Continuing education events

Annual Education Course for Coroners and Pathologists

This two-and-a-half-day course is offered jointly by the OCC and the OFPS every fall. This meeting qualifies as continuing education for the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada.

In 2021, the course focused on “Back to Basics” where lectures on management of hazardous substances, family experiences with the death investigation system, pathology (that is, cardiac, lung, and brain), asphyxial deaths, COVID-19 and public health related deaths, report sign-outs and interpretation of ancillary testing were highlighted.

Department of Laboratory Medicine and Pathobiology, University of Toronto

The Department of Laboratory Medicine and Pathobiology (LMP) at the University of Toronto has a goal to advance teaching and research in forensic medicine. Many of the forensic pathologists working in the Ontario Forensic Pathology Service are faculty for the university’s continuing education programs.

LMP hosts continuing education events that bring national and international experts to University of Toronto to discuss topics in forensics. The courses are attended by academics, those working in forensic disciplines, other medical and legal professionals, and law enforcement practitioners. Courses were offered virtually and covered various topics in pathology. 

Dr. Frederick Jaffe Memorial Lectureship

A special lecture series was created in memory of Dr. Frederick Jaffe, one of the first forensic pathologists in Canada. Dr. Jaffe’s textbook, Guide to Pathological Evidence was used for many years by attorneys and judges. He was also the first director of a province-wide forensic medical service.

In October 2021, Professor Roger Byard presented a lecture in Dr. Jaffe’s name on international initiatives in forensic science. Professor Byard is Chair of Pathology at the University of Adelaide, Australia and Senior Specialist Forensic Pathologist at Forensic Science South Australia.

Training forensic pathologists

Since 2007, the University of the Toronto Department of Laboratory Medicine and Pathobiology (LMP) has been a partner of the Provincial Forensic Pathology Unit (PFPU) to train the next generation of forensic pathologists for Canada and the world. The Ontario Forensic Pathology Service (OFPS) is committed to the virtuous cycle of ‘service, research and teaching’ as the primary driver for advancing and sustaining the profession of forensic pathology. To this end, the University of Toronto and OFPS have become leaders in promotion and training of forensic pathology and forensic medicine practitioners in Canada and internationally to support public death investigations, as well as criminal justice and human rights. The Forensic Pathology Residency Training Program is funded by the Ministry of Health and administered by LMP. It is the first training program in Canada leading to certification in forensic pathology by the Royal College of Physicians and Surgeons of Canada (RCPSC).

In February 2021, the Royal College of Physicians and Surgeons of Canada accredited a new forensic pathology residency training program at the University of Ottawa and the Eastern Ontario Forensic Pathology Unit. This augments the capacity of the two other active training programs in Canada (Toronto and Alberta) and helps to ensure the sustainability of the profession in Ontario and Canada.

Our training program has two branches administered by the University of Toronto: 1) Forensic Pathology Residents who are primarily graduates of Canadian anatomical pathology training programs; and 2) International Clinical Fellows with variable backgrounds in pathology and forensic medicine. The training takes place at the PFPU. Both branches of the program are accredited by the RCPSC, and residents and fellows are eligible to sit the RCPSC sub-specialty examination in Forensic Pathology.

Training Canadian forensic pathologists

Since 2008, 23 pathologists have completed training, 20 of whom are now working within the Ontario Forensic Pathology Service. The PFPU has improved the RCPSC-accredited residency program and has implemented Competency by Design (CBD).

In 2021, two new residents began training in forensic pathology in the University of Toronto program.

Clinical fellows in forensic medicine

The Provincial Forensic Pathology Unit and the University of Toronto are committed to developing global forensic medicine and have outreach activities and training collaborations with Jamaica, the Middle East, Sri Lanka, Chile and Zambia. Since 2007, 20 international fellows have trained in forensic pathology at the PFPU. Since 2016, clinical fellows are eligible to write the Royal College of Physician and Surgeons of Canada examination in Forensic Pathology through the Subspecialty Examination Affiliate Program.

