FORENSIC MEDICINE CLERKSHIP LOG BOOK 2014medicine.kln.ac.lk/depts/foremed/images/pdf/logbook.pdf ·...
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FORENSIC MEDICINE CLERKSHIP
LOG BOOK 2014
Department of Forensic Medicine Faculty of Medicine
Ragama
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!