DEPARTMENT OF FORENSIC

MEDICINE

UNIVERSITY OF PERADENIYA

VISION
JUSTICE THROUGH MEDICINE

MISSION

To;

(1) produce medical practitioners who are aware and capable of discharging their
legal responsibilities and are competent in handling medico legal cases,
providing unbiased, truthful evidence to courts

(2) enhance ethical behavior of the profession

(3) enhance the research output of the department and thereby strengthen the evidence
base of forensic medicine, science and related disciplines contributing to the
advancement of the discipline

(4) strengthen and increase awareness of the medico legal services provided by the
department nationally and internationally

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CLINICAL APPOINTMENT
IN
FORENSIC MEDICINE

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 INSTRUCTIONS FOR STUDENTS

All students following the clinical appointment in Forensic Medicine

1. Attendance: 100% is required.

2. Equipment: Every student should carry a measuring tape, torch and a magnifying glass.

3. A lab-coat with the name tag should be worn over normal attire.

4. The program commences at 8 am each day.

5. The structure of the clinical program is as follows

Monday Tuesday Wednesday Thursday Friday Saturday
Venue TH TH TH Kandy TH Kandy TH Kandy TH Kandy
Peradeniya/ Peradeniya/
Department of Department
Forensic of forensic
Medicine Medicine
Activity Clinical Museum Clinical Clinical Clinical Clinical
cases:History specimen cases:History cases:History cases:History cases:History
taking and discussion, taking and taking and taking and taking and
examination Ethics examination examination examination examination
for discussions, for for for for
Medicolegal Group work Medicolegal Medicolegal Medicolegal Medicolegal
purposes and videos purposes purposes purposes purposes
Autopsies: Forensic Autopsies: Autopsies: Autopsies: Autopsies:
Observation anthropology/ Observation Observation Observation Observation
and assisting odontology and assisting and assisting and assisting and assisting
Documentation Documentation Documentation Documentation Documentation
(MLEF, MLR, (MLEF, MLR, (MLEF, MLR, (MLEF, MLR, (MLEF, MLR,
COD forms) COD forms) COD forms) COD forms) COD forms)

6. For successful completion of the appointment a student should fill two MLEFs , two
MLRs and two PMRs. The MLEF and MLR should be from patients at the TH
Peradeniya. The PMR can be from either THP or GHK. For the purpose of completing
the MLEF and MLR, only two students are allowed to write about one patient while
for completion of the PMR a maximum of five students are allowed to write about
one postmortem examination.

7. Specimen description: Discussion can be done in groups but the report should be
submitted individually in one’s own words.

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8. Students will be taken to court to observe provision of expert medical evidence by
forensic pathologists, exhumations and scene visits, if the opportunity arises.

9. Assessment will be by an OSPE conducted on the last week of the appointment.

For successful completion of the appointment a student should have

 100% attendance
 Complete student log book
 Score above 50% in the OSPE

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 CONTENTS

 INTENDED LEARNING OUTCOMES OF THE CLINICAL APPOINTMENT

 PRERQUISITES

 COMPONENTS

 EXAMINATION OF CLINICAL CASES

 JUDICIAL AUTOPSY

 SKELETAL SURVEY

 ETHICS/PROFESSIONALISM/CRITICAL THINKING

 EVALUATION OF PROFESSIONAL AND PERSONAL ATTRIBUTES OF

STUDENTS

 OBJECTIVE STRUCTURED PRACTICAL

EXAMINATION (OSPE)

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 THE INTENDED LEARNING OUTCOMES (ILO) OF THE CLINICAL
APPOINTMENT

Intended learning Competence

outcome
1. Manage a person for (1) Obtain a medico legal history
medico-legal purposes (2) Access relevant information from hospital records
(3) Identify external and internal injuries
(4) Describe and document injuries
(5) Complete a Medico-legal Examination Form (MLEF)
(6) Prepare a Medico-Legal Report (MLR) for submission to Court
(7) Perform relevant investigations, referrals and reviews where
indicated
2. Conduct postmortem (1) Perform an autopsy under supervision
examinations (2) Perform relevant investigations, referrals when indicated
(3) Obtain a medico legal history and access relevant information
from hospital records
(4) Describe the procedure in carrying out dissection of the face,
neck, perineum, skin, muscle and bone
(5) Prepare a Postmortem Report for submission to Court
3. Evaluate skeletal Examine skeletal productions towards identifying age, sex,
productions stature, injuries, cause of death, time since death
4. Use laboratory and Collect, preserve, document, label and send samples for analysis by
other diagnostic the Government Analyst/Microbiologist/Histopathologist etc
services effectively
5. Maintain medico Identify the different types of legal and medico legal documents.
legal records Keep good medico-legal records, transmit information appropriately
and operate information storage and retrieval systems effectively
6. Communicate Present findings gathered from the examination of patients, autopsies
effectively and and museum specimens in a clear and concise manner, both orally and
honestly in writing
Communicate professionally with colleagues, support staff, courts,
police and other governmental and non-governmental organizations
for the benefit of patients
7. Develop reasoning Apply knowledge of science and logical method to medico legal
skills problems (clinical cases, autopsies, museum specimens, skeletal
productions) and formulate and defend an opinion assessing the
reliability of evidence
8. Ensure safe practice Evaluate the existing facilities especially in the mortuary in relation to
in relation to safe practice in medico legal work
conducting autopsies,
handling blood
products, body fluids
and tissues.

