Forensic Medicine and Toxicology syllabus for MBBS in India (Competency based Education/CBME 2019)

The goal of the teaching of Forensic Medicine is to:
- Produce a physician who is well informed about medicolegal responsibilities in the practice of medicine.
- A physician will also be capable of making observations and inferring conclusions by logical deductions to set inquiries on the right track in criminal matters and connected medicolegal problems.
- A physician acquires knowledge of the law in relation to medical practice, medical negligence, and respect for codes of medical ethics

Topics & competencies in Forensic Medicine and Toxicology for MBBS as per the CBME

Topic	Competencies	Practicals	Procedures for certification	Integrations
1. General Information	11	NIL	Nil	V-1 / H-0
2. Forensic Pathology	35	17	Nil	V-16 / H-0
3. Clinical Forensic Medicine	33	7	Nil	V-29 / H-0
4. Medical Jurisprudence (Medical Law and ethics)	30	NIL	Nil	V-30 / H-0
5. Forensic Psychiatry	6	NIL	Nil	V-6 / H-0
6. Forensic Laboratory investigation in medical legal practice	3	1	Nil	V-1 / H-0
7. Emerging technologies in Forensic Medicine	1	NIL	Nil	NIL
8. Toxicology: General Toxicology	10	4	Nil	V-8 / H-0
9. Toxicology : Chemical Toxicology	6	6	Nil	V-6 / H-0
10. Toxicology : Pharmaceutical Toxicology	1	1	Nil	V-1 / H-0
11. Toxicology : Biotoxicology	1	NIL	Nil	V-1 / H-0
12. Toxicology : Sociomedical Toxicology	1	NIL	Nil	V-1 / H-0
13. Toxicology : Environmental Toxicology	2	NIL	Nil	V-1 / H-0
14. Skills in Forensic Medicine & Toxicology	22	16	Nil	V-4 / H-0
Total: 14	162	52	NIL	V-105 / H-0

Sample of the detailed description of the competencies:

No	Competency	DLC	Teaching	Assessment	V/H
FM11.1	Describe features and management of Snakebite, scorpion sting, bee and wasp sting, and spider bite	K-K/KH-Y	Lecture, Small group discussion, Autopsy	Written/ Viva voce	V: General Medicine

Abbreviations & details:
- No & Competencies: No – serial number of the competency with subject/topic coding, & Competencies – description of competencies
- Domain/level-Core (DLC):
  1. Domain (Identifies the domain): K- Knowledge, S – Skill, A – Attitude/professionalism, C- Communication.
  2. Level (Identifies the level of competency): K – Knows, KH – Knows How, SH – Shows how, P- performs independently.
  3. Core: Y – must achieve/compulsory, N – non-core/desirable/optional
- Skills required to certify: P – many procedures must be done independently for certification/ graduation.
- Integration: V – Vertical Integration, H – horizontal integration.

General Objectives of Forensic Medicine & Toxicology for MBBS

Objectives: Knowledge- At the end of the course in forensic medicine, the MBBS student will be:

1. Able to understand the basic concept of the subject and its importance.
2. Aware of inquest, legal and court procedures applicable to medico-legal and medical practice
3. Able to perform medicolegal postmortem/autopsy findings and results of other relevant investigations for logical conclusion and framing the opinion on cause, manner and time since death.
4. Able to reserve and despatch relevant various articles, trace evidences including viscera in poisoning cases in medicolegal cases/ autopsy examination and handing over the same to appropriate agencies.
5. Able to identify the medicolegal cases, carryout medical examination in such cases, and prepare the medicolegal report as per the law of the land.
6. Aware of code of ethics, duties and rights of medical practitioner, duties towards patients and community, punishment on violation of code of ethics, various forms of medical negligence, duties towards his professional colleagues.
7. Able to diagnose and manage the cases of acute and chronic poisoning and can carryout medicolegal duties.
8. Aware of general principles of analytical, environmental, occupational toxicolgy including toxicovigilance and predictive toxicology
9. Aware of latest advances in Forensic Medicine & Toxicology and their medicolegal importance

Teaching and learning methodology in Forensic Medicine and Toxicology for MBBS

Details of the competencies, lectures, practicals & skills to be acquired are mentioned in the table given above.
Teaching Learning Method:
1. Learner-centric didactic lectures with Vertical/horizontal integrations (CBME).
2. Tutorial & Seminars
3. Problem-based Learning (PBL) & Small group discussions (especially focus on practical & clinical implications of the knowledge through cases)
4. Conventional Practical classes & DOAP session (Demonstrate, Observe, Assess, Perform),
5. Self-directed learning +/- multimedia aids (Audiovisual presentations).
6. Seminars, symposia & quizzes.

