Perceptions of clinical teachers acting as examiners regarding the value of Objective Structured Clinical Examinations.

OBJECTIVES: OSCE (Objective Structured Clinical Examination) is a common method of assessing clinical skills used at many universities. An important and at the same time difficult aspect of good examination preparation is obtaining a properly trained and well-motivated group of assessors. To effectively recruit and maintain cooperation with assessors, it is worth to know their opinion. The aim of this study was to investigate the opinions of teacher-examiners about OSCE and to identify the factors that could shape this opinion and influence on motivation. METHODS: A cross-sectional study was conducted using a questionnaire on teachers who participated as OSCE examiners. This questionnaire consisted of 21 questions about their perceptions. Answers were rated in a five-point Likert-type scale. Chi-square or Fisher's exact test was used to analyze the data. RESULTS: A total of 49 (out of 52) teachers participated in this study. Nearly 90% of examiners believed that it is fair, more than 90% that it is transparent. Despite the fact that 67% of examiners believe the examination is difficult to organize and 71% believe it is stressful for students, according to 72% of respondents the OSCE has a positive effect on learning. More than 91% of examiners believed that the OSCE is an appropriate test to assess students' skills. Opinions about examination were independent of specialty, seniority, gender or taking the OSCE as students. CONCLUSION: Teacher-examiners viewed the OSCE as a fair and transparent examination, adequate for assessment of skills and, despite it being difficult to organize, worth doing as it is appropriate to assess practical skills and positively influences students' motivation to learn tested skills.

The Sydney Lindt café siege: The role of the consultant psychiatrist.

BACKGROUND: In December 2014, after a 16-hour siege of the Lindt café in Sydney, Iranian-born gunman Man Haron Monis shot dead a hostage precipitating the police action which broke the siege. OBJECTIVE: This paper reviews the demographic and other factual details of Monis as documented by the NSW Coroner's Inquest and critically analyses the published findings of the Coroner particularly in relation to the role of the psychiatrist who advised senior police and negotiators during the siege. RESULTS: At the time of the siege, there was no formal protocol that delineated the role of a psychiatrist in hostage negotiations. Despite the psychiatrist's credentials including his extensive experience with siege-hostage incidents and his counter-terrorist training, the Coroner was unfairly critical of the psychiatrist. CONCLUSION: The Coroner's censure of the psychiatrist was clearly prejudiced by hindsight bias. During the siege, the psychiatrist properly considered and evaluated all the available intelligence and other information known about the gunman. As the psychiatrist advised, Monis was a narcissist and the siege was not an Islamic State-inspired terrorist attack. Given that he announced he was armed with a bomb, Monis represented a 'credible threat' to the hostages. The psychiatrist's endorsement of the police strategy to 'contain and negotiate' was prudent in the circumstances. The Coroner's disparagement of the senior psychiatrist may have the unintended consequence that psychiatrists may be reluctant to assist in hostage-sieges or other critical incidents.

Coroners' recommendations for prevention of resident deaths in aged care: The role of primary care providers

BACKGROUND AND OBJECTIVES: Currently, very little is known about how coroners consider a role for general practitioners (GPs) and registered nurses (RNs) in recommendations for the prevention of premature death. Involving these professions in recommendations generally directed towards government organisations or residential aged care providers and management may contribute to more successful broader policy changes. The aim of this article was to examine whether coroners' recommendations describe a specific role for GPs and RNs in the prevention of premature death in residential aged care settings and, if so, what domains of practice were considered. METHOD: This study was part of a larger retrospective cohort study. The National Coronial Information System (NCIS) was used to extract coroners' reports that included recommendations directed towards GPs and RNs. The following information was extracted: mechanism of death, incident location, text of coroners' recommendations. RESULTS: Of 162 unique recommendations, 14 (8.6%) were relevant to GPs and 10 (6.2%) were relevant to RNs. Most recommendations were made in the domains of 'applied professional knowledge and skills', 'organisations and legal dimensions' and 'provision and coordination of care'. Recommendations were primarily made in response to natural cause deaths and complications of clinical care. DISCUSSION: Coroners' recommendations have a limited focus directed towards GPs and RNs, and recommendations focus on their roles in application of skills and knowledge, legal domains, and provision and coordination of care. Recommendations were mainly made in response to deaths due to suboptimal care or from 'complications of clinical care'. Formulating recommendations for these health professions may increase accountability and the likelihood of a recommendation being effectively implemented.