The PFPU hosted one clinical fellow in 2021 and did not host any research fellows.

Some trainees benefit from the G. Raymond Chang Forensic Pathology Fellowship through the University of Toronto’s Department of Laboratory Medicine and Pathobiology. This is the first fund in the world that enables young physicians from the developing world to train and ultimately strengthen forensic capacity in their own countries. This fellowship provides financial support to trainees whose countries may not be able to fund a year of training in Canada, particularly those from the West Indies.

In keeping with the Chang Foundation’s philanthropic vision, the partnership was enhanced in 2017 through the addition of a Catalyst Fund to broaden the strategy to focus on critical infrastructure development in Jamaica, training of West Indian non-physician learners and extension to other global areas in need.

Building on the success of the Jamaican program, we have extended outreach to other global areas of need and have broadened our advocacy for critical infrastructure development.

One our previous fellows, Dr. Mucheleng'anga (Adam) Luchenga, facilitated national legislation to set the framework for forensic pathology in Zambia. He is also spearheading an initiative to establish a medicolegal training centre for sub-Saharan Africa. In partnership with the University of Zambia and the Zambia College of Medicine and Surgery, existing forensic facilities are being refurbished to host a new one-year forensic pathology fellowship for trained pathologists, as well as a new four-year specialty training program for medical officers. The goal is to train 20 forensic pathologists by 2032.

The PFPU hosted two Chang Foundation fellows in 2021.

The Raymond Chang Foundation

The Raymond Chang Foundation is named after the late Toronto-based businessman and philanthropist who had a passion for adult education and was dedicated to improving opportunities where it was most needed. Born in Jamaica, Mr. Chang was a proud and active member of the Caribbean-Canadian community. He was appointed to the Order of Jamaica in 2011 and as an officer of the Order of Canada in 2014.

Raymond Chang understood the relevance of forensic pathology as a truth-seeking tool for justice. The fellowship is a legacy that lives on through ‎the dedication of his children, Andrew Chang and Brigette Chang-Addorisio. Their generosity and shared vision have ensured a sustainable fellowship training program at the University of Toronto. 
 

International assistance and capacity development

Ontario has a proud history of providing leadership and support to international Disaster Victim Identification missions. These humanitarian missions are assembled following natural or human-caused disasters where help is needed to identify victims. The Ontario Forensic Pathology Service has participated internationally with Interpol, the International Committee of the Red Cross (ICRC), the Federal Bureau of Investigation and other experts from the forensic community with a focus on forensic pathology in conflict zones. The value of forensic science is that it can clarify the facts as the forensic pathologist’s focus is on interpretation of injuries, how they may have occurred and determination of cause of death. During these international missions, interdisciplinary teams of anthropologists, archaeologists, odontologists, etcetera, work together to identify remains and assist with the humanitarian response.

Some nations do not have a robust system of forensic medicine to support human rights and justice. Our team has worked to build forensic medicine capacity and support human rights investigations in geographic areas such as the Middle East, South Asia, Africa and the Caribbean. Some of this work has involved United Nations agencies and the International Criminal Court, as well as the ICRC.

In 2021–2022, the PFPU hosted 10 domestic and international guests and observers from the University of Dublin, University of Hawaii, University of the West Indies and Togo, Africa.

Professional activities and outreach

Registered pathologists and forensic consultants enrich the practice of forensic science and medicine by participating in provincial, national and international professional organizations, such as the Ontario Association of Pathologists, Canadian Association of Pathologists, National Association of Medical Examiners, Canadian Society of Forensic Sciences, American Academy of Forensic Sciences, the International Association of Forensic Science and other organizations.

OFPS forensic pathologists participate in activities of the Royal College of Physicians and Surgeons of Canada that focus on education, promotion and accreditation of forensic pathology and anatomical pathology in Canada.

