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Reliability and validity of a quality tool for assessing clinical forensic medicine legal reports

2025-02-25T04:09:39Z

Title: Reliability and validity of a quality tool for assessing clinical forensic medicine legal reports Authors: Stevenson, C.; Kramer, K.; Edmond, G.; Martire, K. Abstract: Objective: It is essential that reports written by forensic medicine practitioners undergo appropriate quality control. The aim of this study is to develop and validate a tool for assessing the quality of medico-legal reports in adult and adolescent sexual assault cases. Methods: The authors developed an audit tool and accompanying guideline aimed at detecting errors, omissions, and inadequacies in medico-legal reports following reported adult or adolescent sexual assault. The authors conducted a benchmarking exercise to reach an agreed audit standard. Subsequently two forensic examiners audited 5 legal reports, first without the tool, and then with the tool following standardised instruction. A further ten forensic examiners audited 20 reports after receiving instruction in use of the tool. Their results were compared to the agreed audit standard. Participants were interviewed about their experiences. Results: Use of the tool to audit reports significantly increased the sensitivity of error detection compared to usual practice (sensitivity with usual practice 55% vs sensitivity with tool 80%). Study participants using the tool to audit 20 reports detected 73% of items designated as errors by the study authors. The overall accuracy in coding items as errors/not errors was 74%. Interrater reliability was good (Cronbach's alpha = 0.87). Sensitivity, overall accuracy, and interrater reliability results varied by category in the audit: reviewers had lower levels of error detection and lower levels of agreement when auditing opinions in the report as compared to items describing the clinical forensic evaluation. Participants had fundamental disagreements about what constitutes good quality in some aspects of a report, including: the acceptability of including 'non-relevant' history; whether to include references and, if so, what constitutes appropriate citations; and how to determine whether the opinions could be understood by a layperson. Study participants reported that using the audit tool and guideline to review medico-legal reports has merit and suggested improvements to increase usability. Conclusion: Use of an audit tool supported by a guideline and training is useful for improving error detection and standardising the review process for clinical forensic medicine legal reports. Further research aimed at improving the consensus about opinion standards in adult and adolescent sexual assault cases would be valuable.

Speculum examinations: Clinicians' attitudes and approaches to obtaining consent in a sexual assault context

2025-01-07T05:14:46Z

Title: Speculum examinations: Clinicians' attitudes and approaches to obtaining consent in a sexual assault context Authors: Roussos, M.; Victoire, A.; Kramer, K. Abstract: Background: In many countries, a forensic medical examination by a trained professional is offered to people who have experienced recent sexual assault. The consultation may include a vaginal speculum examination to visualise injuries and collect forensic evidence, but not all patients will consent to the examination. Clinicians' attitudes to a speculum examination in a sexual assault context and the consequent wording when obtaining consent may influence uptake rates and ultimately health outcomes for sexual assault survivors. Objectives: This survey study identifies (i) factors affecting clinician attitudes towards the use of speculum examinations in sexual assault forensic medical examinations; (ii) situations in which they would offer a speculum examination; and (iii) approaches to seeking consent. Methods: An online survey was sent to all eligible forensic examiners working in sexual assault services across New South Wales (NSW), Australia (n = 100), between August and September 2019. The survey recorded demographic data, experience with speculum examinations, opinions regarding the main purpose of the speculum examination, circumstances in which clinicians would offer a speculum examination, and the wording of their consent process based upon two detailed clinical scenarios (differing only in the hours elapsed since the assault (24 h vs 72 h)). A mixed method approach was used to analyse the data and was completed using SPSS and NVivo. Results: Of the 100 invited participants, there were 32 respondents. Twenty-eight respondents (87.5%) stated that the main purpose of a speculum examination is to both check for injuries and collect evidence. Clinicians were more likely to offer a speculum examination to patients presenting with symptoms (i.e., pelvic pain, bleeding) or presenting more than 24 h after the event. Twenty-seven participants (84.4%) stated that patient-centred factors (i.e., time of presentation, patient comfort with speculum examination) were the main influences in whether they would/would not offer a speculum examination. Clinicians felt more comfortable performing speculum examinations in a forensic setting if they felt comfortable performing speculum examinations in a non-forensic setting (p = 0.004) and less comfortable as time increased from introductory sexual assault training (p = 0.0029). Eight participants (26.7%) would not offer a speculum examination acutely (< 24 h post assault) but only one (0.03%) would not offer it 72 h post assault. Conclusions: This study is the first to explore clinicians' attitudes towards the speculum examination component of the adult sexual assault forensic medical examination and provides foundations for future research. Current guidelines should be reviewed and updated to ensure that speculum examinations are routinely offered, rather than only when endocervical samples are being considered, to ensure potential injuries are not missed.

Consistent with: what doctors say and jurors hear

2025-01-07T05:15:29Z

Title: Consistent with: what doctors say and jurors hear Authors: Ross, R.; Kramer, K.; Martire, K. A. Abstract: While there is an extensive body of literature regarding the factors that influence how juries interpret medical expert statements, there is limited empirical evidence regarding the effects of word choice. The term ‘consistent with’ is widely used in legal proceedings and expert witness statements, so it is important to understand what this term means to a jury. The aim of this research is to understand how potential jurors interpret the phrase ‘consistent with’ in a forensic medical context. Potential jurors were recruited for a survey containing three mock vignettes where the doctor stated that the injury was ‘consistent with’ either self-inflicted injury, accidental injury, or injury by a third party. Participants were asked what the doctor meant, using a range of options taken from the United Nations’ Istanbul Protocol definitions of medico-legal terms used to describe lesions caused by torture. The results from 151 surveys indicate there was no consistent interpretation of the phase within each vignette or between vignettes. This research demonstrates that the phrase ‘consistent with’ can be interpreted in a variety of ways: caution is therefore required when using this expression in legal proceedings. Further research regarding the best choice of terms to use in court is required.

Combatting occupational deprivation and advancing occupational justice in institutional settings: Using a practice-based enquiry approach for service transformation

2024-12-03T05:14:56Z

Title: Combatting occupational deprivation and advancing occupational justice in institutional settings: Using a practice-based enquiry approach for service transformation Authors: Whiteford, G.; Jones, K.; Weekes, G.; Ndlovu, N.; Long, C.; Perkes, D.; Brindle, S. Abstract: Introduction Occupational deprivation is a risk for residents of institutions. This is problematic at several levels: it can cause diminution of individual capacities; such environments pose philosophical and practical challenges for occupational therapists and the erosion of human rights can be an issue. Occupational therapists in an Australian forensic mental health setting ‘reclaimed’ occupation-centred practice, committed to occupational justice and tackled the experience of occupational deprivation of patients through utilising a practice-based enquiry approach. Method A community of practice scholars used a practice-based enquiry approach – a type of action methods research – involving iterative cycles of data collection, analysis, critique and implementation of practice innovations. Findings Through the practice-based enquiry process, participants’ practice became more occupation-centred, based and focused, resulting in: the creation of more opportunities for patients, which combatted occupational deprivation and increased potential for community reintegration; enhanced professional satisfaction and identity; and increased institutional ‘valuing’ of the occupational therapy service. Conclusion Ameliorating occupational deprivation can be achieved through becoming occupation-centred and embracing a stated commitment to occupational justice in the challenging practice setting of a forensic hospital. The use of the deeply reflective process of practice-based enquiry was pivotal to this shift in focus for the group of occupational therapists who participated in this study and also contributed to enhanced practitioner satisfaction, identity, autonomy and confidence.