Forensic Medicine

Goal
The goal of teaching Forensic Medicine in the undergraduate medical course is to produce a physician who will
be well informed and alerts about his/her medico-legal responsibilities and is capable of being discharging
medico-legal duties in medical practice.
Departmental Objectives:
At the end of the course in Forensic Medicine, the undergraduate student will be able to:
 Examine and prepare reports or certificates in Medico-legal cases/situations in accordance with the law of
land.
 Perform medico-legal postmortem and interpret autopsy findings and results of other relevant investigations
to logically conclude about the cause, manner and time since death.
 Practice & apply medical ethics, etiquette, duties, rights, medical negligence and legal responsibilities of the
physician toward patient, profession, society, state and humanity at large.
 Identify & apply relevant legal/ court procedures applicable to the medico-legal/ medical practice.
 Collect preserve and dispatch specimens in medico-legal/ postmortem cases and other concerned materials to
the appropriate Government agencies for necessary examination.
 Diagnose, apply principles of therapy & understand medico-legal implications of common poisons.
 Apply general principles of analytical, environmental, occupational and preventive aspects of toxicology.

List of Competencies to acquire

1. Practice Forensic Medicine according to the expectation of the community and maintaining the dignity &
honour of the medical profession.
2. Perform ethical practice.
3. Capable to give deposition in the court of law as a medical expert.
4. Collect, preserve & despatch the medico-legally important specimen.
5. Keep the proper records.
6. Proper examination of physical assault victim.
7. Perform medico-legal examination including autopsy and interpret the findings.
8. Prepare certificates and reports according to the law of the land.
9. Write discharge certificate and death certificate properly and authentically as per ICD
10. Supervise and guide the member of a medical team regarding the ethical and legal consequence related to
medical issues.
11. Handling dead body ethically & morally
12. Write injury and medical certificate correctly

Finally, on the basis of above context, those who are concern with Forensic Medicine should initiate the
thinking to redesign the curriculum where appropriate and give emphasis on those aspects in teaching learning
and assessment of the students in under graduate medical education in Forensic Medicine.

124
 Distribution of teaching - learning hours

Lecture Tutorial Practical Other classes Total Formative Exam Summative exam
(Integrated teaching
Teaching / hours Preparat Exam Prepara Exam
Assignment) ory leave time tory time
leave
80 hrs 55 hrs 55 hrs 05 hrs 195 hrs 15 days 15 days 15 days 20 days

(Time for exam. preparatory leave and formative & summative assessment is common for all subjects of the
phase )

Teaching-learning methods, teaching aids and evaluation

Teaching Methods Teaching aids In course evaluation
Large Small group Self Others
group learning
Video & slide Multimedia.  Item
Lecture Tutorial Assignment, presentation. Camera (Still & Video) Examination
Integrated Practical self Community Overhead Projector (OHP).  Card final
teaching Demonstration assessment Oriented Slide Projector (SP). Black  Term
& self study. teaching and board. Examination
learning.  Term final
(written, oral+
practical)

2nd Professional Examination:

Marks distribution of Assessment of Forensic Medicine:
Total marks – 300
 Written =100 (MCQ-20, SAQ-70+ formative assessment marks 10)
 Structured oral examination= 100
 Practical=50, OSPE=40 & Others (PM report, Injury certificate & Practical khata)=10

Related Equipments, Aids, Specimen / Models:

Post-mortem video tape, TV, Cassette Player (available on different events/topics), Module on Teaching
Health Ethics (WHO, CME and BM&DC)
Sexual Assault examination kit
Autopsy set, dummy and photographs showing all major types of injuries & other cases
Specimen of poisons and related instruments (e.g. Ryles tube, stomach wash tube etc.)

Weapons:
Mechanical weapons
Firearms and ammunitions

125
 Learning Objectives and Course Contents in Forensic Medicine

Learning Objectives Contents Teaching

hours
Student will be able to: CORE:

 define Forensic Medicine, Medical Jurisprudence &  Discipline of Forensic Medicine and its subdivisions & Medical 1 hr.
differentiate between them. Jurisprudence.
 describe different courts in Bangladesh and their  Courts in Bangladesh and their jurisdiction: 2 hrs.
powers.  Supreme Court, High Court, Sessions Court, Additional
Sessions Court, Magistrates Court, Metropolitan Magistracy.
 Court procedures: 2 hrs.
 describe various court procedure and deposition in the  Summons, conduct money, oath, affirmation, perjury, types of
court. witness, types of examination, recording evidence, court
questions, conduct of doctor in witness box, medical
examiner’s system.
Additional:
 Coroner, medical examiner & continental Medico-legal systems. 2 hr.

