GS Medical Group is a boutique medical organisation providing independent medicolegal services in the UK founded in London on 15.11.21. The Group has a strong interest in medical education.

GS Medical Group takes its name from the Founder Dr G Spoto, FRCPsych MA FAcadMEd MEWI a Consultant Psychiatrist and Medical Educator with over 30 years' experience in the NHS and the Independent Sector

Dr Spoto has an established practice in London as an Expert Witness and is a Member of the Expert Witness Institute .He is a Member of Council of the Medicolegal Society (Formerly the Medicolegal Society of London) and a Member of the Independent Doctors Federation ( IDF ) where he sits on the Education Committee

Dr Spoto is a Fellow of the Royal College of Psychiatrists and a Founder Member of the Academy of Medical Educators. He was a Medical Member of the 1st Tier Tribunal (Mental Health) between 1995 – 2021.

Medicolegal Education and Services are a neglected area of practice, and the role and function of the Expert Witness is poorly understood. The issue is nowhere more problematic than in Psychiatry where recourse to litigation by service users is often necessary, not always as a last resort. GS Medical Group are passionate about the medicolegal interface and determined to drum up interest in this exciting area of practice amongst doctors in training as early and by as many means possible.

Compared to medicolegal services generally, medicolegal services in the UK are plagued by outdated practice.

Bizarrely, in the medicolegal system training also appears to be largely aimed at experienced Consultants and experts with an established medicolegal practice rather than the less experienced experts or medicolegal trainees. In other words, the system is training the trainers rather than the trainees.

In addition, It is clear that educational practice in the medicolegal system is still to this day based on classroom work, a most unsuitable way of teaching and learning for the clinical settings.
Services are otherwise known to be in short supply and unable to meet demand due to limited and ever diminishing number of experts, spiralling costs of litigation, delays in service delivery and poor quality of medical evidence of course notwithstanding, Psychiatry not excluded.

(Box 1) The right to legal aid is enshrined in the European Convention of Human Rights (ECHR). Article 6(3) © guarantees:
1)The right to legal aid where the defendant does not have the means to pay for it;
2)The right to free legal aid where the interest of justice so requires.
‍
The UK is a signatory to the ECHR However it is extraordinary that out of the 49 European states the UK is unique in steadily eroding access to legal aid. Legal Aid does not include access to legal Aid in civil proceedings or outside civil proceedings.
‍
Attempts by the Authorities to reduce costs include Section 57 of the CPR rules (Fundamental Dishonesty) and more recently the introduction of the Intermediate track in 2023 (Pamplin 2023).
‍
Attempts to reduce costs by legislation ignore the law of supply and demand and are unlikely to be successful. They also ignore fundamental issues about the training of Experts

GS Medical Group believes the issues to be interrelated and the poor levels of service provision and lack of satisfactory training in the medicolegal system to stand in a relationship of Cause and Effect.

GS Medical Group aims to challenge this by providing training to those that are starting up in the medicolegal system rather than experienced Consultants and Experts with an established practice as it is the case now. It also aims to make up to date medicolegal education available to Experts, including Supervision and Mentoring and opportunities for Experts to engage in Case based Discussions (CbD’s).

The Groups is by so doing seeking above all to make excellent medicolegal services more directly available regardless of cost (Box 1)

Compared to medical services generally, medicolegal services in the UK are to this day plagued by outdated ideas and practice.It is clear for example that educational practice in the medicolegal system is still based largely on classroom work, a practice which is unsuitable for the clinical settings (De Cossart and Fish ,2005) and indeed a practice that was abandoned elsewhere in medicine a very long time ago. Yet this view underpins much of the education available in the medicolegal system and is the prevailing view to this day.The underlying principle from the point of view of teaching and learning is that knowledge can be “transmitted" to the learner .GS Medical Group aims to challenge this view which according to the standards of good medical practice is positively antediluvian (Box 2).

