What is forensic pathology?
Forensic pathology is a medical specialty involved in the medico-legal investigation of sudden and/ or unexpected deaths. In Singapore, forensic pathologists are part of a team that assists the State Coroner in medico-legal death investigations. The team also comprises police investigation officers and occasionally, public prosecutors. We participate in scene investigations, conduct autopsies and review circumstances of death to arrive at a cause of death. This allows us to provide expert opinions to assist in the proceedings of the courts, primarily, and occasionally, other agencies such as Ministry of Manpower and Ministry of Defence.
My training pathway
Forensic pathology is one of the few medical specialties that retain a five-year seamless training programme. Having completed a six-month Medical Officer Posting Exercise (MOPEX) posting in forensic pathology as a pre-requisite for traineeship application, I applied for the programme while serving my full-time national service and began as a trainee immediately after my time in the Singapore Armed Forces.
The first year of training was spent acquiring various skills in autopsy, anatomical pathology and medico-legal work. I was exposed to a variety of cases, ranging from natural deaths, such as sudden death from ischaemic heart disease, to unnatural deaths, such as suicides, fatal falls from a height, road traffic collisions and workplace incidents. Following which, I spent eighteen months in the pathology departments of Tan Tock Seng Hospital and Singapore General Hospital, training in the various aspects of anatomical pathology. After the anatomical pathology rotations, I spent a few more years in forensic pathology, building my knowledge and experience before an overseas posting to the Victorian Institute of Forensic Medicine, Melbourne, Australia, in my final year of training. I then took the forensic pathology final examination in Australia, before returning to Singapore.
The overseas posting in the final year of training is unique to a few medical specialty training programmes in Singapore. Trainees are posted to an overseas forensic pathology institute to immerse themselves in the foreign medico-legal environment and to prepare them for their examinations in the country of their overseas posting. This posting also allows the trainee to interact with forensic specialists of different fields and nationalities, and bring back invaluable improvements to Singapore's medico-legal death investigation system.
A typical day
A forensic pathology trainee would start the day with a review of the coroner's cases. The process is similar to clerking a clinical case for morning ward rounds, except that the information does not come from the patient (or the deceased in our case) but from the police investigation officer and hospital/clinic medical records. The cases are discussed with the State Coroner who will then direct the forensic pathologist to perform an autopsy, if required. Trainees will then perform the autopsies for their assigned cases and conduct external examinations for the cases not requiring an autopsy.
Autopsies are typically completed by midday. The afternoon is spent preparing the autopsy report and correspondences from police investigation officers, agents from other government agencies, lawyers and other interested parties. All work done by the trainees is supervised by a specialist forensic pathologist. Weekly teaching sessions are conducted, and research opportunities are available should a trainee wish to embark on a project.
My thoughts on forensic pathology
During my training, I gained insights to various aspects of life and death. Forensic pathology involves arenas beyond medicine. It opened my eyes to police work, law, sociology, public health, governance and much more, allowing access to knowledge and experiences that I would otherwise be unable to achieve. As I end this piece of writing, I would like to leave you readers with a quote: "To learn how to live, one must first learn how to die".