CORE:
 describe various medico-legal systems.  Medical certification and Medico-legal reports including dying 1 hr.
declaration & medical documentary evidence.
 Death: 3 hr.
 write various medical documentary evidences  Definition, types: somatic, cellular and brain-death.Sudden
(certificate, reports & dying declaration) death.
 define and describe different types of death.

126
 Learning Objectives Contents Teaching hours

 identify and interpret different signs and modes of  Natural and unnatural death: 2 hrs.
death.  Signs of death.
 diagnose deaths due to environmental cause  Modes of death.
 identify the artefacts on the dead body- both ante-  Presumption of death and survivorship. 2 hrs.
mortem & post-mortem  Suspended animation.
 manage dead body  Death due to occupational and environmental causes e.g. 2 hr.
 write death certificate as per ICD  Chronic metallic poisoning (Arsenic, lead).
 Starvation. 2 hr.
 Electrical injuries.
 Snake bite. 2 hrs.
 Food poisoning.
 Precaution in handling high risk cases during Autopsy 2 hr.
(AIDS, Hepatitis).
 Handling and management of dead body
 Death certificate as per ICD 2 hr.

Changes after death: 2 hr.

Students will be able to identify & differentiate:
 Cooling of body, lividity, Rigor mortis.
 rigor Mortis, saponification, Putrefaction,
mummification & maceration.  Changes of Eyes & Skin.
 Putrefaction, mummification, adepocere. 2 hr.
 determination of time since death.
 identify & describe the eye & skin changes after  Principles of estimation of time of death.
death.  Post-mortem artefacts.

127
 Learning Objectives Contents Teaching
hours
CORE:
Students will be able to: Identification: 10 hrs.
 establish identity of living & dead persons (Age,  Definition, Identity of living persons & dead bodies.
sex, race).  Race, age, sex.
 Identification in mass death & examination of human remains.
 Trace Evidence.
 Forensic – Radiology.
 determine the cause & nature of death from the  Forensic Dactylography.
trace evidences.  Forensic Odontology.
 DNA Profiling.
 Bioinformatics
2 hrs.
 mention medico-legal importance of blood Blood groups: 2 hrs.
grouping, typing to establish identification,
 Medico-legal importance; blood grouping. HLA typing, DNA Profiling.
paternity & maternity.
CORE: 2 hrs.
INQUEST Report:
Medico-legal autopsies: 1 hr.
2 hrs.
 Medico-legal post-mortem.
2 hrs.
 Objectives, procedures, formalities of Medico-legal autopsies. Obscure
2 hrs.
autopsy, Negative autopsy.
 Special procedures in suspected poisoning cases.
Students will be able to demonstrate  Examination of mutilated bodies and exhumation.
Additional:
about: 2 hrs.
 Criteria of a modern mortuarry. 2 hrs.
 inquest done by police, magistrate and coroner.
 autopsy
 exhumation & its medicolegal importances.

Perception about safe working & proper utilization of a

modern morgue & Laboratory facilities.

128
 Learning Objectives Contents Teaching
hours
CORE:
Students will be able to 12 hrs.
 describe different types of wounds, produced by Wounds and its types & M.L Aspects:
different weapons.  Mechanical injuries.
 Fire arm & injuries
 identify the cause of death due to wounds.  Blast injury & injuries caused by explosive.
 Cause of death due to wounds & its legal aspects. 2 hrs.
 Age of wound (Healing of wound)
 Battered Wives and battered baby syndrome.
2 hr.
 Mass disaster and its management

Additional:

 Differences between accidental, suicidal and homicidal wound.

 identify the nature of the wounds.
3 hr.
Regional injuries:
 Head, neck, chest, abdomen, genitalia.
 Extremities. 3 hrs.
 differentiation of deaths due to different regional Injuries due to physical agents:
injuries. Thermal, chemical, electricity, lightning & radiation injuries.
Wounds certification: 3 hrs.
 Medicolegal aspect of wounds ( Simple & Grievous)

129
 Learning Objectives Contents Teaching
hours

Students will be able to  Violence against women. 2 hr.

 identify various forms of battery & their medico-legal  Domestic violence.
importances. Additional:
 Cot death, SIDS
 Death due to neglect
2 hrs.
CORE:

 diagnose various forms of asphyxial deaths, and their Asphyxial deaths:

medico-legal aspects.
 Drowning, hanging, throttling and strangulation &
suffocation
 Traumatic Asphyxia 10 hrs.