(Box 2) The view that knowledge is transmitted from the teacher to the learner as it were by passive osmosis rather than being constructed by the learner is no longer accepted in postgraduate medical education, the prevailing view now being that knowledge is always constructed.
The idea that Knowledge is constructed by the learner rather than being “transmitted “was first introduced by the Constructivist School whose challenge to the Orthodoxy was very successful (Vygotsky, 1978)
In medicine the view of the infant as a “tabula rasa “is also now completely discredited and has lost any traction

Other outdated views however also abound in the medicolegal system which are prejudicial to teaching and learning. The experience of Junior Doctors is for example believed to be very limited, further affecting medicolegal education detrimentally [ A distinction of course ought to be made between experience and expertise , which is acquired over time. The distinction is of vital importance in medicolegal education and has been most eloquently made with regard to the Registration of experts (Rix, Eastman, Haycroft and Adshead 2017)
] . Such views are deep and almost intractable.

Doctors in training are thus thought to be lacking the required experience to be able to undertake any medicolegal work or take instructions and therefore unsuitable to act as an Expert Witness. Accordingly, and from an educational point of view, they are also deemed not to require any training. This view certainly in the field of Psychiatry is manifestly false for at least two reasons:

First, unlike the MRCP, an “entry” exam taken by physicians to enter specialist medical training, the MRCPsch,  an “ exit “ exam taken at the end of core training, certifies  the standards required  of a Psychiatrist  have been met , the GMC’s Specialist Register being a much later invention.

Psychiatrists unlike Psychologists are of course medically qualified and like any other doctors are expected to complete their medical training when they are deemed by definition to be qualified for independent practice.

Secondly, Psychiatrists whose ability “to diagnose and treat Mental Disorder” is capable of being certified by the Secretary of State,  do need of course  to be able to show that they have the  relevant experience to do this , regardless of their being on the Specialist Register. Indeed, they demonstrate this on a regular basis as part of their being “on call “or for example in the case of doing a Mental Health |Act Assessment. The process of certification which is enshrined in the Mental Health Act 1983 is known as Section 12 Approval  [ The role of a Section 12 Approved Doctor  is a quasi-Judicial  role. The role allows a doctor to detain patients in hospital, thereby depriving   a subject of their liberty. Psychiatrists may become Sect 12 Approved subject to certain criteria at a very early stage.
].

A Section 12 Approved Doctor of course provided he or she has the required experience need not even be a Psychiatrist and the role is discharged regardless of status.  The provision to approve doctors as having the required experience to diagnose and treat Mental Disorders is well established and regulated

(Box 3) Reflective practice in the medicolegal system is unknown and Experts are largely self-taught , Medicolegal Curricula being entirely non-existent under the current system .Indeed on many occasions experts will admit privately to have learned their skills in the Coroner’s Court.

Standards of practice in the medicolegal system are also very inconsistent causing Experts to often display very idiosyncratic practices, Joint Expert Statements ordered by the Courts being but one example.

Despite the formal training available there are also no current agreed standards for the delivery of expert evidence to the Courts, and different templates have been suggested by different training organisation.

With regard to standards of practice (Box 3) the system which is also notable for very poor outcomes
and is certainly a far cry compared to the clinical services which have developed and indeed expanded exponentially over the years (Ikkos and Bouras 2021) supported by a robust educational system.

The system has incurred the displeasure of judges on many occasions and has also been criticised repeatedly from a clinical Indemnity perspective (Hendry, 2019).

Although widely adopted elsewhere in medical practice, the concept of Supervision is virtually unknow, in the medicolegal system or indeed the literature.

However, the subject of Supervision has appeared recently in case law (Pinkus vs Direct Line, 2018) where it seems to be undermined The Judgement in this case is known colloquially as the Pinkus Trap.

( Box 4 ) The concept of Supervision meaning literally “a view from above “is not antipathetic to the legal principle of Independence, on the contrary it is plain that it positively reinforces it.
The Pinkus case has however been misconstrued elsewhere as a legal muzzle restricting rather than expanding the scope of medicolegal Education. In practice it is generally perceived as antieducational.

