Draft ME course V3.0
MEDICAL EXAMINER PREPARATORY COURSE
0830
Registration and faculty meeting
0850
Welcome and introductions
Course Director
0900
Overview of medical examiner system
Pilot ME or DH spokesperson
0920
Review of pre course case with example role play
Set of fictitious clinical records circulated to attendees reviewed ‘real-time’ by pilot ME (vocalising thoughts),
liaison with MEO and then discussion with bereaved regarding cause of death
0950
Coffee break
1010
Small group review of scenarios
Faculty pilot MEs leading ? 4 or 5 groups of 10-12
Several (?6) scenarios discussing issues of ‘unnatural’ death and accuracy of MCCD content (including
hospital acquired infection)
1210
Lunch
1300
Medical examiner interactions – introduction
Pilot ME/Bereavement services/MEO
Include introduction to faith considerations, bereavement reactions
1320
Small group review of interactions part 1
Faculty leading ? 4 or 5 groups of 10-12
3 scenarios possibly involving role play, each 20 minutes:



Bereaved who have a complaint about lack of care but this did not contribute to death– include reference to
clinical governance systems
Faith requirement for urgent scrutiny – include discussion of preparatory scrutiny before expected death and
transplantation
Bereaved dispute MCCD content (e.g. HIV infection or morbid obesity)
1420
Tea
1440
Small group review of interactions part 2
Faculty leading ? 4 or 5 groups of 10-12
3 scenarios possibly involving role play, each 20 minutes:



1540
Doctors being difficult – disagree with ME regarding content or need for coroner referral
Dispute with HM coroner’s office – Case put forward for Form 100A but ME uneasy
Late information – e.g safeguarding issue or allegation by another family member after ME2 issued and
death registered
Final question and answer session
Faculty
1600
Closing remarks
Course Director
Suggested faculty list:
Course director
Experienced Pilot ME
Coroner
2 who understand the new ME process
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Draft ME course V3.0
Lay/’relative’
2 Bereavement services officer (or recent experience)
Certification process facilitator 2 Experienced Pilot MEOs
ME’s
3 Experienced Pilot MEs
Basic cost requirement (estimated):
10 faculty members’ travel expenses plus overnight pre-course
(an early faculty meeting will be required)
£3000
Catering for 60
£600
Course materials/postage
£500
Cost of college facilities/admin time*
£?
Total
£4100
Possible additional costs (estimated):
Backfill ‘locum’ arrangements for faculty for one day
£2400
Regional facility hiring if some courses run in provinces (per course)
£2000
Total cost of 10 courses (range)
£41000-85000
DETAIL OF COURSE COMPONENTS
0920
Review of pre course case with example role play
Set of fictitious clinical records circulated to attendees reviewed ‘real-time’ by pilot ME (vocalising thoughts),
liaison with MEO and then discussion with bereaved regarding cause of death
Duration: 30 min
Detail required: Straightforward case with relatively few pages (six or seven) preferably typewritten, so a GP case
with no unnatural features, expected and explainable would be best. Anonymous records essential. Preliminary
MCCD causes proposed by certifying doctor included. These records to be sent out to candidates in advance of the
course with the following preamble:
'The following set of fictitious records will be used as the basis for a demonstration of medical examiner working in
the morning of the course. Please take a few minutes to review the content and form your opinion on the answers of
two questions: 1. Are there any unnatural features that may require the case to be reported to a coroner? 2. What
would be an appropriate way of wording the cause of death?
Please note you will not be judged or marked in any way on this case, and there are likely to be different answers to
both these questions.'
Faculty information: three faculty members to participate. One ME, one MEO, one 'bereaved person'. Format as
follows:
1. Scene setting. ME identifies objectives (introduces and demonstrates main part of scrutiny) and describes
the way the session will be conducted.
2. Dialogue. Real-time run through three distinct stages: ME reviews casenotes and vocalises thought
processes whilst doing so, giving rationale for judgements and decisions, ME completes paperwork and
discusses case and decisions with MEO, ME or MEO discuss cause of death and circumstances with bereaved
relative. Emphasis on answering the two questions posed in the pre-course material.