Additional:
 Sexual Asphyxia.

CORE:
 Pregnancy signs & pregnancy period in the living and in
5 hrs.
 diagnose Pregnancy & delivery with their medico-legal the dead. Medicolegal importance of pregnancy
importances.  Delivery: signs of recent and remote delivery in the living
and dead.

130
 Learning Objectives Contents Teaching
hours
CORE:
Abortion & its legal bearing. 2 hrs.
Students will be able to:  Spontaneous, Artificial-justifiable and criminal abortion,
 define & diagnose abortion its types & complications & delivery 2 hrs.
medicolegal importances. Infanticide: 2 hrs.
 differentiate between criminal and justifiable abortion. Additional:
 describe medico-legal importances of viable age.  Foeticide and viability
 Definition and Medico-legal considerations of viability; 2 hr.
 Determination age of foetus. Foeticide & IUF death.
CORE:
2 hr.
Biological fluids and stain: Collection
 Collection, preservation, dispatch of visceras & blood & body
fluids for chemical analysis.
 Impotency, sterility, virginity and defloration. 2 hrs.
 describe collection, preservation, and dispatch of visceras, blood Artificial insemination and other artificial methods of
and body fluid for chemical analysis. conception with medico-legal implication.
 differentiate between true & false virginity, impotency & sterility.  Surrogated mother & baby.
 describe – Procedure of examination of victim or accused. 2 hrs.
 identify sign & symptoms of rape & other sexual offences with Sexual offences:
their medico-legal importances.  Natural: Rape, Adultery, Incest.
 describe different sexual deviations, artificial insemination with  Unnatural: sodomy, Lesbianism, Bucculcoitus, Bestiality 5 hrs.
their medico-legal importance. Additional:
 Sexual perversions. 2 hrs.
 Paternity and maternity.
Students will be able to: Forensic Psychiatry
 describe how to diagnose a case of mental disorder. 4 hrs.
CORE:
 describe how to fix-up civil, criminal and social responsibilities of
 Types of mental disorder, lucid interval, testamentary
an insane person.
capacity.
 Criminal responsibility of an insane person.
 Diminished responsibility.
 True insanity and feigned insanity:
 Important terms of Forensic Psychiatry.
 Civil & Social responsibilities.
131
 Learning Objectives Contents Teaching
hours
Student will be able to: Medical Jurisprudence
10 hrs.
CORE:
 Code and law of medical ethics, its history and Geneva
 explain the codes of medical ethics & state legislations. declaration, Tokyo declaration & other declarations.
“HEALTH ETHICS”
 Bangladesh Medical & Dental Council (BMDC), its
 describe the functions and disciplinary control of BM&DC. constituents, functions and disciplinary control.
 describe the rights and privileges of a registered medical  Rights and privileges of a registered medical practitioner &
practitioner. rights of patients.
 describe the patients' rights.  Professional secrecy & privileged communication
 describe the professional negligence and its legal responsibilities.  Medical Malpractice: civil & criminal, Negligence,
 describe consent and its type. Misconduct.
 “PHYSICIAN-PATIENT RELATIONSHIP”
 Components of the physician-patient relationship 6 hrs
 Fairness and Equity
 Specific Health Issues
 describe Workmen’s compensation act, Medical maloccurance,  Jargons in the field of medical ethics.
product liabilities & mercy killing with their medico-legal  CODE OF MEDICAL ETHICS OF BM&DC
importances.  Duties of a medical practitioner towards his patient and the
society, Professional infamous conduct/misconduct.
 Precuations against professional negligence.
 Consent
 Duties and responsibilities of a doctor.
 Medical Maloccurance & Product Liabilities, vicarious
liability. 4 hrs
Additional:
 Euthanasia or Mercy killing.
 Organ transplantation Act.
 Consumer protection Act.
 Workmen’s compensation Act.