[Death after a fall in patients with advanced dementia: cause of death natural or unnatural?] / Overleden na een val bij gevorderde dementie.

OBJECTIVE: This article describes and discusses the viewpoints of elderly care physicians and municipal coroners regarding the qualification of natural or unnatural deaths of nursing home residents with advanced dementia who fall. DESIGN: A digital questionnaire was sent to all elderly care physicians-in-training and their trainers in the Netherlands, and to all 23 municipal coroners in the Mid-Holland region. METHOD: As well as questions on knowledge of the Dutch law and prognostic figures concerning dementia-related death, the questionnaire described two cases with minimal differences. The respondents were asked if they would issue a certificate of natural death in each case, and if not, would they have preferred to do so. They were also asked to explain their answers. RESULTS: Of the 405 elderly care physicians who responded, 68% and 49%, respectively, would have issued a certificate stating the cause to be natural death in each case, or if they did not they would have preferred to do so. All 15 coroners who filled in the questionnaire came to the conclusion of unnatural death. CONCLUSION: The majority of the elderly care physicians feel that a certificate of natural death can be issued if a fall in a nursing home results in a fracture, as this can be considered as part of the disease process of dementia.

Health professionals' and coroners' views on less invasive perinatal and paediatric autopsy: a qualitative study.

OBJECTIVE: To assess health professionals' and coroners' attitudes towards non-minimally and minimally invasive autopsy in the perinatal and paediatric setting. METHODS: A qualitative study using semistructured interviews. Data were analysed thematically. RESULTS: Twenty-five health professionals (including perinatal/paediatric pathologists and anatomical pathology technologists, obstetricians, fetal medicine consultants and bereavement midwives, intensive care consultants and family liaison nurses, a consultant neonatologist and a paediatric radiologist) and four coroners participated. Participants viewed less invasive methods of autopsy as a positive development in prenatal and paediatric care that could increase autopsy rates. Several procedural and psychological benefits were highlighted including improved diagnostic accuracy in some circumstances, potential for faster turnaround times, parental familiarity with imaging and laparoscopic approaches, and benefits to parents and faith groups who object to invasive approaches. Concerns around the limitations of the technology such not reaching the same levels of certainty as full autopsy, unsuitability of imaging in certain circumstances, the potential for missing a diagnosis (or misdiagnosis) and de-skilling the workforce were identified. Finally, a number of implementation issues were raised including skills and training requirements for pathologists and radiologists, access to scanning equipment, required computational infrastructure, need for a multidisciplinary approach to interpret results, cost implications, equity of access and acceptance from health professionals and hospital managers. CONCLUSION: Health professionals and coroners viewed less invasive autopsy as a positive development in perinatal and paediatric care. However, to inform implementation a detailed health economic analysis and further exploration of parental views, particularly in different religious groups, are required.

Service failures and challenges in responding to people bereaved through drugs and alcohol: An interprofessional analysis.

This article reports findings from the first two stages of a three-stage qualitative study which considered the role of services, including public, private and charitable organisations, in responding to the needs of adults bereaved following the drug and/or alcohol-related death of someone close. The study, the first of its kind to explore the landscape and role of services in substance use deaths, was conducted over two sites: south west England and Scotland. In stage 1 of the research, adopting both convenience and purposive sampling, data were collected via semi-structured interviews on experiences and support needs of bereaved individuals (n = 106). In stage 2, six focus groups were conducted with a purposive sample of practitioners (n = 40), including those working for the police, coroner's service, procurator fiscal depute (Scotland), health service, funeral service, press, clergy, Public Health England, Drugs Policy Unit, bereavement counselling/support and alcohol and drug treatment services, to investigate how services may better respond to this bereavement. Thematic analysis from both data-sets identified two overarching themes. The first, focusing on practitioner responses, captures how these bereaved people may meet with inadequate, unkind, and discriminatory responses from services. Having to navigate unfamiliar, fragmented, and time-consuming procedures compounds the bereaved's distress at an already difficult time, illustrated by a 'mapping' of relevant services. The second relates to challenges and opportunities for those responding. Service failures reflect practitioners' poor understanding of both substance use bereavement and the range of other practitioners and services involved. Those bereaved are a poorly understood, neglected and stigmatised group of service users. There is a need for services to respond without judgement or insensitive language, and provide information about, communicate and work closely with, other services despite differences in working practices and cultures. These recommendations could positively affect bereaved peoples' experiences, alleviating stress and overwhelm at a particularly vulnerable time.

