History of Clinical Forensics

Emergency medicine physicians (EM) frequently encounter in their daily practice victims of criminal enterprise and events requiring investigation. These enterprises can be further divided into traumatic circumstances including gunshot wounds, stabbings, physical and sexual assaults, and motor vehicle collisions; and medical circumstances including child abuse, elder abuse, human trafficking, and domestic violence. Clinical Forensics combines the legal, medical, and law enforcement aspects of patient care to not only serve the medical needs of the patient, but the acquisition of justice for that patient. It includes the collection and preservation of evidence in a civil or criminal matter requiring detailed documentation, expert testimony, and collaboration with local, state, and federal law enforcement agencies.

History of the Field

The field was developed because of the number of emergency department (ED) patients who are victims of criminal activity. In 1991, the Department of Emergency Medicine at the University of Louisville School of Medicine, in conjunction with the Kentucky Medical Examiner's Office, created the first formal training program for EM residents in forensics. In 2006, the American College of Emergency Physicians (ACEP) established the Forensic Medicine Section to further address forensic issues in EDs. Previously, there existed a one-year postgraduate fellowship in clinical forensic medicine for residency-trained emergency physicians. However, there are currently no ACGME-accredited clinical forensic fellowship programs offered. Most forensic departments that exist are adjunct offices within departments of academic EM.

Current Academic Track

The academic track is a small niche within the EM community. Duties associated with the track include directorship of a sexual assault nurse examiner program, research in forensic procedures and medicine, providing courses for EM residents and faculty on forensic procedures and forensic updates, child abuse teams, or serving as medical director for a crime lab or law enforcement.

The Future of Clinical Forensics

The field has remained stagnant since its conception in the 1990s and interest varies over the years. There does exist a program within the Philadelphia College of Osteopathic Medicine that provides a combined degree program of Doctor of Osteopathic Medicine with a Masters in Forensic Medicine. According to experts in the field, it is unlikely that a formal, ACGME-accredited fellowship will be established. However, for motivated residents, programs can develop a non-ACGME accredited fellowship with a Masters program in Forensic Medicine.