132
 Learning Objectives Contents Teaching
hours

Toxicology
20 hrs.
CORE:
Students will be able to: General aspects of poisoning:
 define a poison.  Forensic Toxicology& general toxicology.
 describe the factors modifying the action of poisons.  Poisons.
 classify poisons.  Factors modifying the action of poison.
 describe the duties of a doctor in case of poisoning.  Antidote.
 outline the principles of management of acute poisoning.  Classification of poisons.
 describe post-mortem appearances of respective  Principles of Management of acute & chronic poisoning.
poisoning cases.  Corrosive poisons: strong acids & alkalis.
 Metallic poisons: Lead, Arsenic and Copper.
 Delirients: Dhatura, Cannabis.
 Somniferous agents: Opium and its derivatives Hypnotics –
Barbiturate.
 Inebriates: Alcohol, Kerosine.
 Gaseous poisons: Carbon monoxide, Chlorine & CO2, Cooking gass
(methane).
 Insecticides: Organo-phosphorus & chlorocomponds.
 Snake Bite.
 Potka fish(Puffer fish)

 describe post mortem appearances in the dead body

of the posoining cases.

133
 Learning Objectives Contents Teaching hours
Tutorial & Observations
CORE:
Students will be able to:  Observation of ten medicolegal autopsies. 10 hours
 Injuries in the casualty department and weapons in the Forensic 2 hours
 performing medico-legal cases individually. Medicine department.
 performing medico-legal autopsies under  Specimens of poisons.
supervision.  Age estimation from bones by X-rays. 2 hours
 attend the court as a witness and dispose there.  Observation/examination of intoxicated persons in the ward
(Indoor). 3 hours
 Examination of victim and accused of sexual offences in the
Forensic Medicine department. 2 hours
Practical Skill
CORE: 2 hours
 prepare/write certificates on injury cases, births, Preparation of certificates on following: Medico-legal situations:
deaths, sickness & fitness, medical, dicharge etc.  Injury certificates, medical certificate & discharge certificate
3 hours
 write reports on medico-legal autopsies.  Birth and death, Physical fitness & sickness certificates.
 prepare dying declaration.  Autopsy report writting of ten cases
 recognize medico-legal cases individually.  Dying declaration. 3 hours
 Insanity.
 Age certificate.
 Certificates of sexual assault.
4 hours
Students will be able to: CORE:
 explain the procedures of examination of sexual  Examining cases of sexual offences.
offences.  Post mortem examination.
 explain and describe the procedure of post.  Determination of age.
mortem examination.
 explain the procedures of determination of age. Management of Poisoning: 2 hrs.
 describe the suspected poisoning cases and can  Stomach wash.
describe the emergency management of an  Visit to court, police station, DNA lab, OCC, Forensic lab.
intoxicated patient in the ward.

134
 Existing summative assessment of Forensic Medicine
Assessment systems and mark distribution.

Components Marks Total Marks

Formative assessment 10 10
WRITTEN EXAMINATION
MCQ 20
SAQ 70 90

Practical Examination 100

ORAL EXAMINATION (Structured). 100

Grand Total 300

 There will be separate Answer Script for MCQ.

 Pass marks 60 % in each of theoretical, oral and practical.

Example of a “Format” for Integrated Teaching

Teacher of Teacher of Teacher of

Anaesthesiology Pharmacology Medicine Teacher of Forensic Medicine

Hazards of The Clinical aspects of  When and how far anaesthetists are responsible for such
anaesthesia and Pharmacological acute opium and death?
causes of death, aspects of opium opoids poisoning.  Legal responsibilities of an anaesthetist.
injury and disability. and opoids.  Forensic aspects of acute opium and opoid poisoning.

 Determination of causes of death due to above poison.

 Methods for determination and confirmation of the poison.