9. Accustom themselves Present cases/specimens to each other in order to learn how to provide
to the processes of as well as accept constructive criticism
audit and peer review

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10. Work in a team in Work with medical as well as non-medical colleagues recognizing the
different capacities essential roles played by and the importance of securing mutual co-
operation
11. Continue self- Access information from different sources and evaluate their
education authenticity

12. Evidence based Critically evaluate articles in scientific literature in order to develop
practice one’s own practice

13. Quality Careful observation, routine recording of change, reflection and offer
improvement suggestions in order to improve the medico legal system

14. Professionalism Demonstrate evidence of reliability, responsibility, adaptability and

favourable attitudes to learning in terms of participation and
attendance

All aspects will be evaluated by presentations (cases/museum specimens), OSPE, observation

of behavior during the appointment and evaluations of log book

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 PREREQUISITES FOR CLINICAL APPOINTMENT IN FORENSIC
MEDICINE
(STATED IN RELATION TO EACH ILO)

ILO 01
1. Pathological and physiological response of the body to trauma and its sequalae.
2. Agents which cause injury to the body and the features of these injuries, prognosis and their
medico legal significance.
3. Legal background for categorizing injuries
4. Taking a history from and the examination of a patient.
5. Surface anatomy.
6. Regional anatomy of chest, abdomen, pelvis, head (eyes, ears, face, teeth) and limbs.

ILO 02
Diagnose death
1. Know changes that occur after death, post mortem artifacts and their
medico legal importance.
3. Legal background of inquests, autopsies and exhumations
4. Procedure for disposal of a dead body, legally, in various circumstances
5. Differentiate between the cause of death, manner of death and mode of
death.
6. Gross anatomy of heart, lungs, brain and GI tract.
7. Macroscopic appearance of disease conditions which could result in sudden death

ILO 03
1. Identification of bones as human
2. Features of the human skeleton which would help in the determination of sex and age

ILO 04
1. Basic principles of collecting and transportation of specimens

ILO 05
1. Document and store information effectively and confidentially

ILO 06
1. Active listening skills and ability to present information verbally and
in writing in a clear and concise manner, appropriate to the needs of the audience

ILO 07
1. Apply knowledge of science in clinical practice.
2. Formulate opinion based on application of logic, critical thinking and problem solving skills
3. Identify general/basic medico legal issues prior to a case

ILO 08
1. Be aware of the importance of protecting one’s self and other from disease and injury
2. Transmission of infections and diseases

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ILO 09
1. Be open to constructive criticism
2. Provide feedback in a constructive manner
3. Maintain flexibility and open mindedness
2. Withstand/accept conflict of ideas

Objective 10 - Work in a team

1. Be prepared to lead and to follow

ILO 11 – Continue self-education

1. The habit of keeping abreast with recent developments in Sri Lanka
and elsewhere by referring scientific journals and critically evaluating their value in current
medical practice.

ILO 12 - Evidence based practice

1. Critically evaluate evidence in the literature
2. Be prepared to adopt new methods/practices

ILO 13 - Quality improvement

1. Observational skills and creativity

ILO 14 - Professionalism
1. Respect for others
2. Strive for high standards

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 CLINICAL CASES

Date MLEF no Type of case Category of hurt JMO

(signature)

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Date MLEF no Type of case Category of hurt JMO
(signature)

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 JUDICIAL AUTOPSY

OBSERVATION OF POST MORTEM EXAMINATIONS

Serial no. Postmortem no. Date Name of Signature

supervisor

ASSISTING AT POSTMORTEM EXAMINATIONS

Serial no. Postmortem no. Date Name of Signature

supervisor

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 SKELETAL PRODUCTION

Specimen no:

Date:

Time:

Place:

Supervised by:

Referred by:

Police station:

History:

