NAME Committee on Forensic Pathology Training: Recommendations

The Committee on Forensic Pathology Training has completed its efforts to prepare guidelines for forensic pathology training programs. Our committee initially surveyed the NAME membership and the 42 current FP training programs, in order to attempt to delineate more clearly the areas of FP training that must be addressed. We then reviewed the ACGME/RRC guidelines and program information forms which are used during accreditation proceedings. At the last NAME meeting, we presented our recommendations at the business meeting. Our next goal is to publish the recommendations. Prior to this, we have attempted to contact as many training programs as possible for final comment. Finally, we are posting the guidelines on the NAME website for general membership review and comment. Please direct all comments to Joe Prahlow.

The following updated recommendations are divided into several categories. First, a general synopsis of the current RRC requirements and program information forms, with suggestions to the ACGME/RRC to make them more appropriate. Second, we list items we feel the ACGME/RRC should REQUIRE of all FP training programs. Third, we list items we feel the ACGME/RRC should RECOMMEND in all FP training programs.

1 – General Synopsis of Current RRC Training Requirements and Program Information Forms: The current ACGME Program Requirements for Residency Education in Forensic Pathology list several specific requirements and/or recommendations within part III (Educational Program) that are not specifically addressed in the Program Information Form used by the RRC during the accreditation process. For example, the requirements state that trainees should perform 250 to 350 autopsies during their training year, yet, in the Program Information Form, there is no question specifically asking how many autopsies the fellows perform. As such, we would like to recommend to the ACGME that the forms be re-evaluated and revised in order that they address the same topics. Another area of concern is that the minimum autopsy number requirement is apparently not "enforced." Almost half of all FP training programs reported in the survey that their fellows perform fewer than 250 autopsies. If the 250 minimum is a recommendation rather than a requirement, it should be stated as such. The current ACGME guidelines may be viewed under the heading, "Program Requirements for Residency in Forensic Pathology" at the ACGME website

2 – Requirements (ACGME/RRC): The following is a list of items we feel the ACGME/RRC should require of all FP training programs. These should be listed in part III (Educational Program) as described above, and they should be specifically addressed in a revised Program Information Form. Please note that we feel strongly that the following items should be requirements, not just recommendations. Also please note that these suggestions would replace the current requirements in part III of the ACGME Program Requirements for Residency Education in Forensic Pathology guidelines:

• An accredited program shall provide a wide variety of case types (homicides, suicides, accidents, natural deaths, childhood deaths, decomposed remains, charred remains, etc…) for examination and autopsy by the trainee.
• An accredited program shall provide to its trainees supervised training with gradual increased responsibility.
• The minimum number of autopsies performed at an accredited program’s autopsy facility shall be 500.
• The minimum number of complete autopsies performed by a trainee during his/her fellowship year shall be approximately 200.
• The maximum number of complete autopsies performed by a trainee during his/her fellowship year shall be 350.
• Each fellow should perform a minimum of approximately 20 to 30 homicide autopsies during the training year.
• Upon completion of their fellowship training, fellows should be capable of satisfactorily performing child abuse autopsies.
• Upon completion of their fellowship training, fellows should be capable of satisfactorily performing "in-custody" death autopsies.
• Fellows shall receive training and experience in decision-making regarding whether or not medical examiner/coroner jurisdiction exists, and whether or not bodies should be transported to the office for examination/autopsy.
• Fellows shall receive training and experience in decision-making regarding whether or not an autopsy should be performed.
• Fellows shall receive training and experience in scene investigation, with a minimum number of approximately 15 scenes investigated.
• Fellows shall receive training and experience in death certification, including cause-of-death and manner-of-death classification.
• Fellows shall receive training and experience in issues pertaining to tissue & organ donation.
• Fellows shall receive training and experience in the following areas related to postmortem examination:
  
  
  1. Evisceration, including head and tongue
  2. Anterior neck (layer-by-layer) dissection
  3. Posterior neck dissection
  4. Spinal cord removal
  5. Eye removal
  6. Middle/inner ear removal
  7. Sexual assault & other evidence collection


• Fellows shall receive training and experience equivalent to approximately 80 hours in toxicology. The training may be attained in a variety of ways and must include some time devoted exclusively to the toxicology laboratory. Other methods of toxicology training may include (but are not limited to) didactic lectures, toxicology conference, pending conference, and educational meeting attendance.
• Fellows shall receive training and experience devoted exclusively to ancillary forensic science specialties (firearms, trace evidence, etc…) for a minimum of 40 hours.
• Fellows shall receive training and experience in forensic neuropathology, forensic anthropology, forensic odontology, forensic radiology, and forensic entomology autopsy specimen collection.
• Fellows must have experience accompanying staff forensic pathologist(s) to court for criminal trial proceedings.
• Fellows must be provided an opportunity to testify (in criminal and/or civil settings) during their training. If time-constraints or other factors do not allow this, arrangements for experience in "moot court," "mock trials," or via other means should be provided.
• Fellows must be allowed to attend a national forensic meeting (Note: this does not imply that the program must provide funding for this purpose).
• Fellows should become familiar with the various laws and statutes which relate to all aspects of forensic pathology practice within the jurisdiction where they train.

2 – Recommendations: The following is a list of items we feel the ACGME/RRC should list as "highly-desirable" recommendations (but NOT required) for FP training programs. Failure to implement any of these items would NOT result in a penalty:

• Funding for trainees to attend a national forensic meeting.
• Research opportunities for trainees with recognition that research projects may extend after the fellowship year.
• Opportunity for trainees to participate in teaching.
• Training in photography.
• Training in management, public relations, family counseling, interaction & communication with attorneys, police, media members, families and others.
• Clinical forensic medicine experience.
• Access to computer/Internet.
• Experience attending Child Death Review Committee & other similar meetings.
• Official accreditation of facility/office via government agency, laboratory association and/or NAME.

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