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The path to becoming a coroner can sometimes appear to be somewhat confusing. This is due largely to the fact that the education required to enter the field can vary greatly, depending on where an individual wishes to be employed in the role. In most jurisdictions, the term ‘coroner’ is used to refer to the person who investigates suspicious deaths. In some states or counties, however, the coroner is required to be a specialized physician and may be referred to as the ‘medical examiner’ (ME). This distinction, of course, points to two different sets of responsibilities and two different educational tracks.
Coroners are often elected officials. If they work in states where they are not required by law to be a medical doctor, their involvement in the science and forensics of death is reduced; they direct technologists and physicians who perform tests and autopsies. Depending on the jurisdiction, coroners’ formal education may be limited to a specialized training program comprised of as little as forty hours of coursework in injury recognition, causes and manner of death, suicides, abuse recognition, evidence collection and preservation, courtroom testimony, and death investigation laws. Many coroners, though, hold a Bachelor’s degree in a discipline such as criminology, anatomy, forensic science, experimental pathology, pathology, physiology, medicine, or pre-medicine. Because the duties of the role involve death investigation from both medical and legal perspectives, aspiring coroners often complete an undergraduate program that bridges the two disciplines.
Licensing and certification of coroners vary by state. In some states, coroners must pass a licensing exam, while in others they may be required to become certified death investigators through associations such as the American Board of Medicolegal Death Investigators.
Medical examiners are licensed physicians and are generally appointed to their position. In some jurisdictions, only a forensic pathologist can serve as a medical examiner. The required education track for these professionals comprises undergraduate studies, medical school, a residency, a fellowship, and certification by the American Board of Pathology.
Some states stipulate that their larger counties have a medical examiner and allow their smaller, less populated ones to have a coroner who is not a medical doctor. Sometimes, the decision is based on resources. Many rural areas may not have a qualified forensic pathologist nor the facilities needed for them to properly do their job. In addition, areas with little or no violent crime or unexplainable deaths do not require a full-time forensic specialist.
The National Academy of Science has suggested that U.S. states with the coroner system – which is not based on medicine – need to undergo a transition to death investigation by certified forensic pathologists who work as medical examiners.
How long does it take to become a Coroner?
The post-secondary educational track for a coroner who is not required to be a medical doctor is considerably shorter than that for a medical examiner, who must be licensed physician:
Educational track for a coroner not required to be a medical doctor – not more than four years
Coroner training program – as short as forty hours
Bachelor’s degree – four years
Educational track for a medical examiner, who must be a licensed physician (typically, a forensic pathologist) – thirteen to fifteen years
Pre-med Bachelor’s degree – four years
Medical school – four years
Residency – four to five years
Fellowship – one to two years
Steps to becoming a Coroner
Before committing to this career, it is crucial to understand the significant differences between the pathway to working as a coroner and the pathway to working as a medical examiner. The two terms are not interchangeable.
1 High School
Take classes in biology, chemistry, physiology, anatomy, computer applications, foreign languages, and first aid
Take advancement placement and college preparatory courses in the science and math fields
Take an introductory course in healthcare
Research undergraduate and graduate schools that offer the best science and medical programs
2 Bachelor’s Degree
While some prospective coroners undergo a condensed specialized coroner training program, most earn a Bachelor’s degree, often with a major in forensic science, pathology, or pre-med. Coursework typically includes inorganic and organic chemistry, biology, mathematics, and physics.
For students pursuing a career as a medical examiner, the four years of undergraduate study prepare them for the Medical College Admissions Test (MCAT) and entry to medical school. These students, in particular, typically focus on biology and biochemistry courses with a pre-med emphasis. They may also seek an advisor to assist them in mapping out a timeline of courses which will best prepare them for the MCAT, and to counsel them on resume presentation and finding volunteer and research opportunities.
3 Election / Licensure / Certification (applies only to coroners, who are generally elected officials)
Coroners who are not required to be licensed physicians are often elected officials. They are therefore required to run a campaign and win an election in order to assume the office.
Requirements for licensing of coroners varies by state. Some states require coroners to pass a licensing exam, while others require successful completion of a state-approved specialized training program or course of study.
In addition to obtaining their license, coroners may apply for certifications from the American Board of Medicolegal Death Investigators (ABMDI) and the American College of Forensic Examiners Institute (ACFEI).
4 **PLEASE NOTE**
Please note that the steps below – Steps 5 through 11– apply only to medical examiners, who must be licensed physicians.
5 Medical School Admissions Test
During their junior year of undergraduate study, prospective medical examiners must sit for the Medical College Admissions Test (MCAT) administered by the Association of American Medical Colleges (AAMC). Through a set of multiple-choice questions, this standardized exam allows medical schools to evaluate a candidate’s training and skill set. Many schools share their incoming student MCAT score average on their website to inform undergraduates of how well they need to score to compete with other applicants.
To achieve their highest possible MCAT score, students are encouraged to take advantage of assistance available to them. This includes study materials, pre-tests, practice tests, and online and in-person tutoring. These resources are designed to ensure that students attain the best possible score, which will open doors to medical schools.