Work-related trauma, alienation, and posttraumatic and depressive symptoms in medical examiner employees.

OBJECTIVE: First-responder employees, including firefighters, police, and medical examiners, are at risk for the development of depression and posttraumatic stress disorder (PTSD) as a result of exposure to workplace trauma. However, pathways linking workplace trauma exposure to mental health symptoms are not well understood. In the context of social-cognitive models of depression/PTSD, we examined the role of negative cognitions as mediators of the cross-sectional and longitudinal relationship of workplace trauma exposure to symptoms of depression/PTSD in medical examiner (ME) employees. METHOD: 259 ME personnel were recruited from 8 sites nationwide and completed an online questionnaire assessing potential trauma exposure (i.e., exposure to disturbing cases and contact with distressed families of the deceased), negative cognitions, and symptoms of depression and PTSD, and 151 completed similar assessments 3 months later. RESULTS: Longitudinal analyses indicated that increases in negative cognitions, and, in particular, thoughts about alienation predicted increases in depressive symptoms from Time 1 to Time 2. In cross-sectional analyses, but not longitudinal analyses, negative cognitions mediated the relationship of case exposure to symptoms of both depression and PTSD. Negative cognition also mediated the relationship of contact with distressed families to depressive symptoms. The strongest effects were for negative cognitions about being alienated from others. CONCLUSION: The results of this study support social-cognitive models of the development of posttraumatic distress in the workplace and have implications for the development of interventions to prevent and treat mental health symptoms in first responders. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Contradictory coroners? Decision-making in death investigations.

AIM: National coroner data demonstrate differences in the rates at which coroners across England and Wales choose to investigate reported deaths and the frequency by which they record certain conclusions. This study sought to examine how decisions are made by coroners and whether they differed when faced with identical case information. METHODS: Three different clinical scenarios were circulated via a web link to all senior coroners. The case information was contained within a 'Decision Board' displayed on screen. Each scenario had nine consistent categories of information, such as the cause of death and the medical history. Participants were asked to indicate an inquest conclusion (verdict) using free text and to provide comments. The way in which participants accessed the case information (order, frequency, etc) was recorded by the computer software. RESULTS: 35 coroners responded. There was little consensus as to conclusion with scenarios 1 and 2 generating four different outcomes and scenario 3 generating an extraordinary eight different conclusions among respondents. Despite coming to widely different conclusions, coroners demonstrated very similar decision-making processes. Conclusions were robustly defended yet proffered alternatives were plentiful. The comments made indicated a difference in the personal attitudes of coroners towards case information. CONCLUSIONS: Different coroners faced with identical case information arrived at widely different case outcomes ranging from no further investigation to finding numerous alternative verdicts. Disparity appeared to be a product of differing personal attitudes among coroners. National coroner consensus to achieve a shared inference from available evidence is urgently needed.

Negotiating grief and trauma in the coronial jurisdiction.

This article is placed within the wider context of lawyer wellbeing research, which evidences abnormally high levels of depression, substance abuse and suicide among the legal profession. To date, however, relatively few works have sought to explore the phenomenon of lawyer distress in particular segments of the legal services industry. This article seeks to explore and understand the affective experiences of legal professionals working in the coronial jurisdiction. It examines the ways in which solicitors, barristers and coroners negotiate grief and trauma in the performance of a public role. The point of departure is an enduring conflict between the responsibilities of office and the cultivation of intimate relations. In exploring the likelihood of distress among legal personnel in the coronial jurisdiction, this article looks not only to research on the wellbeing of legal personnel, but to the literature on vicarious or secondary trauma reactions and compassion fatigue among professions dealing with trauma. In examining the different ways in which legal personnel manage and negotiate grief and trauma, the article draws on the sociological concept of intimate citizenship to suggest that the operational model of the court, informal networks among professionals and strong personal relationships may serve to ameliorate distress.