In this case, an extremely complex case of Personal Injury, eventually thrown out on the grounds of Fundamental Dishonesty, the claimant’s Expert, a Neuropsychologist sought help from a senior colleague in the form of Supervision.

The Defendant in this matter applied successfully for disclosure of the supervisory material before the case went to trial. The Expert was in any event severely reprimanded for lacking “independence “ ( Box 4 .)
Medicolegal Case based Discussions (CbD’s) otherwise have been advocated in Medicolegal Education for some time (Rix and Powers, 2021) but its place in practice is to this day poorly understood (Box 5 ).

( Box 5 ) CbD’s are a vital part of Appraisal and evidence of engagement is normally provided in the Appraisal Document under Quality Improvement .The use of Medicolegal CbD’s however to this day is unknown , the requirement to engage in Whole Practice Appraisal again notwithstanding

Indeed, the use of medicolegal CbD’s during Appraisal is to this day believed to be very low possibly due to the fact that Medicolegal practice is a part time activity for Consultants and certainly compared to the GMC requirement to engage in 360 Degree feed back

Tools for 360 Medicolegal Feedback as it applies to the medicolegal system have now been developed and are commonly in use although still very experimental. Medicolegal CbD’s however lack any tools to undertake them although a dedicated Form designed especially for this purpose has been suggested (Rix and Powers 2021).

Spiralling costs of litigation delays in the provision of medical evidence to the Courts and the poor quality of evidence available to the Courts are seriously poor outcomes and in the opinion of GS Medical Group the direct consequences of an outdated system which needs to change and in the opinion of the Group is ripe for reforming.

The shrinking of the pool of experts is of course a further adverse outcome noted in medical indemnity settings amongst others (Hendry 2019).

GS Medical Group challenges outdated practice in Medicolegal Education and Services (Box 6 ) and is determined to update them.

(Box 6) There are several potential reasons why outdated practice is still prevalent in the medicolegal system such as the following:
vested interests
‍
fee paying structure

contractual constraints

conflicting educational objectives equating for example Forensic and Medicolegal practice

social isolation

fragmentation due to the many training organisations providing medicolegal training in the UK

the role and function of Reporting Agencies in the medicolegal system including administration and marketing of expert services exceedingly legalistic as opposed to clinical views and priorities in medicolegal education

Unlike training available under other organisation where principles and values are rarely stated, training under GS Medical Group is value-based and based on the following principles.

A ) medicolegal training should within the law be practice based and based on real cases

B ) trainees make excellent Expert Witnesses provided they are adequately trained and suitably supervised.

Medicolegal training in the UK unlike Medical Education generally, is mostly undertaken in the classroom and therefore didactic and out of date. Yet the literature on the subject of medicolegal education is silent research being entirely non-existent, It is likely that this be due to the practice of medicolegal work being remote and undertaken outside mainstream medicine, usually in the private sector.

Indeed even important contributions to Medical Education ( De Cossart and Fish 2005; De Cossart and Fish 2007 ) which can be said to have changed Medical Education for ever do not include chapters on the subject of Medicolegal Education.

One study (Spoto 2018) where medicolegal practice was included in the Job Description (JD) of a large rotational scheme for Higher Psychiatric Training in the South East of England shows the new scheme to have been very successful. However the Study which is believed to be the first of its kind in the UK is yet to be replicated.

The placement where the experience was available was very popular with trainees and a number of trainees were later found in the study to have started their own medicolegal practice as a Consultant some even becoming Medical Members of the 1st Tier Tribunal (Mental Health).

The study shows the introduction of medicolegal experience in the JD of Higher Psychiatric trainees to be entirely feasible also demonstrating the importance of early medicolegal experience both in terms of generating more Experts and increasing the pool , but also in terms of recruiting new Medical Members to the 1st Tier Tribunal (Mental Health) .

