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FORENSICMEDICINECLERKSHIP

LOGBOOK2017

DepartmentofForensicMedicineFacultyofMedicine

Ragama

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CONTENTS

Page

Introduction 4

AimsandObjectivesoftheclinicaltraining 5

Medico-legalExamination 6

MLEF,MLR&Peerreview 7

Postmortemexamination 8

Postmortemreport(PMR) 10

Specialcases 11

Postmorteminstruments 12

Museumspecimens 14

FixedLearningMaterials 15

Medico-LegalfunctionsoftheJMO’sOffice 16

Presentations 17

Self-Assessment 18

References 19

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1. INTRODUCTION

Thepurposeofthis logbookistokeeparecordofyourcumulativeexperience as you progress through the clerkship in ForensicMedicine.Itisarecordofmilestonesyouachieveduringyourclinicalappointment. This can also be used as a diary of your trainingactivities.

ThelogbookhasbeendesignedinamannerforyoutoacquirethenecessaryskillsandtrainingexperienceduringtheForensicmedicineclerkship so that you will be able to function independently as amedical officer in the future. To work in the capacity of a houseofficer, Medical Officer at the OPD, District Medical Officer or aMedicalOfficer-MedicoLegalyouwilldefinitelyneedthisexposureto Forensic Medicine to take correct decisions when required.Therefore,pleaseutilizethisopportunitytothemaximum.

KEEPYOURCLINICALCLERKSHIPLOGBOOKSAFEANDUPTODATE

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2. AimsandObjectivesoftheclinicaltraining

AIMThis ‘two weeks’ attachment is meant to provide training to themedical students in all aspects of Clinical Forensic Medicine andForensicPathologyincludinginvestigations,diagnosisandformulationofconclusionsandopinions.OBJECTIVESAttheendoftheattachment,thestudentshouldbeableto;1. Examinepatientsformedico-legalpurposes

a. Toobtainarelevantmedico-legalhistoryb. Identifytypesofinjuriesc. Describetheinjuriesformedico-legalpurposes

2. CategorizeinjuriesaccordingtothePenalCode.3. Formulateopinionsastothecausativeweapon,ageofinjuries,

mannerofinflictionetc.4. Completethemedico-legaldocuments(Medico-legalexamination

formandMedico-legalreport)5. Performaroutinepostmortemexamination.6. Identifythepostmortemchangesandexplaintheirimportance7. DescribethepostmortemfindingsinaroutinePostmortem

examination8. CompletethePostMortemReport(H42)9. FormulateCauseofdeathaccordingtoWHOclassification10. Identify,describeandformulateconclusionsonplant,soft

tissueandbonespecimensofforensicimportance11. Aidinestablishingtheidentityofthedeceasedorlivingperson12. Recognizetherightsofthevictimsandsuspectsanddevelop

correctattitudetowardsmedico-legalexaminations,whichisprimarilybasedonimpartialityandintegrity.

13. Identifythedifferentrolesofhouseofficer,MO-Medico-legalandanynon-specialistmedicalofficerwithregardstomedico-legalcases.

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3. Medicolegalexaminationofapatient

At theendof2weeks you shouldbeable to takeapropermedicolegalhistory,examineandcompleteaMLEFandMLR.Youshouldgivespecialattentiontotheinvestigations,referraltotherelevantspecialistsandcollectionoftraceevidenceinappropriatecases.

Youareexpectedtoexamineaminimumof03patientswithinjuriessustainedinthefollowingcircumstances,andpresentatleastonecasetothetutorduringawardclass.AcompletedMLEF&MedicoLegalReportwillbeassessedattheendoftheappointment.

Theacceptedtypesofcasesare:-

-Accidents

-Assaults

-Headinjuries

-Anygrievousinjury

Setyourselfagoaltoachieveinthisarea,duringthenexttwo

weeks

MyGoal:

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4. MLEF,MLR&PEERREVIEWFillingofmedico-legaldocuments

1 2 31.Nameofthevictim

2.BHTNo

3.MLEFNo

4.MLRfilled

5.DateofIssue

6.DateofExamination

7.PoliceArea

8.TypeofCase

9.Categoryofhurt

10.SupervisingDoctor

11.Signature

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

Self-assessmentPeerReview

Studentsareexpectedtopeerreviewtheircolleaguesmainlyintheaspectofhistorytakingandexaminationofpatientsformedico-legalpurposes.Apeerevaluationformwouldbeprovidedanditshouldbecompletedandstapledwithyourlogbook.

