute, Dr. McCrone can be said to have been responsible for the training of a large majority of microscopists who literally analyzed tens of millions of samples. These analyses were performed utilizing methodologies developed predominately by him and adopted by regulatory agencies in the United States and abroad. The methods he fostered are a major part of the arsenal of microscopical techniques employed by forensic environmental microscopists in their efforts to identify a manufacturer of an insulation product for the purpose of litigation.