Kerala: Why learning autopsy procedure is a struggle for private medical college students

In our country, a medical degree is all you want to be qualified to perform a postmortem examination on a body. However, the Medical Council of India (MCI) has not prescribed any practical examination in the curricula to assess the skill of an MBBS doctor in making observations and interpreting findings of a postmortem examination.

The MBBS programme, which has a forensics paper, requires students to participate in and document a minimum of 15 postmortem examinations, each involving various causes of death and autopsy techniques. However, private medical students in Kerala find it tough to fulfill this criterion as only Amrita Medical College students can conduct postmortem examinations. Usually, students are often taken to nearby government hospitals or medical colleges in neighbouring states for this purpose. Regrettably, most health service-affiliated hospitals cannot accommodate all private students for postmortem practical experiences or observations.

Medical excursion

In this scenario, students are forced to embark on a medical excursion to neighbouring states for a few days to witness the autopsy process. Those who do get the chance to observe these procedures in the hospitals there clearly don’t have the opportunity to witness a total of 15 postmortems.

“According to the updated curriculum, watching a video of a postmortem is considered acceptable, but it cannot be considered equivalent to witnessing it in person,” opined Dr Sreelakshmi, a forensic science instructor at a private medical college in Kerala.

“We were taken to Ernakulam Government Hospital for postmortem observations, but we were only able to attend three sessions in person. For the remaining sessions, we had to rely on YouTube videos and document our observations accordingly,” said a 23-year-old house surgeon of one of the private medical colleges in Kerala.

“We recently organised a 10-day trip to Karnataka, during which we stayed there to observe postmortems at the medical colleges. Though we couldn’t witness as many cases as we had hoped for, having some exposure was better than none, " another medical student said. The issue in going for these tours is that it’s an additional expense and many could not afford such a burden, he added.

Kerala govt steps in

The issue is back in the limelight due to social media posts of Dr Sreelakshmi in which she compared the quality of postmortems conducted in Kerala and those performed in other states.

“It’s disheartening that we must take our students to other states with significantly lower standards. Upon recognising this, I requested the government to permit private students to access neighbouring government medical colleges in Kerala as well. This request was granted and the credit goes to Dr Hithesh Shanker TS, the Head of the Department of Forensics at Government Medical College, Manjeri. I wish all private students will have the chance to benefit from this opportunity and the government will take the necessary steps to facilitate it,” Dr Sreelekshmi posted on Facebook.

Health Mnister Veena George said the government has taken this issue seriously and would explore the possibility of allowing private medical students in mortuaries of the government medical colleges. “I came across Dr Sreelakshmi's social media post about medical students having to leave the state to witness postmortem procedures. She has written to us also. I have directed the Director of Medical Education to investigate the matter and take the appropriate actions,” said the health minister.

Govt order in place

Dr JS Veena, Assistant Professor, PSG Institute of Medical Sciences and Research, Tamil Nadu, felt that the ball is in the court of the state government as a government order in this regard is already in place. “The 2020 order by the National Medical Commission clearly states that in case the college is not permitted to carry out medico-legal autopsies, the college shall have a memorandum of understanding (MoU) with a government/district hospital for postmortems to teach and train students. I think the Kerala hospitals have overlooked this part. The faculty of private medical colleges should have been more vigilant,” Dr Veena told The Federal. In Tamil Nadu too, no medical college except for Sri Ramachandra Institute of Higher Education and Research has permission to carry out medico-legal autopsies, said Dr Veena.

A health department source confirmed this, stating that students at Kerala University of Health Sciences (KUHS) have been extended this opportunity since 2020. These students are required to pay a specified fee for this privilege.

Nevertheless, many experts in the field believe that proper implementation of this order may be more challenging in practice because the government medical colleges in Kerala may not have the capacity to accommodate additional students from outside, given that they already have their own students to cater to.

“House surgeons at government medical colleges are required to complete a one-week compulsory rotation in the mortuary. This allows them to gain practical experience, even though they are not permitted to actively participate in the procedures. Considering the annual enrolment of at least 2,000 private medical students, it becomes challenging for medical colleges to accommodate all these students if they cannot offer house surgency positions to them in government facilities,” observed Dr PS Jinesh, a forensic surgeon working abroad.

Finding way out

Forensic and academic experts suggest that the most practical solution to the issue is to permit private medical colleges to perform autopsies, except for those related to criminal cases. "As far as I know, no private institution except Amritha Medical College had applied for postmortem privileges and that’s why they are not allowed to perform it,” said Dr Ajaya Balachandran, another forensic surgeon who works with the Amritha School of Medicine under the Amritha Viswa Vidya Peetham, Kochi.

“Every private medical college possesses postmortem facilities as per mandatory requirements. Some of these hospitals have retired doctors as forensic professors, who may not be interested in carrying out autopsies. If granted permission to conduct postmortems, it would be advantageous for both the public and the legal system. At present, there is a dearth of qualified doctors to carry out postmortems in the government sector. In many health service hospitals such as district and taluk hospitals, autopsies are being performed by doctors who lack forensic qualifications,” said Dr Ajaya.

Private doctors contend that if one questions the authenticity and legality of postmortems conducted by private forensic surgeons should autopsy reports from them be considered admissible in court? The wound report from any doctor who first treated the victim is legally admissible as per Indian laws. They argue that having autopsy reports from forensic specialists in private hospitals would be far more advantageous than relying on reports prepared by individuals with medical degrees working in the government sector.