It is clear that more research is required in this regard however this has so far met with insurmountable obstacle, for example the Consultant Contract and lack of familiarity with Action Research (Elliott 1991).

GS Medical Group builds on the original study and is today the only Medical Organisation in the UK that is able to provided up to date Medicolegal Education based on practice entirely on a commercial basis. A copy of the JD used in the original study is available on demand.

It is presently the case under the current system that doctors in training or for that matter less experienced Consultants are deemed unsuitable to act as Expert Witnesses in the UK Courts and generally believed to be lacking all or any of the required experience. Training is for this reason therefore under the current system also rarely provided. In the opinion of GS Medical Group this opinion is outdated and unjustified.

(Box 7 Experience gathered in the context of the 1st Tier Tribunal (Mental Health) certainly shows that excellent medical evidence can be provided in a tribunal setting by doctors in training.

In 1st Tier Tribunal hearings supervised medical evidence is routinely provided by doctors in training both orally and in writing, Supervisors also attending hearings in many cases.

GS Medical Group believe on the contrary and are firmly of the view that subject to certain conditions and provided they are adequately supervised Doctors in training, whom they call “Junior Experts” can make excellent expert witnesses in the medicolegal system and should be able to regularly act as Expert Witnesses as a matter of course and in most jurisdictions (Box 7).

GS Medical Group are also entirely of the view that provided they are suitably supervised “Junior Experts”
rather than experienced Consultants should be used as the expert of choice in most legal proceedings except in the most complex cases (Spoto, 2020).

With regard to the training of Experts GS Medical group are also firmly of the view that training should be practice based (Box 8), as opposed to didactic as it is now widely accepted that in the clinical settings didactic teaching is entirely unsuitable (De Cossart and Fish ,2005)

(Box 8) Practice based learning as an alternative to classroom work hailed as “New Ways of Teaching and learning” by KSS Deanery, was first introduced in Postgraduate Medical Education under the banner of Liberating Learning, (KSS Deanery 2007), believed then to be hijacked by the European Working Time Directive.
The lack until recently of practice-based approaches to medical education in the clinical settings is thought to be a hangover from practice in the London Teaching Hospital going way back to the 18C.
Historically for example in the London Teaching Hospital students may be observed to be allowed to walk the walk but the lecture is king (Heaman, 2003).

Unlike other training organisations which today fail to make training available to less experienced Experts, GS Medical Group for the first time in the UK seeks to train less experienced Experts such as Consultants that have been newly appointed and higher psychiatric trainees.

Furthermore, and again contrary to other training organisations where the training available is to this day essentially didactic and therefore entirely out of date (Box 9) GS Medical Group champions up to date ways of teaching and learning in Medicolegal Education and does so deliberately and in a systematic way
(Box 10).

(Box 9 ) In some training organisations, a form of practice-based teaching is available in the form of “mock” Court room practice but teaching based on real cases is not available
Despite services being provided in settings that are essentially clinical, namely the Expert’s Consulting room, Medicolegal Education in the UK is still largely based in the classroom resulting in seriously adverse consequences for service provision and the delivery of Justice.

(Box 10 )The place where learners engage in supervised practice away from the classroom is called a “Practicum “ , a safe place where practice is the priority rather than the Lecture The term “Practicum” was originally introduced in undergraduate education , as a place where the real world of professional practice is simulated
In the clinical settings the “Practicum” was originally introduced in the training of Surgeons at the start of the Century (De Cossart and Fish, 2005). The concept of a “Practicum “in the medicolegal system is unknown.

Under GS Medical Group didactic teaching is disallowed and a practice-based approach to teaching and learning is rigorously enforced (Box 11) including Supervision. The Group also provides opportunities for Experts to engage in CbD’s and Mentoring is available as part of the scheme.

The Expert is also expected to reflect on their practice engaging in reflections both “in action” and “on action” (Schon 1987) Other forms of Active Learning which are regularly updated are also implemented and very strongly encouraged at every stage.