5. Postmortemexamination

You are expected to assist and clerk at least one post-mortemexamination. Theyare compulsory for successful completionof theclerkship. You should get the signature of themedical officer whoconductedthepost-mortemexaminationandsupervisedyouontherequireddocuments.(Youcanassistandclerkanymedico-legalpostmortemexaminationthat isbeingdone intheCNTHmortuarywiththepermissionoftherelevantMedicalOfficer.)

ICan

StronglyAgree3marks

Agree2marks

Disagree0marks

1 TakeaMedico-legalhistory 2 Identifyanddescribeinjuries 3 FilltheMLEFandMLR 4 Interpretinjuries 5 Formulateanopinion 6 Applymyknowledgetosolve

problems

Total

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However, you are encouraged to witness as many medico-legalautopsiesaspossibleduringthesetwoweekspreferablyofdifferentvarieties. You shoulddevelop the skills of compilinga reportwhichincludesabriefhistory,examinationfindings,causeofdeath,samplestakenforfurtherexaminationandrelevantopinion.Youmustobserveminimumof5differentpost-mortemexaminations.Setyourselfagoaltoachieveinthisarea,duringthenexttwo

weeks

MyGoal:

Typesofcasesobserved

Observed

Signatureofthe

SupervisorDate

NaturalDeaths TransportationAccident DeathfollowingbluntforceTrauma

DeathfollowingsharpforceTrauma

AsphyxialDeaths Burns Ingestionofpoison Electrocution Fallfromheight Firearm&Explosives Other v TickRelevantboxes

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6. PMRPostmortemobservedandbriefreportscompiled

SRNo

NameofDeceased

SummaryofFindings

CauseofDeath

SamplestakenforInvestigation

SignatureofSupervisor

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3

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The following special dissection procedures should be witnessed,discussedorwatchedfromavideo.Aftercompletionofthetaskyoursupervisorshouldsignontherelevantcolumn.

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Yes SignatureoftheSupervisor DateNeck Pelvis Face Spinalcord Muscular-Skeletal v TickRelevantboxes

7. Specialclinicalforensicmedicalandforensicpathologicalcases

Youareencouragedtoclerk,observeandassistasmanycasesaspossible.Ifthereisaspecialcaseyouareadvisedtotakeextrainterestinthehistory,injurypatternandothersignificantfindings.

TypeofSpecialCase Yes Read/witnessed/Clerked

Self-Inflictionofinjuries Burns&Scalds Firearm Explosives Electrocution/Lightening ChildAbuse Abortion SexualOffences GenderViolence ElderAbuse OccupationalAccident AlcoholIntoxication IngestionofPoison VictimofanoffencewithpsychiatricDisorder Victimsforestimationofage

v Tickrelevantboxes

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Self-assessment

8. Postmorteminstruments

Youmustbeabletoidentifythepostmorteminstrumentsincludingtheinstrumentsusedinspecialdissectionsandexplainwhyandhowtheyareused.Youcanlearnabouttheseinstruments• Whileassistinganautopsy

• Byreferringtextbooks

• FromtheInternet

• FromtheHandbookoninstruments(AvailableintheDepartmentofForensicMedicine)

ICanStronglyAgree3Mark

Agree2Marks

Disagree0Marks

1 PerformaPost-mortemexamination 2 Describepost-mortemfindings 3 Completeapost-mortemreport(PMR) 4 Formulateacauseofdeath 5 Giveanopiniononfinding 6 Applymyknowledgetosolveproblems Total

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Setyourselfagoaltoachieveinthisarea,duringthenexttwo

weeks

MyGoal:

v TickRelevantbox

NameoftheInstrument Observed DateSignatureof

theSupervisor

1.Scalpel 2.TissueForceps-Teeth 3.TissueForceps-Serrated 4.BoneSaw 5.BoneCuttingForceps 6.Ribcutter 7.RibShear 8.DissectingScissors 9.BowelScissors 10.CoronaryScissors 11.BrainKnife 12.Post-MortemSteelKnife 13.Hammer 14.BoneChisel 15.Needle 16.Scale 17.BodyMeter 18.Osteometer

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Self-assessment

9.Museumspecimens

Duringthetenureof‘twoweeks’Forensicclerkshipyoushouldhavefamiliarizedwithspecimensinthecategorieslistedbelow

Setyourselfagoaltoachieveinthisarea,duringthenexttwoweeksMyGoal:_________________________________________

_________________________________________

AttendedmuseumClass

Referredtohandbook

SoftTissues PlantPoisons BoneSpecimensonIdentification SkullInjuries Photographs v TickRelevantbox

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ICan Stronglyagree3marks

Agree2marks

Disagree0marks

Identifyallaboveinstruments Total

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Self-assessment

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10. FixedlearningMaterials

Fixedlearningmaterialsaredisplayedinthemuseumintheformofphotographs,softtissueandbonespecimeninselectedmedico-legalthemes.Youareadvisedtoviewthemasearlyaspossiblebyyour own, and get any doubts cleared by discussing with theteachingstaffwhenevernecessary.Pleasemarktheappropriatecolumnwhenyouhavecompletedthetask.