OFPS pathologists lectured and delivered courses to audiences that included forensic pathologists and scientists, medical practitioners, the judiciary, lawyers, police, advocacy groups and others. Some include:

  • Toronto Police Missing and Missed Implementation Team
  • Some presentations include:
    • AJ Lafrenier, CM Milroy, JL Parai. Beta-hydroxybutyrate and the Forensic Pediatric Autopsy: A Retrospective Case Series. 2021 Fall meeting of the Society of Pediatric Pathology; Virtual meeting, October 8–9, 2021.
    • F Auld and AE Walker. The value of the second postmortem examination in England and Wales. 2021 annual meeting of the National Association of Medical Examiners; West Palm Beach, USA, October 15–19, 2021.
    • T Mack, JL Parai, CM Milroy. Establishing Vitreous Glucose and Beta-hydroxybutyrate Thresholds to Assist in the Diagnosis of Hypothermia. 111th Annual Meeting of the United States and Canadian Academy of Pathology (USCAP); Los Angeles, California, March 19–24, 2022. Winner of the Association of Directors of Anatomic and Surgical Pathology Autopsy award.

OFPS pathologists serve as members of editorial boards of international peer-reviewed forensic journals and act as reviewers for other specialist journals.

Scholarly activities

Teaching

Most forensic pathologists and forensic consultants hold academic appointments at their respective universities. They teach undergraduate and graduate forensic science students, medical students, pathologist assistant and physician assistant students, dentists, nurses, medical artists, law students, medical imaging residents, and pathology and forensic pathology residents. Forensic pathology units also host many medical students and pathology residents from Canadian universities and elsewhere.

The PFPU participates in the University of Toronto’s Department of Laboratory Medicine and Pathobiology’s digital library by providing digital histological images of forensic interest for the educational purposes of pathology residents.

Forensic pathologists also act as visiting faculty to foreign universities.

Research

Forensic pathologists contribute to and support research aimed at understanding causes of sudden death, Nodding Syndrome and improving public safety.

Academic activity

Journal publications

Bellis, M., Cunningham, K. S., & Pickup, M. J. (2020, November 27). Heart of glass: fatal hematemesis caused by bronchiolo-cardiac fistula. Forensic Science, Medicine and Pathology, 17(2), 334–337.

Dmetrichuk, J. M., Rosenthal, J. S., Man, J., Cullip, M., & Wells, R. A. (2022, March). Retrospective study of non-natural manners of death in Ontario: Effects of the COVID-19 pandemic and related public health measures. The Lancet Regional Health - Americas, 7, 100130.

Herath, J. C. (2021). Firsthand experience in graduating three cohorts of forensic pathologists trained with competency by Design (CBD) curriculum. Academic Forensic Pathology, 11(4), 196–207.

Hickey, T. B. M., Mathews, R. Z., & Pickup, M. J. (2022, August 23). Pediatric push pin aspiration: clinical, radiologic, and pathologic correlation — case report. Egyptian Journal of Forensic Sciences, 12(1).

Hickey, T. B., MacNeil, J. A., Hansmeyer, C., & Pickup, M. J. (2021, September). Fatal methemoglobinemia: A case series highlighting a new trend in intentional sodium nitrite or sodium nitrate ingestion as a method of suicide. Forensic Science International, 326, 110907.

Hojilla, C., Armstrong, S., Pun, C., Hickey, T. B. M., Mete, O., Han, R., Hahn, E., Shivji, S., Done, S., & Lu, F. I. (2021, May 20). A Holistic Approach to Pathology Education During the Coronavirus Disease 2019 (COVID-19) Pandemic. Archives of Pathology & Laboratory Medicine, 145(8), 923–924. 

Liu, J., Budylowski, P., Samson, R., Griffin, B. D., Babuadze, G., Rathod, B., Colwill, K., Abioye, J. A., Schwartz, J. A., Law, R., Yip, L., Ahn, S. K., Chau, S., Naghibosadat, M., Arita, Y., Hu, Q., Yue, F. Y., Banerjee, A., Hardy, W. R., Mossman, K., Mubareka, S., Kozak, R. A., Pollanen, M. S., Orozco, N. M., Gingras, A., Marcusson, E. G., & Ostrowski, M. A. (2022, January 21). Preclinical evaluation of a SARS-CoV-2 mRNA vaccine PTX-COVID19-B. Science Advances, 8(3).

