How is the new MIR specialty of Legal Medicine?

Josep Arimany Manso.

The period to apply for MIR places has already begun and this year is the first in which the training system for resident medical interns (MIR) will offer places in the specialty of Legal and Forensic Medicine. In total they will be eight seats that, according to some estimates referred to by the president of the National Commission of the specialty of Legal and Forensic Medicine of the Ministry of Health, Josep Arimany Manso, could be one of the specialties that exhausts its places among the first 300 adjudications and, therefore, of the more attractive, even aspiring to unseat Dermatology and Plastic Surgery from the throne of those that were previously exhausted.

Arimany acknowledges in an interview with Medical Writing that the situation of the specialty of Legal and Forensic Medicine “it was critical and it was going to disappear”but with their entry into the MIR training system, the “consolidation of the specialty in the 21st century”. The president of the National Commission for this specialty states that he “didn’t think she was going to be so attractive”, while advancing that she is already working on double the places for next year to 16 because he sees “a great future for Legal and Forensic Medicine and has many career opportunities“.

How did the need arise to create the specialty of Legal and Forensic Medicine?

It is one of the oldest specialties in Spain and with the legislation that has been coming out a great dichotomy had been created. There was the forensic doctor, who is a doctor who is under the orders of the administration of Justice and, therefore, enters the body of forensic doctors with oppositions made by the Ministry of Justice; and then there was Legal Medicine, the specialty itself, which was academic. On the one hand, there were forensic doctors who did practical Legal Medicine and, on the other, theoretical Legal Medicine was done by university students.

How was the process to get there?

We have followed the guidelines of the European Union, since the European Council of Legal Medicine asked the Government of Spain that the specialty of Legal and Forensic Medicine should exist and that it had to be done through the system of specialists. We have been working on it for many years, since I was the director of the Institute of Legal Medicine of Catalonia. There was a modification of the Organic Law 6/85 that required to be in possession, apart from the bachelor’s degree or degree, the title of specialist to enter the body of forensic doctors and in 2015 there was another provision. All these provisions have meant that in the end, between the Ministry of Justice and the Ministry of Health, an agreement has been reached and I am delighted. Minister Salvador Illa was very important, who caused Royal Decree 704/2020 to be promulgated by the Council of Ministers, which established access to the title of specialist doctor through the MIR residence system. This changes everything.

What advantages does this novelty offer?

We will have highly trained people since this training is done at the hospital level for two years. It is very important that Legal and Forensic Medicine specialists know a Pediatric or Gynecology Service. Legal and Forensic Medicine is a discipline that covers many topics, such as medical liability, crimes against sexual freedom, autopsies, damage assessment and traffic accident assessment. Having good, well-trained MIRs is very important. In addition, with this modification that was made in the year 90 to enter the body of forensic doctors, it will be a prerequisite that they have the specialty, and this is a great change. In the chairs of Legal Medicine in Spain there is a very important deficit of specialists, therefore, academic life with Legal Medicine is difficult and this will pave the way.

In large hospitals, for example, in the Hospital Clínic de Barcelona, ​​in the Hospital Universitari Vall d’Hebron or in the Hospital Clínico San Carlos, which has one, Legal Medicine units will be created that will advise the hospital, doctors, to doctors and health professionals in all areas and disciplines of Legal Medicine. Many times there are issues of requests from the judges or the application of protocols. Forensic Medicine services have a great future, in terms of statistics, death certification, application of protocols or being in the morbidity and mortality commissions of hospitals. It will allow us to have very well-trained doctors who will be able to have access, instead of the opposition, to a competition-competition that will be held by the Ministry of Justice, and we will share it in Europe.

“With the creation of the specialty, Legal and Forensic Medicine units will be created that will advise hospitals and health professionals”

What knowledge will MIRs who opt for Legal and Forensic Medicine acquire?

