Correspondence

Herding Cats: a Kit's response

Sir: I read with interest your Editorial concerning the state of forensic pathology in the United Kingdom (Editorial. Herding Cats. Science & Justice 2002; 42: 1-2). One of the key issues that you touched upon was training of junior doctors to become forensic pathologists in the presence of a manpower crisis. I have had the opportunity to speak to several young doctors who have a desire to become forensic pathologists, and currently am myself a trainee in the field. I was lucky, having the opportunity to join a university department, through which several, now consultant, forensic pathologists have evolved. But even in this post, I have found a degree of uncertainty of how exactly to achieve my goals of Home Office Pathologist.

Presently, there is no consensus of the approach to training. At least three different approaches seem feasible. Some of these are unattractive to those whose aim is to become a forensic pathologist. Most forensic pathologists have in previous lives been histopathologists, and have trained in this specialty. After this training, they have taken further examinations in forensic pathology. The other way of becoming a forensic pathologist is to base your training in forensic pathology from the beginning. Membership to the Royal College of Pathologists can be then gained by a slanted examination in forensic pathology.

Currently, most trainees entering the field seem to be encouraged to take full training as a histopathologist. Speaking to others considering forensic pathology as a career, this seems to be a major negative influence. It takes six or so years to pass through the histopathology training. It is a difficult and challenging specialty, even for those individuals intent on becoming a histopathologist. For someone wishing to become a forensic pathologist, many hours spent looking at gynaecological cytology can become frustrating particularly with the knowledge that after qualification, one may never actually see a pap smear again. Most of the unused knowledge gained in passing the histopathology examination will disappear into the cerebral ether, having never actually been used in forensic practice. It may well be that the trainee forensic pathologist could be held back a year or so, if there is continued failure of the examinations. Being prevented from continuing your career because of failing an examination designed for another specialty seems absurd.

I agree that a certain level of histopathological competence is required, with an understanding of the principles of general pathology. One should be able to diagnose haemochromatosis, carcinoma, and understand the diagnostic problems of mesothelioma. However, I feel that the specialties of histopathology and forensic pathology are becoming more and more divorced, and a new approach to training will be required, if we are still to encourage new trainees. Dr Peter Ackland presented some well thought ideas at a recent British Association of Forensic Medicine meeting. His thoughts included a year of histopathology, time spent in accident and emergency departments and attachment periods to other departments of forensic pathology around the world. I would

probably include time spent in the surgical specialties also, to aid autopsy work in the hospital death. I believe this type of approach would be more useful to the forensic pathology trainee. At present, we seem to be training for an examination, and not training for a job.

The other major problem - and I think at the heart of forensic pathology at present - is career structure. There is no real career structure at present. In fact, there is little structure in forensic pathology in the United Kingdom. Throughout the Kingdom, in their various areas, the Forensic Pathologist is a university employee, an independent businessman, or a mixture of NHS and forensic pathologist. When new jobs arise, they are not always advertised. This uncertainty of the future puts a great strain on the trainee forensic pathologist. If you terminally differentiate early into a Forensic Pathologist, could you be doomed with no job to go to? Or should you do histopathology as a "back-up" (but you do not want to be a histopathologist).

At this point, fueled with uncertainty and filled with irrelevance, why not continue in your post as an SHO in A & E or surgery, or join that GP training scheme - at least you know where you are going. With this muddle of training, it is difficult to advise a colleague on how to become a forensic pathologist, and I feel many have been "put off' forensic pathology before they even start training. I purposely have not dealt with other training issues in this letter, including length of training and funding, and I envisage that to overcome this manpower crisis, a major alteration in forensic pathology in the United Kingdom is required (and I am sure is coming).

Dr PD Lumb, B.Med.Sci (Hons), MB ChB, DipRCPath (Forensic), DMJ (Path)

Lecturer in Forensic Pathology The University of Sheffield

science&~justice Volume 43 No.2 (2003) 121 Page 121