3. Questions and discussion points from audience (will need careful control).
4. Summary. This should be brief and a reiteration of the objectives.
Committee member action: provide casenotes and MCCD/preliminary cause of death. Also outline 'script' of
conversation with MEO and bereaved relative. ME2 form (or electronic version) needed.
Suggest John Buchan
______________________________
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Draft ME course V3.0
1010
Small group review of scenarios
Faculty pilot MEs leading ? 4 or 5 groups of 10-12
Several (?6) scenarios discussing issues of ‘unnatural’ death and accuracy of MCCD content (including
hospital acquired infection)
Duration: 2 hours, six scenarios of 20 min each
Detail required: six summary scenarios of cases illustrating various aspects of a possibly 'unnatural' death. Not all
possibilities can be covered of course, but there should be lively discussion around most frequently encountered
situations with the following:
1. Hospital-acquired infection. Case where Clostridium difficile at least contributed to death in hospital.
2. Medical or surgical procedure. Surgical case where a patient has died despite recent surgery (e.g. bowel
cancer).
3. Falls. Causing an osteoporotic fracture (e.g. vertebrae or rib). Must include discussion about the history of
the fall and circumstances.
4. Industrial. Case of a patient with end-stage lung cancer and some pulmonary fibrosis dying in a hospice.
Possible occupational link to asbestos.
5. Neglect. Significant pressure sores in a dependent patient with dementia in a nursing home.
6. Cause unknown. Unexpected death following an 'asked to see' with an unexplained acute deterioration (e.g.
hypoglycaemia, but not this).
Faculty information: one ME per station supported by one coroner or one MEO. Four stations in total with 12
candidates. Considerable small group teaching experience and confidence required to keep order and draw in
contributions from quieter members.
Could keep same group for all six scenarios, but equally possible to rotate through two or three stations at 40 min or
60 min intervals respectively.
Format for each scenario must adhere to a consistent pattern:
1. Scene setting. Brief outline of case highlighting points likely to be of most significance in discussion.
Emphasis on the '2 questions' (unnatural? Cause of death wording?).
2. Dialogue. Opening question, 'what are the issues?' Discussion about what may or may not make the death
unnatural. Example causes of death and wording (with or without Form 100A/HMC1) to be discussed.
3. Summary of key points.
4. End of scenario. Keep to time!
Committee member action: provide 100-150 word summary scenarios with suggested causes of death if
applicable. Committee consensus required on answers to the 'two questions'.
Suggest John McCarthy for scenarios 1, 2, and 3, John Buchan for scenarios 4 and 5, Alan Fletcher for scenario 6
______________________________
1300
Medical examiner interactions – introduction
Pilot ME/Bereavement services/MEO
Include introduction to faith considerations, bereavement reactions
Duration: 20 min
Detail required: PowerPoint presentation to whole group highlighting the most frequently encountered faith
consideration matters and bereavement reactions. Possibly with one or two example scenarios.
Faculty information: presentation delivered by MEO and/or Bereavement services worker.
Committee member action: provide PowerPoint slides for committee review.
Suggest Anne Wadey
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Draft ME course V3.0
______________________________
1320
Small group review of interactions part 1
Faculty leading ? 4 or 5 groups of 10-12
3 scenarios possibly involving role play, each 20 minutes:



Bereaved who have a complaint about lack of care but this did not contribute to death– include reference to
clinical governance systems
Faith requirement for urgent scrutiny – include discussion of preparatory scrutiny before expected death and
transplantation
Bereaved dispute MCCD content (e.g. HIV infection or morbid obesity)
Duration: 1 hour, three scenarios of 20 min each
Detail required: short scenario for each with script as a guide for participating faculty:
1. Bereaved who have a complaint about lack of care but this did not contribute to death– include reference to
clinical governance systems. Elderly frail patient with ischaemic bowel confirmed by CT dies before senior
doctor review but was never fit for surgery. Early warning scores not acted on in a timely way. Family
vehemently opposed to autopsy.
