Become a medical examiner
Medical examiners will soon become a core part of the process of investigating patient deaths across the NHS in England and Wales. In order to become a medical examiner, you first need to ensure you have the right knowledge and qualifications, before completing both online and face-to-face training.
College membership for medical examiners
The Royal College of Pathologists would like to welcome new medical examiners as members of the College. As part of their membership they will be awarded the use of the new post nominals ‘RCPathME’.
Medical examiners will be eligible to join on completion of:
- 26 eLfH Medical Examiner e-learning modules (Nov 2018 revision). We expect this to take 8 hours of learning
- the RCPath face-to-face Medical Examiner training
They must also demonstrate current registration with the GMC or equivalent medical registration from overseas body and have a licence to practise.
An annual membership fee, £100 in the first year, will be charged to remain a member and use the post nominals (RCPath College fellows will not be required to pay the £100 annual membership fee).
On completion of the face to face training you will be invited to apply for membership.
Who can be a medical examiner?
You can apply to become a medical examiner if you:
- have at least five years’ experience as a fully registered medical practitioner
- are currently practicing or have retired in the last five years
- hold a licence to practise with the GMC or the equivalent medical registration from overseas body.
In addition, you’ll need to demonstrate:
- up to date knowledge of medical conditions, treatments and causes of death
- knowledge of relevant legislation and processes
- knowledge of local and national clinical governance systems
- strong communication skills that enable them to deliver their role in a compassionate, professional and discreet manner
- ability to work in a multi-disciplinary team.
Pilot and early adopter sites have typically appointed consultants and GPs as Medical Examiners. Experienced SAS doctors and senior trainees are also eligible to work as Medical Examiners, subject to the requirements of their employing organisation. Medical Examiners should have at least five years post-qualification experience before taking on the role. While completion of training is mandatory for all Medical Examiners, there is no automatic entitlement to work as an ME after completing the training. Most organisations will appoint following competitive interviews to identify the individuals best suited to providing the service locally.
Yes, however it is recommended that GPs should have the equivalent level of experience to consultants undertaking this role e.g. to General Practitioner Principal level. However, in principle, there is no barrier to GPs becoming medical examiners and indeed as medical examiner systems are extended to cover deaths outside of hospital, having medical examiners from a range of disciplines will be an asset.
Non-medics will not perform the role of the medical examiner because of the level and range of clinical knowledge required to be able to carry out robust and proportionate scrutiny of the medical circumstances of deaths.
What do medical examiners do?
Medical examiners are senior medical doctors, who are trained in the legal and clinical elements of death certification processes. Their role includes:
- speaking to the doctor who was treating the patient on their final illness
- reviewing the medical records and any supporting diagnostic information
- agreeing the proposed cause of death and the overall accuracy of the medical certificate cause of death
- discussing the cause of death with the next of kin/informant and establishing if they have any concerns with care that could have impacted/led to death
- acting as a medical advice resource for the local coroner
- informing clinical governance systems to highlight deceased patients who require a mortality case record review so any formal learning can be gained for the provider organisation
- ensuring that patterns and or concerns with care and associated clinicians and or providers are raised appropriately
- enabling a medical examiner officer to conduct component parts of the role under delegated authority.
To explain more about the role of medical examiners, Dr Alan Fletcher, recently appointed National Medical Examiner, has provided the following video resources.
For more information about the role of medical examiners, download the model job description, which has been produced and approved by the Department of Health and Social Care.
The independence of medical examiners
A medical examiner must always be independent of the case and cannot know, or have treated, the deceased patient on which they are carrying out scrutiny of the circumstances of death.
They are responsible for completing the following steps to arrive at their decision:
- a proportionate review of medical records
- interaction with the attending doctor
- interaction with the bereaved.
The above should be completed within 24 hours of the medical notes being received (for cases not investigated by the Coroner). The interaction with the attending doctor and the bereaved may be undertaken in collaboration with medical examiner officers.
Medical examiners will be employed by NHS acute provider organisations and will have a separate line of professional accountability to the Regional Lead Medical Examiner. Those who work in medical roles within the NHS are accustomed to having different roles and different lines of accountability and to making this work, and it is expected that NHS acute providers respect this distinction. Appraisal and revalidation processes will support independence. Medical examiners will also have case independence and in future, digital tools available to them to record information about each case, including time of death. Engagement with senior coroners is encouraged at the outset and specifically to support appointment committees. In Wales, medical examiners will be employed by the NHS Wales Shared Services Partnership, supporting their independence.