Sample:
Sealed: Seals -Intact/not intact

Description of wrapping:

Sketch drawing of the parcel:

Contents

Human remains; yes /no

Reasons

List and Number each human remain

Animal remains; yes/ no

(Separate Animal remains)

Other Contents e.g. Slippers, clothes (specify and give serial numbers)

State of putrefaction: (moderate /advanced/ not applicable)

Skeletonized yes/ no Mummified – yes/no

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Minimum number of Individuals (MNI)

Give Reasons

Gender

Skull

Pelvis

Other evidence of gender

Discussion

Conclusion of Gender

Age

Skull

Teeth

Symphysis pubis
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 Evidence of ossification centers

Other evidence of age

Discussion

Conclusion

Estimated stature

Method used

Discussion

Conclusion

Time since death

Indicators

Discussion

Conclusion

Injuries identified Opinion

Cause of death (if Possible)

Reasons

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Special techniques recommended for specific identification

Sample sent to other units

Sample Unit sent By whom

COURT VISITS
(Minimum one visit

Date Case number Signature of

accompanying staff
member

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 Ethics professionalism and critical thinking

Answer the following questions based on the movie “50-50”

a. Identify behaviours which demonstrate lack of empathy of doctors for the

patients at the first consultation
b. Identify unethical behavior of the therapist
c. What ethical issues could arise as a result of a dual relationship* with a
patient?
d. What would amount to bad news in healthcare situations?
Why is it important to learn the skill of breaking bad news
empathetically?
What are the barriers to breaking bad news effectively
How can breaking bad news appropriately help the patients?
How can learning the proper way of breaking bad news help the
doctor?
Strategies for breaking bad news (SPIKES model)

*This could occur when your patients are your friends, relatives or colleagues

Answer the following questions based on the movie “First do no harm”

a. Who is an autonomous agent

b. What are the limits to autonomy in the healthcare setting?

Answer the following questions based on the movie – “The doctor”

a. How can you be sensitive to patients’ needs for privacy and respect during
teaching ward rounds?
c. When is humor appropriate/inappropriate in the medical setting?
d. What are the challenges faced by doctor in balancing their work and home
lives?
e. What strategies can doctors use to protect their personal time?

You have been requested to assess a scientific paper to determine suitability for
publication in a scientific journal (Article to be provided)

You have been requested to review a proposal which has been sent for Ethics
approval to the faculty ethics review board (Student to review each other’s
research proposals)

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 STUDENT NOTES ON
ETHICS/PROFESSIONALISM/CRITICAL THINKING

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 EVALUATION OF PROFESSIONAL AND PERSONAL ATTRIBUTES
OF STUDENTS
___________________________ ________________________
Name of student Batch No.

________________________ ____________________
Name of tutor Group No.

______________________
Tutor’s signature

Please comment constructively on each attribute in the appropriate cage

1. Reliability, responsibility and attitude to learning

Fulfills responsibilities in a reliable manner

Completes assigned tasks
Contributes to discussions
Actively participates in team activities

2. Self improvement and adaptability

Accepts constructive feedback

Recognizes limitations and seeks help
Respectful of colleagues and patients
Incorporates feedback in order to make
changes in behavior
Adapts to change

3. Relationship with students, staff and patients

Establishes rapport
Sensitive to the needs of patients
Pays attention to issues such as consent,
confidentiality and privacy
Establishes and maintains appropriate
boundaries in work and learning situations
Relates well to fellow students in a learning
environment
Relates well to staff in a learning
environment

4. Attendance during the clinical appointment ________________________________

5. Participation – Debating / Presentation

I have neither participated in nor witnessed any acts of academic dishonesty pertaining to this
appointment.

(Signature of student)
Lecturers’ Remarks
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Date Remark Signature

OBJECTIVE STRUCTURED PRACTICAL EXAMINATION (OSPE)

This examination will be held on the last Friday of the clinical appointment & will consist
of 15-20 stations and cover the following areas.

Description and interpretation of Museum specimens (plant, soft tissue and skeletal)
Autopsy dissection techniques and autopsy instruments
Legal system of Sri Lanka
Identifying Injuries and categorizing for medico-legal purposes
Identifying medico-legal documents/files/registers
Collection and preservation of specimens to be sent to the Government Analyst/
Microbiology/ Histopathology

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 EVALUATION

Component Grade/mark Signature of

examiner
Examination of clinical cases
Judicial autopsy
Medical ethics
Skeletal survey
Evaluation of professional and personal attributes of students
OSPE

To be completed by the Head of Department

Comment

Signature

Prepared by; Dr. Deepthi Edussuriya

Updated on 08/11/2018

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