YES NOPhotographs SoftTissues PlantPoisons BoneSpecimens

4 Ican

StronglyAgree3Marks

Agree2Marks

Disagree0Marks

1 Identifyspecimens 2 Describespecimens 3 Formulateconclusionsandopinion 4 Applymyknowledgetosolveproblems Total

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11. Medico-LegalFunctionsoftheJMO’soffice

Thegroupmonitor shouldmakeappointmentswith the Inquirerinto Sudden Death and the senior police officer of the hospitalpoliceposttoarrangeadiscussionwiththemabouttheirdutiesinsuddendeathsandclinicalmedico-legalexaminations.

You are also advised to acquire an understanding of day to daymanagementoftheJMO’sofficeandthemortuarybydiscussingwiththerelevantindividualmembersofthestaff.Someofthesefunctions,youareadvisedtoconcentrateonarerecordkeeping,maintainingconfidentialityofsensitiveinformation,co-ordinationof different services concernedwithmedico-legal examinations,dispatchingsamplestorelevantinvestigatingagenciesetc.

IdiscussedtheMedicoLegalfunctionswith Yes No

1. ISD 2. Policepost 3. JMO’sofficestaff 4. Mortuarystaff 5. Forensiclaboratory

v TickRelevantbox

Self-assessment

StronglyAgree3Marks

Agree2Marks

Disagree0Marks

Iunderstandclearlythemedico-legalfunctioninahospital

Total

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12. Presentations

DevelopingpresentationskillsareimportantinForensicMedicinebecause the doctor has oral evidence as an expertwitness in acourtof law. Therefore,developingpresentationskills, standingup and facing good or bad comments will help the student infuture.ITskillsarenowbecomingessentialsforprofessionalsandthe faculty is promoting developing such skills. Thus, thepresentationclassaimsindevelopingskillsmentionedabove.Thegroupmonitor should obtain the topics for presentation on thefirstdayoftheappointment.Eachstudentisexpectedtoprepareapower-pointpresentationontheirownandpresent itwithin5minutes. At the end of each presentation the students areexpectedtocriticallyevaluatethepresentation.Setyourselfagoaltoachieveinthisarea,duringthenexttwoweeksMyGoal:

Yes No

literaturesurveyusinginternet Preparationofpower-pointslides presentationabilities Criticalappreciatingabilities

Self-assessment

StronglyAgree

3MarksAgree2arks

Disagree0Marks

Iimprovedpresentationskills

IimprovedITskills Iimprovedmycriticalevaluationskills

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Self-Assessment

DearMedicalStudent,

Thislogbookisnotatestingtool.Theactivitieslistedinthisbookwillhelpyoutoidentifytheimportanttasksyouareexpectedtofulfilduringyourclerkship.Attheendofyourappointmentyoucanplaceyourselfinthefollowinggradesbasedonyourachievements

Self-assessment

However,youhavetosubmitthecompletedlogbooktothedepartmentalongwithyourclinicalappointmentbookasaprerequisiteforsignature.

StronglyAgree3Marks

Agree2Marks

Disagree0Marks

Myoveralllevelofdevelopmentofknowledge,skills&applicationinForensicmedicinehasimprovedduringtheclerkship

Total

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13. Recommendedreadingmaterials

i. Simpson’sForensicMedicine;Eds:JasonPane-James,RichardJones,StevenKarch,JohnManlove13thEdition

ii. MargaretMStark:ClinicalForensicMedicine,Aphysician’sGuide2ndEdition

iii. PekkaSaukko&BernardKnight:Knight’sForensicPathology,:3rdEdition

iv. VincentJMDiMaioandZuzannaEDana:HandbookofForensicPathology;2ndEdition

v. PathologyoftraumabyJKMason&BNPurdue3rdEdition1999

vi. ForensicMedicineClinicalandPathologicalAspectsJasonPane-James,AnthonyBusuttil,WilliamSmock2002

vii. Prof.RavindraFernando:ManagementofPoisoning;4threvisededition

viii. LBLDeAlwis:LectureNotesinForensicMedicine;volumeI,II,III,IV

WEWISHYOUABRIGHTFUTURE!

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DepartmentofForensicMedicineFacultyofMedicineUniversityofKelaniya

2017