2. Faith requirement for urgent scrutiny – include discussion of preparatory scrutiny before expected death and
transplantation. Young Muslim patient with spontaneous subarachnoid haemorrhage. Brainstem death
criteria fulfilled by Saturday afternoon. Consider steps if non-Muslim and organ retrieval team arrive at
22:00 hours.
3. Bereaved dispute MCCD content (e.g. HIV infection or morbid obesity). Young southern African patient with
advanced HIV related disease. Family unwilling to accept MCCD with HIV identified as cause of death.
Faculty information: one ME per station supported by one MEO/bereavement services worker. Four stations in total
with 12 candidates. Considerable small group teaching experience and confidence required to keep order and draw
in contributions from quieter members. Must be restrained and credible in role-play.
Format for each scenario must adhere to a consistent pattern:
1. Scene setting. Brief outline of case highlighting points likely to be of most significance in discussion.
Emphasis on the '2 questions' (unnatural? Cause of death wording?).
2. Dialogue. Role-play between faculty. Clear end to role-play and session leader invites comments and
discussion points from candidates. Three key learning points per scenario must be covered.
3. Summary of key points.
4. End of scenario. Keep to time!
Committee member action: provide 100-150 word summary scenarios with script and suggested causes of death if
applicable. Three key learning points per scenario must be provided. Committee consensus required on learning
points.
Suggest John McCarthy for scenario 1, Anne Wadey for scenarios 3, Alan Fletcher for scenario 2
______________________________
1440
Small group review of interactions part 2
Faculty leading ? 4 or 5 groups of 10-12
3 scenarios possibly involving role play, each 20 minutes:



Doctors being difficult – disagree with ME regarding content or need for coroner referral
Dispute with HM coroner’s office – Case put forward for Form 100A but ME uneasy
Late information – e.g safeguarding issue or allegation by another family member after ME2 issued and
death registered
Duration: 1 hour, three scenarios of 20 min each
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Draft ME course V3.0
Detail required: short scenario for each with script as a guide for participating faculty:
1. Doctors being difficult – disagree with ME regarding content or need for coroner referral. NH resident with
multiple significant comorbidities, including warfarin treatment for AF. Patient fallen in nursing home two
days before death. Progressive decline in conscious level. Community DNAR. Attending doctor wants to
certify as 1a Bronchopneumonia.
2. Dispute with HM coroner’s office – Case put forward for Form 100A but ME uneasy. Patient dies following
possible anastomotic leak following curative surgery for bowel cancer. ME notes this is the third case that
year involving the same surgeon. Case reported to the coroner but the officer informs the case is for a form
100A and 'I spoke to the family they don't want a PM and are happy for the doctor to issue'.
3. Late information – e.g safeguarding issue or allegation by another family member after ME2 issued and
death registered. Message from local authority social work department: frail elderly patient dies at home
and death registered by son as informant, but daughter has contacted social services because worried son
took away money intended for patient/physical abuse and GP didn't visit (allegedly).
Faculty information: one ME per station supported by one MEO/bereavement services worker. Four stations in total
with 12 candidates. Considerable small group teaching experience and confidence required to keep order and draw
in contributions from quieter members. Must be restrained and credible in role-play.
Format for each scenario must adhere to a consistent pattern:
5. Scene setting. Brief outline of case highlighting points likely to be of most significance in discussion.
Emphasis on the '2 questions' (unnatural? Cause of death wording?).
6. Dialogue. Role-play between faculty. Clear end to role-play and session leader invites comments and
discussion points from candidates. Three key learning points per scenario must be covered.
7. Summary of key points.
8. End of scenario. Keep to time!
Committee member action: provide 100-150 word summary scenarios with script and suggested causes of death if
applicable. Three key learning points per scenario must be provided. Committee consensus required on learning
points.
Suggest John Buchan for scenario 1, Anne Wadey for scenario 3, Alan Fletcher for scenario 2
______________________________
1540
Final question and answer session
Faculty
Duration: 20 min
Detail and faculty information required: open discussion session with at least one ME, one MEO, one coroner and a
chair person. To operate as a plenary discussion as at a conference.
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