135
 Program for Integrated teaching

Teaching &
Topics Learning Objective Learning Assessment Department
Methods

 Sudden natural death – Medicine + F. Medicine. Students will be able to: Lectures & Medicine
 Clinical toxicology – Pharmacology. + F.Medicine  Identify sudden natural death cases. Seminers &
 Identification and legal aspects of Forensic Medicine
deaths due to poisoning.
 Identification and blood group & inheritance. Students will be able to:
 Blood Transfusion hazards and death.  Ascertain legitimacy and paternity of a Blood Transfusion
 Determination of parenthood. child. &
 Legal responsibility of a blood transfusion Forensic Medicine
officer.
 Legal responsibilities of a Radiologist.  Ascertain age of victim (person) from
 Determination of ‘bone age. radiological studies. Radiology
 Detection of foreign bodies in victims of crime.  Diagnose pregnancy. &
Forensic Medicine
 Diagnosis – pregnancy etc.
 Ultra-sonographic diagnosis of pregnancy.
 Radiological hazards (hazards of radiation).
Toxicological and forensic aspect  Identify the P.M Findings in case of
 Common poisons. these poisons. Pharmacology
 Atropine. &
 Morphine and its derivatives- heroin /phensidyl Therapeutics
&
 Tranquillisers. Forensic Medicine
 Barbiturates.
 Alcohol.
 Cannabis indica in different forms.
Insecticides / pesticides -Do-
 Organophosphorus compounds.
 Chlorocompounds.
 Classification and definition of mental disorders.  Diagnose a case of mental disorder & Psychiatry
 Mental disorders and crime. fix up his civil, criminal & social &
 Mental disorders and Civil and Criminal responsibilities. Forensic Medicine
responsibilities.

136
 Continued
 legal aspect and clinical aspect.  Identify & interpret these injuries in Surgery
 Injuries in general. living and dead bodies. &
 Head injury and neck injury. Forensic Medicine
 Chest injuries.
 Abdominal injuries.
 Burns and scalds.

 Anaesthetic hazards and causes of death  Identify death due to anaesthetic Anaesthesiology
 Respiratory failure in poisoning. hazards. &
Forensic Medicine

 Inflammation  Understand the pathological changes in Pathology

 Infection these conditions. &
 Histopathological studies: Forensic Medicine
1. Antemortem wounds.
2. Post-mortem wounds.
3. Lungs and other viscera in asphyxial death and
correlation with pneumonia and pulmonary
oedema.
4. Detection of bloodstain and seminal stain.
 Pathological study of hair:
1. Pathological studies of sudden death.
2. Pregnancy tests.
3. H.L.A., blood group and paternity.

 Pregnancy.  Understand how to diagnose these Obstetric & Gynaecology

 Abortion. cases with their medico-legal &
 Labour. importance. Forensic Medicine
 Lactation.

137
 Academic Schedule for Forensic Medicine
2nd Phase
1st TERM 2nd TERM
1 2 3 4 5 6 7 8 9 10 11 12
 Forensic Medicine, Medical  Wounds, Regional injure injuries Internal
Jurisprudence Internal due to physical agents, Wound Assessment
 HEALTH ETHICS assessment certification, Vehicular injuries.
 BMDC, Rights & Privileges of Doctors,  Pregnancy and delivery, Abortion,
Code & law of medical ethics, Infanticide, Biological fluid/ swabs
Professional Secrecy. preservation and despatch, Sexual
 Inquest, Medical certificate, offences, Impotence and sterility,
Medicologal reports including dying Artificial insemination and
declaration, Courts procedures, Medico- disputed paternity and maternity,
legal systems. Practical 25 hrs.
Forensic psychiatry
 Malpraxis, Consent, Duties of medical Lecture- Practical 30 hrs. Lecture-
Tutorial 25 hrs.
 General aspect of poisoning and its
practitioners. 40 Tutorial 30hrs. 40
classification, Medicolegal
 Death, Changes after death,
Autopsy in poisoning, Preservation
identification, Medical-legal autopsy
and despatch of viscera,
 Asphyxial death
management of acute poisoning.
 Mass disaster
 Strong acids and alkalis, Metallic
 DNA profiling poison, Deliriant poison,
inebriants.
 Gaseous poisons, Insecticides,
Animal poison
 Assisted reproduction
 End life care

138
 Hours of Teaching:
 Large group
* Lecture - 80 hours.
 Small group
* Practical - 55 hours.
* Tutorial - 55 hours.
* Integrated teaching/ Assignment - 5 hours.
Total = 195 hours.

Summary of the Forensic Medicine Academic Programme

1st Term 2nd Term Total

Lecture/Revision 40 hrs 40 hrs 80 hrs
Practical/ Demonstration 30 hrs 25 hrs 55 hrs
Tutorial 30 hrs 25 hrs 55 hrs
Integrated 3 hrs 2 hrs 5 hrs
Teaching/Assignment
Total --------- --------- 195 hrs

139