Mala praxis en Psicología Clínica y Forense a la luz de los tribunales de justicia españoles: un análisis exploratorio / Malpractice in Clinical and Forensic Psychology in Spanish courts: an exploratory analysis

En este artículo se analizan los problemas más significativos en la práctica de la Psicología Clínica y Forense que han llegado a los tribunales de justicia españoles en los últimos años. Entre estos problemas de mala praxis se incluyen: a) ausencia de consentimiento informado en relación con el diagnóstico y el tratamiento psicológico, b) errores en el diagnóstico debidos a una negligencia profesional, c) transgresión del secreto profesional y revelación de información confidencial del paciente en determinadas circunstancias, d) negligencia para prevenir el daño para el propio paciente u otras personas (suicidio u homicidio), e) conflictos relacionados con la protección o conservación de la historia clínica, f) problemas relacionados con la hospitalización psiquiátrica involuntaria y con el manejo del riesgo en pacientes suicidas o violentos y g) peritajes contradictorios en los tribunales. Se comentan asimismo algunas sugerencias para las investigaciones futuras en este campo

This paper reviews the most relevant ethical and malpractice issues in Clinical and Forensic Psychology arising in Spanish courts of justice. The main issues related to malpractice include: a) lack of informed consent regarding diagnosis and psychological treatment, b) mistakes in diagnosis because of professional negligence, c) violation of the professional secrecy and disclosure of confidential information without the consent of the individual in various circumstances, d) clinical negligence in preventing harm to patients or other people (suicide or homicide), e) negligence in protecting clinical records regarding the ownership of psychological records and data, f) involuntary psychiatric hospitalization and risk management with suicidal or violent patients and g) contradictory expert reports in courts. Suggestions for good practice in this field are considered

The moderating impact of interacting with distressed families of decedents on trauma exposure in medical examiner personnel.

OBJECTIVES: Prior research has examined the incidence of posttraumatic stress stemming from either direct or indirect trauma exposure in employees of high-risk occupations. However, few studies have examined the contribution of both direct and indirect trauma exposure in high-risk groups. One particularly salient indirect trauma often endorsed as the most stressful by many occupational groups is interacting with distressed family members of victims of crime, illness, or accidents. The present study examined the extent to which interacting with distressed families moderated the impact of cumulative potentially traumatic event (PTE) exposure on depression and posttraumatic stress disorder (PTSD) symptoms in 245 employees of medical examiner (ME) offices. METHOD: Employees from 9 ME office sites in the United States participated in an online survey investigating the frequency of work place PTE exposures (direct and indirect) and mental health outcomes. RESULTS: Results revealed that cumulative PTE exposure was associated with higher PTSD symptoms (PTSS) for employees who had higher frequency of exposure to distressed family members. After controlling for cumulative and direct PTE exposure, gender, and office site, exposure to distressed families was significantly associated with depressive symptoms, but not PTSS. CONCLUSIONS: Findings of our research underscore the need for training employees in high-risk occupations to manage their reactions to exposure to distraught family members. Employee training may buffer risk for developing PTSD and depression. (PsycINFO Database Record

Thematic analysis of key factors associated with Indigenous and non-Indigenous suicide in the Northern Territory, Australia.

INTRODUCTION: Given the impact of suicide on individuals, families and communities, particularly for rural, remote and Indigenous populations, the current study was undertaken to enhance understanding on this topic. Coroners' reports were identified as a rich data source, amenable to thematic summary to reveal key factors associated with suicide. METHODS: Thematic analysis was undertaken of 411 coroners' reports of completed suicides across a 10 year period, occurring in the Northern Territory, Australia. Data were extracted numerically and qualitatively, categorised and tallied. RESULTS: Key factors associated with suicide in order of frequency of identification by coroners were (i) alcohol and other drug abuse, (ii) conflict and relationship breakdown and (iii) mental illness and mental health concerns. Considerable differences were noted between Indigenous and non-Indigenous cases. In addition to numerical summaries, examples of coroners' comments are provided that underscore the relevance of these factors. CONCLUSION: An array of factors was associated with suicide and considerable variation was found between Indigenous and non-Indigenous cases. The relative importance of social and contextual factors is confirmed for people at risk of suicide in rural, remote and Indigenous populations. These findings suggest relative priorities for suicide prevention and postvention.

"Killed by its mother": infanticide in Providence County, Rhode Island, 1870 to 1938.

This article analyzes infanticide based on the Coroners' Records for Providence County, Rhode Island, from the 1870s to 1938 to determine doctors' and coroners' attitudes toward mothers who killed. The nineteenth century witnessed a medical discourse on the possibility of postpartum insanity as a cause of infanticide. While some women claimed temporary insanity, and some doctors and coroners legitimated this defense, its application to mothers who killed was arbitrary. They determined who deserved this diagnosis based on the woman's character, her forthrightness, and extenuating circumstances. Infanticide divided the profession nationally and at the local level and prevented doctors or coroners from speaking in a united voice on the issue. This article does not attempt to follow cases of infanticide through to jury verdicts. Instead, it provides an opportunity to analyze the circumstances women faced that led them to kill their newborns, and to analyze the responses of doctors and coroners to these mothers who killed. Unlike the findings of other studies, neither physicians nor coroners in Rhode Island were united in a claim of ignorance to save these women from guilty verdicts.