Distribution of approximate teaching hours in Forensic Medicine and Toxicology for MBBS

NBE provided the particulars of competencies, teaching methodology, Vertical/horizontal integrations, AETCOM & Exam methodology however the distribution of hours per class/tutorial & practicals are left for the individual universities to be handled therefore subjected to inter-university variability.

Total number of teaching hours: approximately 150 hrs (teaching hours & distribution might differ slightly per university).
Theory:

Chapter	Duration
1. Introduction	1
2. Indian legal system	3
3. Personal identity of the living and the dead	4
4. Death and its medico-legal aspect	3
5. Medico-legal autopsy	3
6. Examination of decomposed bodies	1
7. Examination of biological stains	2
8. Mechanical injuries	5
9. Traffic accidents	2
10. Regional injuries	4
11. Firearms and firearm wounds	4
12. Medicolegal aspects of injuries	4
13. Artefacts	2
14. Mechanical asphyxial deaths	5
15. Anaesthetic and operative death	2
16. Other forms of death	2
17. Impotence, sterility and artificial insemination	3
18. Virginity, pregnancy and delivery	4
19. Legitimacy, disputed paternity	2
20. Sexual offences	6
21. Abortion	3
22. Infant death	4
23. Forensic psychiatry	4
24. Law relating to medical practice	3
25. Toxicology	20
26. Forensic science laboratory	2
27. Common provisions of Law in Medicolegal practice.	2
Total	100

Practicals:

Chapter	Duration
1. Clinical Case Demonstration	2
2. Medicolegal autopsies in cases	10
3. Study of dead body at autopsy	2
4. Collection, Preservation and forwarding of viscera for chemical analysis	2
5. Dissection of neck structure, Demonstration of antemortem injury & artefacts caused by decomposition	2
6. Study of foetus regarding Age, Live Birth and cause of Death etc.	2
7. Study of weapon of offence	6
8. Study of Firearms and ammunition	2
9. Examination of blood stains/ Blood by Physical, Chemical, Microscopic and spectroscopic methods	2
10. Morbid specimen and slides	2
11. Slides demonstration: Sexual Offences etc.	2
12. Study of photographs and X-rays	2
13. Study of Identification methods	2
14. Identification of poisons	8
15. Proformas for demonstration	4
Total	50

Examination pattern & marks distribution in Forensic Medicine and Toxicology for MBBS

Exam pattern:
1. The formative or internal assessment will not be added to the university examination marks.
  - Should score 50 % & in theory and practical combined to be eligible to sit for university exams.
2. University exam: Each subject will have two papers.
  - 200 marks will be reserved for the theory of two papers.
  - Another 100 will be reserved for either practical, oral, or clinical exams.
  - Should secure 50 % in theory and practical to pass in university examinations

Formative Assessment:
1. Theoretical assessment: clickers, one-minute papers, and muddiest point
2. Practical/clinical assessment: one-minute preceptor (OMP) and/or viva voce.
3. Scheduling: during teaching-learning activities & planned by the teachers on a day to day basis and modified depending on the tasks at hand.
Internal assessment
1. Theory: Written tests, should have essay questions, short notes, and creative writing.
2. Practical / Clinical: practical/clinical tests, Objective Structured Clinica/Objective Structured Practical Examination (OSPE) and/or viva voce.
3. Scheduling:
  - Minimum Number of tests during the year: 2
  - Clinical subjects should also be tested at end of each posting (EOP)-Theory and Practical
  - There should be at least one short question from AETCOM in each subject
  - One of the tests in Ophthalmology, Otorhinolaryngology/Forensic Medicine & Toxicology/ Community Medicine should be prelim or pre-university examination
Summative assessment (For Universities)
- Theory Papers: 2 papers for 200 marks
  1. Suggested combination of various types of question:
    1. Structured essays (Long Answer Questions – LAQ)
    2. Short Answers Questions (SAQ)
    3. Objective type questions (Various type of MCQs: < 20% weightage)
  2. Distribution of the competencies: The examiner must sample the contents appropriately from competencies.
- Practicals for 100 marks:
  1. Application-oriented exercises (Should not be simple tests of knowledge).
  2. Objective Structured Practical Examination (OSPE), One- Minute Preceptor (OMP), Directly Observed Procedural Skills (DOPS) etc. can be suitably modified for this purpose and/or viva voce.
- Scheduling:

List of recommended books in Forensic Medicine and Toxicology for MBBS

The essential of Forensic Medicine & Toxicology, K.S.N.Reddy
Modi‘s Textbook of Medical Jurisprudence and toxicology, Edited by BV Subramanyam,
A textbook of Medical Jurisprudence, Forensic Medicine & Toxicology, C.K.Parikh
Principles of Forensic Medicine, Apurba Nandy