The single most important quality control or assurance (QC/QA) mechanism in the ME's office is the appointment of qualified and certified forensic pathologists, particularly in the position of chief medical examiner. In modern medical practice, board certification of physicians is expected and usually required for the full exercise of the practice privileges in a medical specialty.
Similarly, such certification is necessary in the field of forensic pathology to indicate that a practitioner has met the minimum standards of training and knowledge in the field. In the United States, the only path to certification in forensic pathology accepted by NAME34,35 is through the American Board of Pathology (a member board of the American Board of Medical Specialties).
This organization sets requirements and standards for training, examination, and certification in the field of pathology and its subspecialties, in this case, forensic pathology.
This requires completion of accredited (by the American Council of Graduate Medical Education) residency and fellowship training programs in both anatomic and forensic pathology, with subsequent successful completion of qualifying examinations given by the American
Board of Pathology in both areas. If these requirements are met, the physician will receive certification in anatomic pathology, and special qualification in the field of forensic pathology, also referred to as board certification.
At this point NAME recognizes the individual as a forensic pathologist.
While this certification does not guarantee excellent practice, it does show that the practitioner has met a minimum level of training and performance in the field.
While some physicians utilize the term board eligible to indicate that they have taken the requisite training in pathology or its subspecialties but have not passed the board certification examinations, this designation is not recognized by the American Board of Pathology, and should not be used or accepted.
In addition to board certification, practitioners may now be held to professional standards of practice in the field of forensic pathology. The National Association of Medical Examiners has published such standards to provide guidance and objective criteria for the assessment of the practice of forensic pathology.
In 2003, NAME formed a committee to investigate the advisability of formally adopting standards for medicolegal autopsy practice.
After much debate and discussion, including surveying the membership about proposed standards, the "Forensic Autopsy Performance Standards" were approved by the membership of NAME and published in 2006 in the American Journal of Forensic Medicine and Pathology. These set forth standards for practice of forensic autopsy pathology, provide some defnitions elated to the field, and discuss standards for associated techniques, such as toxicological analysis, radiography, histology, and written reports. While broad and relatively basic, such standards do require a certain level of practice by physicians and can serve as an objective guide in assessing an individual's level of practice.
While certification and standards refer to the practitioner and his or her practice, accreditation refers to the assessment of a death investigation system or office as an organization, without assessing the performance of any individual practitioner. Currently the only organization accrediting medical examiners' offices on a national basis is NAME.
In 1975 the organization established a voluntary peer review system using criteria developed for inspection and accreditation of death investigation systems.
Accreditation of a medical examiner or coroner's office involves a thorough inspection of the office by an outside trained forensic pathologist, utilizing a checklist devised by the Standards and Accreditation Committee of NAME. Criteria within the checklist are divided into two categories: Phase I requirements, which are desirable, but the lack of which will not significantly impact on the function of the system, and Phase II requirements, which are considered essential for the system to function adequately. Upon successful completion of this inspection, with no Phase II deficiencies and no more than fifteen Phase I deficiencies, the office is issued a certificate of accreditation for a period of five years. If the inspection is not successful, the ffice management will be counseled regarding deficiencies and methods of correcting them. Provisional accreditation for a brief period and reinspection are available to assist offices in meeting this goal.
