FORENSIC MEDICINE CLERKSHIP

LOG BOOK 2014

Department of Forensic Medicine Faculty of Medicine

Ragama

Name:.………………………………………………………………………………………

ME No: ………………………………………………

Group: ……………………………………………….

1. INTRODUCTION

The purpose of this log book is to keep a record of your cumulative

experience as you progress through the clerkship in Forensic

Medicine. It is a record of mile stones you achieve during your

clinical appointment. This can also be used as a diary of your training

activities.

The log book has been designed in a manner for you to acquire the

necessary skills and training experience during the Forensic medicine

clerkship so that you will be able to function independently as a

medical officer in the future. To work in the capacity of a house

officer, Medical Officer at the OPD, District Medical Officer or a

Medical Officer- Medico Legal you will definitely need this exposure

to Forensic Medicine to take correct decisions when required.

Therefore please utilize this opportunity to the maximum.

KEEP YOUR CLINICAL CLERKSHIP LOG BOOK SAFE AND UPTO DATE

2. Aims and Objectives of the clinical training

AIM This two week attachment is meant to provide the medical student in training, all aspects of Clinical Forensic Medicine and Forensic Pathology including investigations, diagnosis and formulation of conclusions and opinions. OBJECTIVES At the end of the attachment, the student should be able to;

1. Examine patients for medico-legal purposes

a. To obtain a relevant medico-legal history b. Identify types of injuries c. Describe the injuries for medico-legal purposes

2. Categorize injuries according to the Penal Code

3. Formulate opinions as to the causative weapon, age of injuries, manner of infliction etc.

4. Complete the medico- legal documents ( Medico-legal examination form and Medico-legal report)

5. Perform a routine postmortem examination

6. Identify the Postmortem changes and explain their importance

7. Describe the Postmortem findings in a routine Post mortem examination

8. Complete the Post Mortem Report (H 42)

9. Formulate Cause of death according to WHO classification

10. Identify, describe and formulate conclusions on plant, soft tissue and bone specimens of forensic importance

11. Aid in establishing the identity of the deceased or living person

12. Recognize the rights of the victims and suspects and develop correct attitude towards medico-legal examinations, which is primarily based on impartiality and integrity.

13. Identify the different roles of house officer, MO medico-legal and any non-specialist medical officer with regards to medico-legal cases.

3. Medico legal examination of a patient

At the end of 2 weeks you should be able to take a proper

medico legal history, examine and complete a MLEF and

MLR. You should give special attention to the investigations,

referral to the relevant specialists and collection of trace

evidence in appropriate cases.

You are expected to examine a minimum of 03 patients with

injuries sustained in the following circumstances, and present

at least one case to the tutor during a ward class. A

completed MLEF & Medico Legal Report will be assessed at

the end of the appointment.

The accepted types of cases are:-.

-Accidents

-Assaults

-Head injuries

-Any grievous injury

Set yourself a goal to achieve in this area, during the next

two weeks

My Goal:

4. MLEF & MLR

Filling of medico-legal documents

1 2 3

1. Name of the victim

2. BHT No

3. MLEF No

4. MLR filled

5. Date of Issue

6. Date of Examination

7. Police Area

8. Type of Case

9. Category of hurt

10. Supervising Doctor

11. Signature

Rate yourself on each item in the following chart according to the following scale

Self assessment

5. Post mortem examination

You are expected to assist and clerk at least one postmortem

examination. They are compulsory for successful completion of the

clerkship. You should get the signature of the medical officer who

conducted the postmortem examination and supervised you on the

required documents. (You can assist and clerk any medico-legal post

mortem examination that is being done in the NCTH mortuary with

the permission of the relevant Medical Officer.)

I Can

Strongly Agree

3 marks Agree

2 marks Disagree 0 marks

1 Take a Medico-legal history 2 Identify and describe injuries 3 Fill the MLEF and MLR 4 Interpret injuries 5 Formulate an opinion 6 Apply my knowledge to solve

problems

Total

1

However, you are encouraged to witness as many medico-legal

autopsies as possible during these two weeks preferably of different

varieties. You should develop the skills of compiling a report which

includes a brief history, examination findings, cause of death,

samples taken for further examination and relevant opinion.

You must observe minimum of 5 different postmortem

examinations.

Set yourself a goal to achieve in this area, during the next two

weeks

My Goal:

Types of cases observed

Observed

Signature of the

Supervisor Date

Natural Deaths Transportation Accident

Death following blunt force Trauma

Death following sharp force Trauma

Asphyxial Deaths

Burns

Ingestion of poison

Electrocution

Fall from height Firearm & Explosives

Other

Tick Relevant boxes

6. PMR

Post mortem observed and brief reports compiled

SR

No Name of Deceased

Summary of Findings

Cause of Death

Samples taken for Investigation

Signature of Supervisor

1

2

3

4

5

6

7

8

9

10

The following special dissection procedures should be witnessed,

discussed or watched from a video. After completion of the task your

supervisor should sign on the relevant column.

Yes Signature of the Supervisor Date

Neck

Pelvis

Face

Spinal cord

Muscular-Skeletal Tick Relevant boxes

7. Special clinical forensic medical and forensic pathological cases

You are encouraged to clerk, observe and assist as many cases as possible. If there is a special case you are advised to take extra interest in the history, injury pattern and other significant findings.

Type of Special Case Yes Read/witnessed/ Clerked

Self-Infliction of injuries Burns & Scalds

Fire arm

Explosives

Electrocution/ Lightening

Child Abuse

Abortion

Sexual Offences

Gender Violence

Elder Abuse

Occupational Accident

Alcohol Intoxication

Ingestion of Poison

Victim of an offence with psychiatric Disorder

Victims for estimation of age Tick relevant boxes

Self assessment

8. Postmortem instruments

You must be able to identify the post mortem instruments

including the instruments used in special dissections and explain

why and how they are used.

