Reliability and validity of a quality tool for assessing clinical forensic medicine legal reports |
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| Institution: | 1. New South Wales Health Education Centre Against Violence, Locked Bag 7118, Parramatta CBD, 2124, Sydney, Australia;2. Sexual Assault Services and Child Protection, Mid North Coast Local Health District, Pacific Highway Coffs Harbour, 2450, Australia;3. Expertise, Evidence and Law Program, School of Law, University of New South Wales, Sydney, 2052, Australia;4. School of Psychology, University of New South Wales, Sydney, 2052, Australia;1. Maternity and Children Hospital, Dammam, Saudi Arabia;2. College of Public Health, Imam Abdulrahman Bin Faisal University, 2835 King Faisal Road, Dammam, 34212, Saudi Arabia;1. Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan;2. Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan;3. Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan;1. Saint John, New Brunswick, Canada;2. Bristol, England, United Kingdom;1. Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia;2. Department of Forensic Medicine, Taher Sfar University Hospital, Mahdia, 5100, Tunisia;3. Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia;1. Department of Psychology, University of Castilla La Mancha, Albacete, Spain;2. Department of Psychology, Social Work and Social Services Area, Almería, Spain;3. Department of Psychology, The University of Hong Kong, Hong Kong;4. Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King''s College London, London, United Kingdom;5. European Social Survey ERIC, City, University of London, London, United Kingdom and School of Law, Trinity College Dublin, Dublin, Ireland |
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| Abstract: | ObjectiveIt is essential that reports written by forensic medicine practitioners undergo appropriate quality control. The aim of this study is to develop and validate a tool for assessing the quality of medico-legal reports in adult and adolescent sexual assault cases.MethodsThe authors developed an audit tool and accompanying guideline aimed at detecting errors, omissions, and inadequacies in medico-legal reports following reported adult or adolescent sexual assault. The authors conducted a benchmarking exercise to reach an agreed audit standard. Subsequently two forensic examiners audited 5 legal reports, first without the tool, and then with the tool following standardised instruction. A further ten forensic examiners audited 20 reports after receiving instruction in use of the tool. Their results were compared to the agreed audit standard. Participants were interviewed about their experiences.ResultsUse of the tool to audit reports significantly increased the sensitivity of error detection compared to usual practice (sensitivity with usual practice 55% vs sensitivity with tool 80%). Study participants using the tool to audit 20 reports detected 73% of items designated as errors by the study authors. The overall accuracy in coding items as errors/not errors was 74%. Interrater reliability was good (Cronbach's alpha = 0.87). Sensitivity, overall accuracy, and interrater reliability results varied by category in the audit: reviewers had lower levels of error detection and lower levels of agreement when auditing opinions in the report as compared to items describing the clinical forensic evaluation. Participants had fundamental disagreements about what constitutes good quality in some aspects of a report, including: the acceptability of including ‘non-relevant’ history; whether to include references and, if so, what constitutes appropriate citations; and how to determine whether the opinions could be understood by a layperson. Study participants reported that using the audit tool and guideline to review medico-legal reports has merit and suggested improvements to increase usability.ConclusionUse of an audit tool supported by a guideline and training is useful for improving error detection and standardising the review process for clinical forensic medicine legal reports. Further research aimed at improving the consensus about opinion standards in adult and adolescent sexual assault cases would be valuable. |
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| Keywords: | Medico-legal Forensic Sexual assault Peer review Expert evidence Report |
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