Clinical Forensic Medicine (CFM)
WHAT IS CFM?
CFM is a specialty sub branch of medicine concerned with cases where clinical medicine and the law intersect. Forensic physicians advise police, hospitals and the courts in relation to violent crimes such as physical and sexual assault, child abuse, custodial medicine and traffic offences where alcohol or drugs may be involved. Forensic physicians provide clinical medical services to victims, suspects and perpetrators of crimes in a variety of settings including hospitals, prisons, police stations, sexual assault centres and mental health facilities.
WHAT ATTRACTS REGISTRARS TO CFM?
Forensic medicine attracts registrars that like to challenge themselves and are interested in exploring a different type of medical specialty Dr Cunningham said. They are taken out of their ‘comfort zones’ and experience the fascinating world of forensic labs, police stations and courts [where they] meet the good, the bad and the bizarre, in a job where no two days are the same.
Registrars who are excited about the prospects of stimulating work in a highly supportive environment enjoy great satisfaction from developing their skills and taking that knowledge back to their workplaces and sharing it with colleagues.
For those like Dr Cunningham, who has been with the VIFM for 12 years, the attraction remains the variety of practice where every story is unique; the collegiate experience of working with a close knit team of forensic professionals, and the enjoyment of teaching registrars as they come through the system.
WHAT’S INVOLVED IN THE REGISTRAR EXPERIENCE
After a period of orientation and buddying, the registrars work independently and participate in an on-call roster that includes night and weekend work. They visit victims and offenders of physical or sexual assault in hospitals, police stations, prisons, custody centres, or one of the dedicated sexual assault examination rooms. The registrar may also triage people in custody if there are concerns about the person’s physical or mental well-being. The first priority is to identify any medical issues and provide appropriate support for victims and offenders of violent crime. The registrar will advise police about whether a person should be interviewed or treated in hospital or a mental health facility prior to interview.
Registrars are well supported by the senior physician who is on-call 24/7. While registrars may be at the police station or hospital on their own, they are encouraged and expected to call their supervisors for advice on specific issues and cases. Registrars also develop strong peer support networks with each other. They go back to their careers having become good friends and so keep in contact and support each other long after training ends.
Each week during the placement there are dedicated teaching sessions, clinical discussions about cases, written reports and formal supervision of casework. They learn how to interview, assess and treat victims and suspects and develop skills in forensic procedures. They also learn about the function of the police force, the judicial system, court processes and there is a strong emphasis on documenting injuries, writing medico-legal reports and presenting evidence in court settings.
Dr Cunningham stressed that registrars who do the placement will have to present evidence in court.
The course changes their thinking about how they document cases. They develop a high level of precision in their writing because they see, first hand, how things might be scrutinised or looked at in court. They are also exposed to a lot of expert opinion work that the senior physicians do when they review hospital or GP files and provide expert opinion to the police based on what has been documented.
EXTENDED SKILLS APPLICATION PROCESS AND PRE-REQUISITES
The extended skills post is for six months and is accredited with the Australasian College for Emergency Medicine, the RACGP and the Sexual Health Chapter of the Royal Australasian College of Physicians. In May each year the Institute sends out fliers to the GP training providers for distribution. Interviews for positions occur around June and offer an opportunity for registrars to ask questions and develop a more in depth understanding of what is required.
The VIFM has the capacity to employ three registrars each semester from a pool of GP registrars, ED registrars and others working in a clinical field. Preferred applicants will have a several years of clinical experience and a strong background in acute medicine prior to becoming a forensic medicine registrar.
During the first two months placement, registrars develop an understanding of the work of the clinical forensic physician and familiarise themselves with various aspects of the field. The remainder of the term provides an opportunity for registrars to immerse themselves in the work, develop their confidence and skills and enjoy the diversity and value of this type of medicine.
They are exposed to a number of medical and non-medical disciplines including toxicology, gynaecology, sexual health, addiction medicine, psychiatry, general practice, custodial health, bioethics as well as medical law, the police, custodial and judicial systems. In addition, the Institute is located in a building that houses a range of forensic specialists working in anthropology, odontology, radiology, entomology and toxicology so there are opportunities for registrars to be exposed to and interact with a wide range of forensic professionals in various fields. The Coroner’s Courts are close by and registrars have the opportunity to observe some medical inquests and develop an understanding of that work.
Those that wish to further their interest may work occasional shifts on the after-hours roster or embark on a Master of Forensic Medicine with Monash University. The course is delivered by correspondence but students meet together each semester to attend sessions and observe each other’s presentations.
The VIFM has recently become a Faculty of Clinical Forensic Medicine with the Royal College of Pathologists. A new and formalised training program currently being finalised, will lead to a Fellowship of Clinical Forensic Medicine for those who wish to follow an interesting and challenging career.
DR NICOLA CUNNINGHAM
Dr Nicola Cunningham is a Forensic Physician with the Victorian Institute of Forensic Medicine (VIFM) Southbank where she manages the Forensic Medicine Registrar program and is a primary supervisor of MCCC GP registrars. She also works as an emergency physician at St Vincent’s Hospital.MCCC registrars are fortunate to have a supervisor of the calibre of Dr Cunningham. She is a Fellow of the Australasian College for Emergency Medicine, a Fellow of the Faculty of Clinical Forensic Medicine with the Royal College of Pathologists of Australasia and an Emergency Physician at St Vincent’s Hospital, Melbourne.
She has a Masters in Forensic Medicine and holds honorary appointments with The Faculty of Medicine, Dentistry and Health Sciences at Melbourne University and the Department of Forensic Medicine, Faculty of Medicine, Nursing and Health Sciences at Monash University. She has presented papers and published, nationally and internationally on forensic medicine and is currently the medico-legal editor of the Emergency Medicine Australasia journal (EMA) and is a section editor for an international textbook on Emergency Medicine.
For more information about the extended skills term in Clinical Forensic Medicine, contact Dr Cunningham at the Institute on Ph: +61 3 9684 4480 or check out the website at www.vifm.org