You can learn about these instruments

While assisting an autopsy

By referring text books

From the Internet

From the Hand book on instruments (Available in the Department of Forensic Medicine )

I Can

Strongly Agree

3 Mark Agree

2 Marks Disagree 0 Marks

1 Perform a Post-mortem examination

2 Describe post-mortem findings

3 Complete a post-mortem report(PMR)

4 Formulate a cause of death

5 Give an opinion on finding

6 Apply my knowledge to solve problems

Total

2

Set yourself a goal to achieve in this area, during the next two

weeks

My Goal:

Tick Relevant box

Name of the Instrument Observed Date Signature of

the Supervisor

1.Scalpel

2.Tissue Forceps- Teeth

3.Tissue Forceps- Serrated 4.Bone Saw

5.Bone Cutting Forceps

6.Rib cutter

7.Rib Shear

8.Dissecting Scissors

9.Bowel Scissors

10.Coronary Scissors

11.Brain Knife

12.Post-Mortem Steel Knife

13.Hammer

14.Bone Chisel

15.Needle

16.Scale

17.Body Meter 18.Osteometer

Self assessment

9. Museum specimens

During the tenure of two weeks forensic clerkship you should have familiarized with specimens in the categories listed below

Set yourself a goal to achieve in this area, during the next two weeks

My Goal: __________________________________________

_________________________________________

Attended

museum Class Referred to hand book

Soft Tissues

Plant Poisons

Bone Specimens on Identification Skull Injuries

Photographs Tick Relevant box

3

3

3 I Can Strongly

agree 3 marks

Agree 2 marks

Disagree 0 marks

Identify all above instruments

Total

3

Self assessment

10. Fixed learning Materials

Fixed learning materials are displayed in the museum in the form

of photographs, soft tissue and bone specimen in selected

medico-legal themes. You are advised to view them as early as

possible by your own, and get any doubts cleared by discussing

with the teaching staff whenever necessary. Please mark the

appropriate column when you have completed the task.

YES NO

Photographs

Soft Tissues

Plant Poisons

Bone Specimens

4

I can

Strongly Agree

3 Marks

Agree 2 Marks

Disagree 0 Marks

1 Identify specimens

2 Describe specimens

3 Formulate conclusions and opinion

4 Apply my knowledge to solve problems

Total

4

11. Medico-Legal Functions of the JMO office

The group monitor should make appointments with the Inquirer into Sudden Death and the senior police officer of the hospital police post to arrange a discussion with them about their duties in sudden deaths and clinical medico-legal examinations.

You are also advised to acquire an understanding of day to day management of the JMO’s office and the mortuary by discussing with the relevant individual members of the staff. Some of these functions, you are advised to concentrate on are record keeping, maintaining confidentiality of sensitive information, co-ordination of different services concerned with medico-legal examinations, dispatching samples to relevant investigating agencies etc.

I discussed the Medico Legal functions with

Yes No

1. ISD

2. Police post

3. JMO’s office staff

4. Mortuary staff

5. Forensic laboratory Tick Relevant box

Self assessment

Strongly Agree

3 Marks

Agree 2 Marks

Disagree 0 Marks

I understand clearly the medico-legal function in a hospital

Total

5

12. Presentations

Developing presentation skills are important in Forensic Medicine because the doctor has oral evidence as an expert witness in a court of law. Therefore developing presentation skills, standing up and facing good or bad comments will help the student in future. IT skills are now becoming essentials for professionals and the faculty is promoting developing such skills. Thus, the presentation class aims in developing skills mentioned above. The group monitor should obtain the topics for presentation on the first day of the appointment. Each student is expected to prepare a power-point presentation on their own and present it within 5 minutes. At the end of each presentation the students are expected to critically evaluate the presentation.

Set yourself a goal to achieve in this area, during the next two

weeks

My Goal:

Yes No

literature survey using internet

Preparation of power-point slides

presentation abilities

Critical appreciating abilities

Self assessment

Strongly Agree

3 Marks Agree 2 arks

Disagree 0 Marks

I improved presentation skills

I improved IT skills I improved my critical evaluation skills

6

Self Assessment

Dear Medical Student,

This log book is not a testing tool. The activities listed in this book

will help you to identify the important tasks you are expected to

fulfill during your clerkship. At the end of your appointment you

can place yourself in the following grades based on your

achievements

Self assessment

However, you have to submit the completed log book to the

department along with your clinical appointment book as a

prerequisite for signature.

Strongly Agree

3 Marks Agree

2 Marks Disagree 0 Marks

My overall level of development of knowledge, skills & application in Forensic medicine has improved during the clerkship

Total

7

13. Recommended reading materials

i. Simpson’s Forensic Medicine; Eds: Jason Pane-James, Richard Jones, Steven Karch, John Manlove 13th Edition

ii. Margaret M Stark: Clinical Forensic Medicine, A physician’s Guide 2nd Edition

iii. PekkaSaukko& Bernard Knight: Knight’s Forensic Pathology,: 3rd Edition

iv. Vincent JM Di Maio and Zuzanna E Dana: Hand book of Forensic Pathology; 2ndEdition

v. Pathology of trauma by JK Mason & BN Purdue 3rd Edition 1999

vi. Forensic Medicine Clinical and Pathological Aspects Jason Pane-James, Anthony Busuttil, William Smock 2002

vii. Prof.Ravindra Fernando: Management of Poisoning;

4th revised edition

viii. L B L De Alwis: Lecture Notes in Forensic Medicine;

volume I,II, III,IV

WE WISH YOU A BRIGHT FUTURE!

Department of Forensic Medicine Faculty of Medicine

University of Kelaniya

2014