6 Medical School & National Licensing
Forensic pathologists obtain either a Doctor of Medicine (MD) degree or a Doctor of Osteopathic Medicine (DO) degree.
Medical school is a very challenging four years of study that is divided into two parts. The first part, comprising the first two years of the schooling, is focused on course and lab work that prepares students intellectually for patient interaction. This training is in the biological and natural sciences, physiology, chemistry, medical ethics, and the art and practice of medicine. To tests their grasp of this portion of training, in the second year of medical school students pursuing an MD must take and pass the United States Medical Licensing Examination (USMLE) – Step 1. Those pursuing a DO must take and pass the United States Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) – Level 1. A passing score on the USMLE or COMLEX-USA indicates that students are ready to begin supervised patient visits and gain clinical experience.
The second part of medical school, the second two years, is called Rotations. During this time, students have the opportunity to experience a variety of medical specialties and a variety of medical settings under the supervision of experienced physicians. Rotations further students’ understanding of patient care, situations, scenarios, and the teams that come together to help those that are sick. As they complete rotations, students tend to find out that they gravitate towards certain specialties or environments that fit their particular interests and skill sets. It is important that this time inform their decision of specialty or subspecialty, so that they find complete satisfaction as a physician.
After part two of medical school, students take the United States Medical Licensing Exam –Step 2 or the United States Comprehensive Osteopathic Medical Licensing Examination – Level 2. The objective of these exams is to test whether or not students have developed the clinical knowledge and skills that they will need to transition into unsupervised medical practice.
To become medical examiners, medical school graduates complete their residency in anatomic pathology. The program is built around rotations in the major sub-specialties of the field: surgical pathology, cytopathology, and forensic pathology. It immerses residents in the process of diagnosing diseases through an autopsy. Practical experience is gained by participating in investigations and autopsies.
8 State Licensing & Continuing Education
All physicians in every state need to be state licensed. To be eligible to sit for a state’s licensing exam, candidates must have completed medical school and a residency program. While licensing rules and regulations vary from one state to another, periodic license renewal and continuing education are common requirements.
9 Board Certification
Forensic pathologists must be certified by the American Board of Pathology (www.abpath.org), a member of the American Board of Medical Specialties (ABMS). To be eligible for the Board’s basic certification, applicants must have graduated from an accredited medical school, obtained a medical license, completed a pathology residency, and passed written and practical certification testing. Candidates may pursue certification in anatomic pathology, clinical pathology, or a combination of the two. Additional certification is available in the forensic pathology subspecialty.
To retain their professional certifications, licensed pathologists must meet certain requirements. For this reason, the American Board of Medical Specialties administers a Maintenance of Certification (MOC) program. The program involves continuing medical education, testing, and periodic performance reviews to ensure that physicians remain up-to-date on their medical training and knowledge of advances in their specialty.
A ‘fellow’ is a physician who completes further training or a ‘fellowship’ in a specialty or subspecialty, after or near the end of residency.
Forensic pathology fellows work on a forensic team at a medical examiner’s office. They participate in crime scene investigations, prepare courtroom testimonies, test body fluids, and assist with autopsies. Over the course of their fellowship year, they perform up to three hundred autopsies under the supervision of a certified forensic pathologist. Training focuses on evidence collection and the identification of poisoning, disease, trauma, or ballistic wounds during autopsies.
Medical examiners are normally appointed by a state board. It is common for them to serve as a deputy medical examiner before transitioning to the position of chief ME. A chief medical examiner generally has greater interaction with the government agencies that work in tandem with the office.
Should I become a Coroner?
Individuals looking to become a coroner or medical examiner must be willing to be exposed to disturbing circumstances. Elected coroners must be prepared to campaign for political office. Over and above these prerequisites and specific education demands, the roles call for a particular set of soft skills and an especially important character trait:
Attention to detail and analytical skills
The consummate coroner/medical examiner is detail-oriented, methodical, and analytical; and embraces the science of examining microscopic samples of tissues, cells, or fluids to identify a cause of death.
Critical thinking and decision-making skills
Information gathering and organizational skills
Communication and interviewing skills
Coroners and medical examiners often consult with protective service workers, the court system, and bereaved family members.
Coroners and medical examiners often use graphics and photo imaging software; toxicology databases; and Forensic Filer, a specialized case management software program.
Coroners and medical examiners must be able to effectively operate autopsy tools.
Coroners and medical examiners with genuine human compassion and a desire to resolve mysterious deaths to bring some peace to victims’ families are more likely to be able to accept the frequently sad circumstances surrounding their work.
The job of coroner or medical examiner also presents some distinct pros and cons:
Opportunity to make a positive contribution to community
Possibility of assisting police in solving homicide cases
Irregular hours – coroners/medical examiners must often attend crime scenes
Possibility of encountering biohazards
Often stressful, sometimes traumatic working conditions
Before embarking on the path to becoming a coroner or medical examiner, it is important to consider what is at the heart of the profession. Dealing with the deceased on a regular basis might be a negative for some individuals. For others, solving questions related to unexplained deaths may be rewarding. To which of these groups do you belong?