Forensic Pathology

Forensic Pathology

Dr Sophie Wallace is a specialty trainee in forensic pathology.

Tell us about yourself

 I am one of two forensic pathology trainees in the East Midlands deanery.  I am currently an ST5 based at the East Midlands Forensic Pathology Unit, within the University of Leicester.  I completed two years of general histopathology training prior to this role, and passed my FRCPath Part 1 exam before starting the post.

I applied and started medical school with an interest in forensic pathology.  Throughout my time at medical school, I had the opportunity to take part in dissection and shadow general pathologists performing autopsy and microscope work, which piqued my interest further.

I undertook an intercalated degree at Barts and the London Medical School in Molecular Medicine, which had a module in Forensic Medicine.  This gave me the time and the opportunity to study and read about forensic pathology in greater detail, as well as undertaking a dissertation on the accuracy of alcohol measuring devices in reference to drink driving arrests.  The breadth of knowledge which forensic pathology requires confirmed my decision to pursue a career in this field.

Why did you choose forensic pathology?

 At medical school I had limited opportunity to focus and appreciate pathological changes with regards to disease within the human body.  Once I started histopathology, a specialty which is heavily based on pattern recognition and the visual appearance of disease in macroscopic specimens and at autopsy, it was apparent that this was where my strengths lay.

Forensic pathology is an intellectually stimulating subspecialty with great variety and the opportunity to work with many different professionals.  It requires the ability to make key decisions when approaching a case, identifying relevant negative and positive findings, ordering and taking appropriate ancillary tests, and having a working knowledge of the legal system.

We largely work alongside non-medical colleagues, specifically the police and so our work is subject to strict confidentiality.  Discussions with these colleagues are robust and challenging with a focus on ensuring that the conclusions reached by the investigating team are supported by clear evidence.

Our work appears heavily in fictional dramas within the media and is often misportrayed or out of date, and so part of our role is ensuring that we provide accurate information about specific death processes in these investigations.  This can also involve highlighting what information cannot be ascertained, which can be critical in shaping in the direction of a police investigation.

What is the application process?

 The recruitment process is run individually by each training department (England and Wales: Leicester, Liverpool and Newcastle), (Scotland: Glasgow, Edinburgh, Aberdeen and Dundee).  An application for a post can occur when a trainee has completed their training, and so posts typically arise, on average, every 4 years.  There are 6 posts in England and Wales, and 3 in Scotland.  The earliest opportunity to apply for forensic pathology training is after 18 months of general histopathology training.  Applicants are required to complete an online form and provide references.  Applicants are then shortlisted and invited for interview.  An applicant is also required to have the FRCPath Part 1 exam before starting the post.

Describe a typical working day

 It is difficult to describe a typical working day for a forensic pathologist as there is often little routine.  As trainees we shadow a consultant who is on call for the week and attend any autopsy cases that arise.  These can occur at any point during the working day into the late evenings, as well as weekends.  The autopsy can be held in one of a number of mortuaries in the East Midlands and so part of our working day requires driving up and down the M1.  The consultants also attend Coroner’s Court and Crown Court across the East Midlands to provide evidence and be cross examined by the defence which we have the opportunity to observe.  On occasion the on call consultant and forensic pathology trainees may be called to attend a scene in the East Midlands, if it is of benefit to the investigating police team.  As trainees we also perform Coroner’s post-mortems, write up reports, read journals and prepare our casebook which is an assessment for part of the FRCPath Part 2 examination.

The quality of training in forensic pathology is excellent.  It is an apprenticeship role and we are able to shadow the consultants at every stage, which includes learning a number of autopsy techniques, understanding the role of the colleagues that we work alongside, observing how information is communicated both with colleagues and in court, and recognising the key learning points from a wide breadth of cases that we are involved with.

Each day can be incredibly varied requiring flexibility and a good level of organisation.  I enjoy not knowing what the day will entail, it may start in a suit at Crown Court and end with scrubs and wellies performing an autopsy late into the night.

What is the best part of the job?

 The variety and the challenge, no two cases are the same.  They require a keen mind in problem solving to identify the sequence of events.  The investigations performed and the information provided by a forensic pathologist can act as crucial evidence in a criminal case before a jury.

What is the worst part of the job?

 We don’t come across the most pleasant of smells in the mortuary; decomposition, maggots and bodily contents are not always what you want to see first thing in the morning.

How is it different from general histopathology?

 The autopsies undertaken in general histopathology by consultants and trainees are coronial autopsies.  These are cases where, with the information provided, the Coroner considers them to be a non-suspicious death.  The cause of death in these cases can be largely discovered with an internal examination and often don’t require many ancillary tests.  Typically, a coronial autopsy takes less time and so a general pathologist will often perform a number of cases in a morning, whereas one forensic case can take many hours.  General pathologists are still required to give evidence at an inquest if the Coroner deems it necessary.

Forensic pathologists do perform microscope work on the histology samples taken following an internal examination at autopsy.  A large part of a general pathologist’s workload involves examining surgical pathology specimens, which does not feature in forensic pathology.

What is the future of forensic pathology?

 The main addition seen in forensic pathology practice in more recent years is the use of post-mortem CT (PMCT) scanning.  Mobile CT scanners have already been used in a number of mass disasters in the UK in conjunction with remote radiology reporting e.g., Grenfell.  PMCT scans are also beneficial as an adjunct in forensic cases when identifying trauma alongside performing a traditional autopsy and internal examination.  In many cases this results in a reduced need for invasive dissection to demonstrate significant findings when a scan image can suffice.  Even with this technology, demand for forensic pathology remains high.

Advice from anyone considering forensic pathology as a career

 Forensic pathology is a fascinating specialty full of variety and challenge.  For those interested in considering pursuing a career in this subspecialty or who want to find out more about what the job entails I would recommend a short placement shadowing in a forensic pathology department.

As a foundation doctor, a good grounding in clinical medicine spanning any area is beneficial.  Whilst some doctors choose to do a rotation during their foundation year in histopathology this is by no means essential.  Emergency medicine and intensive care medicine may seem like surprising areas to suggest, however many forensic cases come from these hospital departments if patients have received any treatment prior to death.  Therefore, learning how these patients are treated, the medications and various protocols used, as well as the invasive medical procedures undertaken in this cohort are of benefit.

It should be highlighted that, since at least 18 months of training needs to be undertaken in general histopathology, a period of shadowing and understanding of this field is also desirable prior to the national application process.

Experience in some form of teaching, undertaking an audit and/or leadership roles are all skills that are of benefit in general pathology as well as forensic pathology.

As a discipline Forensic Pathology involves the application of rigorous scientific processes and the practical application and development of many of the skills that are learned in medical school. It is an interesting and rewarding career – which offers variety and challenge – albeit involving long hours and a relatively unpredictable schedule