Ndikumana, R., Lal, A., & Herath, J. (2021, September). Aortoesophageal Fistula Secondary to Esophageal Diverticulum Resulting in Sudden Unexpected Death. Academic Forensic Pathology, 11(3), 141–146. https://doi.org/10.1177/19253621211038122

Williams, A. S., Dmetrichuk, J. M., Kim, P., & Pollanen, M. S. (2021, May). Postmortem radiologic and pathologic findings in COVID-19: The Toronto experience with pre-hospitalization deaths in the community. Forensic Science International, 322, 110755.

Xie, Y., & Herath, J. C. (2021, October 19). A case of persistent severe sequelae of COVID-19 infection: potential role in sudden death? Forensic Science, Medicine and Pathology, 18(1), 69–73.

Book chapters

Alcohol, drugs, toxins and post-mortem toxicology. Smith C, Milroy C. In: Forensic Neuropathology, 2nd Edition. Editors Whitwell H, Milroy C, du Plessis D. CRC Press 2021.

Contact sport and blast-related neuropathology. du Plessis D, Milroy C. In: Forensic Neuropathology, 2nd Edition. Editors Whitwell H, Milroy C, du Plessis D.  CRC Press 2021.

Difficult areas in forensic neuropathology. Milroy C., Whitwell H. In: Forensic Neuropathology, 2nd Edition. Editors Whitwell H, Milroy C, du Plessis D.  CRC Press 2021.

Forensic Pathology. Walker AE. In: Pathology Review and Practice Guide, 3rd Edition 2021. Editor Gao Z-H. Brush Education 2022.

Scalp, facial and gunshot injuries. Milroy CM. In: Forensic Neuropathology, 2nd Edition. Editors Whitwell H, Milroy C, du Plessis D.  CRC Press 2021.

Sudden death in epilepsy. Milroy C, du Plessis D. In: Forensic Neuropathology, 2nd Edition. Editors Whitwell H, Milroy C, du Plessis D.  CRC Press 2021.

The role of the expert witness. Watson P, Milroy C.  In: Forensic Neuropathology, 2nd Edition.

Peer reviewed manuscripts

Gorski, Z., Parai, J. L., & Milroy, C. M. (2021, August 25). Evaluating small vessel neutrophils as a marker for sepsis. Journal of Forensic Sciences, 66(6), 2289–2298. 

Klaric, K. A., Parai, J. L., Kepron, C. A., Walker, A. E., & Milroy, C. M. (2022, May 9). Postmortem survey of haemoglobin A1c, non-alcoholic steatohepatitis and liver fibrosis within a general population. Journal of Clinical Pathology, jclinpath-2021. 

Published presentation abstracts

T. Mack, JL Parai, C Milroy. Establishing vitreous glucose and beta-hydroxybutyrate thresholds to assist in the diagnosis of hypothermia.  Abstracts from USCAP 2022 (Abstract 12): Autopsy and Forensics. Mod Pathol 35, 75-97, 2022

Awards

  • David Larraguibel
    • BioCommunications Association – Bio Images 2022
      • Category: Still Image Division – Biomedical – Human and Animal
        • Premier Award – Cerebral Reflections
        • Image of Distinction – Fatal Cardiac Gunshot Wound
        • Images of Merit – Blue Ironstone and the Lost Pilot & Retinal Hemorrhage due to fatal crush injury of the skull

Committees

Forensic Pathology Advisory Committee (FPAC)

FPAC provides advice to the CFP regarding professional medicolegal autopsy practices. This committee includes the directors of the FPUs and the President (or delegate) of the Ontario Association of Pathologists.

During the reporting period, the committee convened four times to discuss policy issues, including the framework for the new Diversity, Equality and Inclusion Committee, responses to the recommendations of DIOC and external bodies, and the updated pathologist register and practice manual.