The first month after taking the place they will be assigned to the Institutes of Legal Medicine to learn what Legal Medicine is. They will immediately join the hospital and go through the different services: Traumatology, Gynecology, Paediatrics, Pathological Anatomy, Psychiatry… They will do this during the first two years. In the following two years, because they are four years of specialization, they will be assigned to the Forensic Medicine institutes and will carry out clinical autopsies with the Forensic Pathology Service, with the Clinical Service they will carry out psychiatric assessment and damage assessment, they will be assigned to the civil registries for the evaluation of death certificates, will be at the forensic laboratories, that is, they will do all the practice that forensic doctors do. In addition, they will participate in the clinical sessions of the institutes, the official program of the specialty determines a minimum number of autopsies and reports, assessment of damage, and a number of Psychiatry reports, among others. Therefore, it is a great advance and all this means that we have very well-prepared people and we assimilate to what the European Union asked of us.

What objectives are met with the creation of this specialty?

The main objective is to improve technical advice on Legal Medicine, for example, in the administration of Justice, with judges, prosecutors and courts. The incorporation of these specialists will ensure that universities and departments of Forensic Medicine are nourished in the academic world with good training for undergraduate and postgraduate students in the field of Forensic Medicine.

Later, the possibility of the presence in the hospital environment of these medical specialists with the creation of hospital Legal Medicine services. Promote research and knowledge transfer in the case of Legal and Forensic Medicine, addressing Europe. Legal and Forensic Medicine has a tradition in Spain of more than 175 years, the situation was critical in recent years and the specialty was going to disappear. Now the consolidation of the specialty in the 21st century is taking place. For a medical specialty to enter the MIR health system is always a success.

What can the union of hospitals and institutes contribute to the MIR?

A benefit in acquiring knowledge because many times Legal Medicine specialists have to assess an alleged malpractice, because if he has trained in Traumatology or Pediatrics because he has done the rotation, he will know the protocols very well. It is clear that three months’ knowledge of Pediatrics does not make him a pediatrician, but he may have some basic knowledge of how it works, which was not the case until now. This involvement between the hospital health system or the Primary Care health system and the Forensic Medicine institutes will ensure that we give good training to future Forensic and Legal Medicine specialists. That there is an enrichment in the entire field of public health in the general administration can involve important knowledge. I believe that Spain is making progress in this because this system that we have of forensic doctors in the administration of Justice and of specialists, this dichotomy will be very joint and will be very positive.

“Spain is advancing in enrichment in the entire field of public health in the general administration with this specialty”

Are the places currently offered enough?

I am already working as president of the National Commission of the Legal and Forensic Medicine specialty of the Ministry of Health to double the vacancies for next year because we need many more vacancies, up to 16 or a little more. For example, if there is currently one square in Catalonia, next year there should be three; in Aragon two; and there must be in Galicia, in the Canary Islands, in Andalusia, in the Community of Madrid… I have been surprised because I have seen that it seems that the specialty will be among the first 300 that will be requested. I don’t get it because I didn’t think she was going to be that attractive.

It is difficult to know the figure in the medium term because at the moment we are doing a demographic study of how many forensic doctors there are in Spain, we have an estimated idea of ​​approximately 800, and what will be the temporality with the coming legislation. We are also doing a demographic study at the university level: how are the vacancies per university, how many specialists are there,… All this will help us to make a gear and make a forecast of the number of vacancies that will be needed. We will evaluate year by year so that there is never a surplus, but rather that the number is fair and balanced to the study we are doing. 16 places would not be enough in the medium term because I see a great future for Legal and Forensic Medicine.

What professional opportunities does the specialty of Legal and Forensic Medicine have?

Large hospitals, for example, the Hospital Clínic in Barcelona, ​​the Vall d’Hebron University Hospital in Catalonia, the Virgen del Rocío University Hospital or the San Carlos Clinical Hospital in Madrid, which already have a Legal Medicine Service, if they begin to create services, as they will need Legal Medicine specialists. In universities there is also a significant aging of the workforce. In the chairs of Legal Medicine, professors are retiring and new ones are joining, this is another very important exit. Insurance companies that want to assess damages will also need Legal Medicine specialties. He has many professional opportunities, some public, which would be an official of the Administration of Legal Medicine Justice; another public, but at an academic level, which would be the university world as full professors, associate professors or professors; hospital services of large centers that may need a Legal Medicine specialist and then the private sector, in the field of cultural damage assessment.

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