[Psychological aspects of public activity of a forensic medical examiner].

In the recent years, professional activity of forensic medical examiners has been gaining publicity which necessitates knowledge of individual psychologic personality traits, the ability to effectively communicate, and high vocational culture on the part of each specialist. The specific character of professional contacts of a forensic medical expert is self-evident taking into consideration that he (she) has to deal with a great variety of persons including law enforcement officials, law breakers and criminal offence victims, men and women, young and aged people, representatives of different social groups, subjects in a specific emotional state, etc. In order to organize efficacious cooperation with all these individuals, the expert must develop high communicative competence, possess knowledge of psychology of communication, abilities and skills necessary for the establishment and maintenance of professional and business contacts.

Perceived value of trauma autopsy among trauma medical directors and coroners.

INTRODUCTION: Although autopsy is acknowledged as essential for improving quality of medical care of trauma patients and accuracy of injury surveillance systems, the autopsy rate has remained well below 100% for certain categories of trauma. We obtained recent documentation of the frequency of autopsy among trauma-related deaths in Ohio, and surveyed coroners and trauma program medical directors (TMDs) about the perceived benefits and challenges of performing autopsy. MATERIALS AND METHODS: Copies of death certificates were obtained for the years 1996-2001. Death and autopsy rates were calculated and examined for trends over time. Surveys covering the topics of mechanisms of injury prompting autopsy, uses and users of autopsy data, and barriers to performing autopsy were sent to Ohio's coroners, coroners from nearby states, and Ohio TMDs. The chi(2)-test for trend analysed autopsy rates over time, while responses among groups were compared using the chi(2)-test. RESULTS: The autopsy rate for injury related deaths increased from 50% in 1996 to 66.5% in 2001 (p=.0018). During the study period the volume of autopsies rose by 18%, from 2990 to 3546. There was no review by the coroner in almost 10% of trauma deaths. TMDs more often indicated that autopsies advance medical knowledge than did Ohio and non-Ohio coroners (62.9% versus 33.4% and 47.6%, respectively, p=.016). TMDs more frequently reported themselves as users of autopsy information than did Ohio and non-Ohio coroners (91.4% versus 14.6% and 20%, respectively, p<.0001). All groups reported inadequate funds and personnel as the two most common barriers to performing autopsies, although TMDs were more likely to identify these as barriers than coroners (p<.0001). Almost 27% of Ohio coroners agreed with the statement, "I do not feel that trauma-related autopsies are necessary". CONCLUSION: Significant barriers exist to improving autopsy rates among trauma patients who die. These include not only more well-recognised impediments such as inadequate funds and personnel, but less commonly reported issues concerning differing points of view on the role of trauma-related autopsy among coroners and TMDs. To improve trauma-related autopsy rates, each of these issues requires attention and cooperation among all parties.

[A study on the experiences of nurse coroners].

PURPOSE: The purpose of this study was to describe the essential structure of the postmortem- examination experiences of nurse career coroners (forensic investigators), to have a profound understanding of their experiences, and ultimately to lay the foundation for nurses' entry into the field of forensic nursing. METHODS: The subjects in this study were six coroners. After an in-depth interview from January to June 2007, the collected data were analyzed by Colaizzi as qualitative research. RESULTS: Four categories emerged from seven theme clusters. The four categories were: attracted by being dubbed a stabilized public official, a sense of achievement due to having clarified false death, self-confidence after distinguishing the victim and the wrongdoer, eternal developmental potential is seen. CONCLUSION: It is expected that this study will provide useful information for nurses who are interested in becoming coroners. It will be helpful for career nurses to extend their nursing science into emerging fields like coroners and select a follow-up career.

Mechanism and strategies for preventing post-traumatic stress disorder in forensic workers responding to mass fatality incidents.

Mass fatality incidents (MFIs) expose medical examiners/coroners and associated staff to circumstances that may increase their risk for developing post-traumatic stress disorder (PTSD). The aim of this paper is to provide guidance for efforts to prevent the development of PTSD in forensic teams who respond to mass disasters. We present a model of the paths through which exposure to mass fatality incidents may lead to PTSD symptoms in forensic and recovery workers. The model is based on current research in stress and coping and the psychophysiology of PTSD and is used to generate worksite intervention strategies to reduce the risk for PTSD.