(Box 11) The model which under GS Medical Group is strictly adhered to hails back to Vygotsky’s idea of “scaffolding “(Vygotsky 1978) which demands complete abstinence from any kind of classroom work. The model regards any attempts by either the learner or the Teacher to go back to the lecture as the model “reverting to type “and they are forcefully resisted.
Vygotsky also introduced the idea of a zone of “proximal development “and Bruner thought that learning requires appropriate frameworks of social interaction (Bruner ,1978).

Uniquely, and again for the first time in the medicolegal system GS Medical Group provides Experts with access to a Library of medicolegal reports and other training materials for their personal use thus further enhancing the training experience (Box 12 ). Members of the Group are indeed required to upload their report to the Library as a condition of their membership

A Forum is also available for Members to engage in dialogue and access to the Forum is a further benefit of membership.

Unlike other training organisations Assessment under GS Medical Group is regularly undertaken and formative and summative instruments are used at regular intervals underpinning training progression, supported by other well-known tools of educational practice such as the Learner’s Journal (Monn 2002).

(Box 12) Supervision is still a novel way of teaching and learning in medicine. At the start of the NHS when Consultants agreed to undertake teaching responsibility largely undergraduate in the Teaching Hospital in exchange for services undertaken by their academic colleagues, they did so provided support by a Junior Doctor under supervision was available. The arrangement was known as the Firm.
Interestingly. this is to this day always a contentious issue in other medical specialties and although once a week supervision in Psychiatry is mandatory, this is only a recent development.
By contrast Supervision has always been a central feature in the training of Lawyers. Barristers for example who are based in chambers are required to undertake duties under supervision for several years before being called to the Bar, a system known as “pupillage “.
Interestingly the correct title of a Barrister is that of a “Junior Barrister “until they become a KC The process known as “taking silk”.

Training is available in the area of Personal Injury, Clinical Negligence and Employment Law, in relation to patients of working age. Family Law in relation to parenting and Immigration are also areas of interest, and evidence is provided regularly to the Courts by members of the Group both in relation to Claimants or the Defendant.

GS Medical Group has a further interest in the area of Mental Capacity including capacity to engage in litigation and in certain aspects of crime, including Fitness to Plead or stand trial, and provides services in such areas.

Specialist Info
Bruner J (1978)” The role of dialogue in language acquisition” in Sinclair A , Jarvelle RJ and Levelt WJM
(Eds) ”The child’s concept of language”
New York, Springer Verlag

De Cossart L and Fish D (2005) "Cultivating a Thinking Surgeon. New perspectives on clinical teaching learning and assessment".
TFM Publishing Ltd.

De Cossart L  and Fish D  (2007) "Developing the wise doctor.  A resource for Trainers and Trainees in MMC". RSM Press Ltd.

Elliott J (1991) "Action Research for educational change".
Open University Press. Buckingham.

Fish D (2013). "Quality mentoring for student teachers. A principled approached to practice".
Routledge.

Fish D and Coles C( 2005 ) “ Medical Education. Developing a Curriculum for Practice”
Open University Pressin Association with McGraw Hill
Maidenhead

Heamsn EA (2003) “St Mary’s: the history of a London Teaching Hospital”
Mc Guill-Queen University Press

Hendry R (2019). "More Doctors need to train as Expert Witnesses say MPS”.
Expert Witness Magazine.  BMJ,364

Ikkos G & Bouras N (2021) "Mind State and Society. Social History of Society and Mental Health in Britain 1960 - 2010.”
Cambridge University Press.

KSS Deanery (2007). "Liberating Learning. A practical guide for learners and teachers in postgraduate medical education and the European Working Time Director.  The report of the conference of Postgraduate medical deans ad hoc working group on the educational implications of the European Working Time Directive".
KSS Denary

Lishman W A (1978 ) ” Organic psychiatry. The psychological consequences of Cerebral Disorder “
Blackwell Scientific Publications

Malik A, Bhugra D and Brittlebank A (2011) “Workplace -based Assessments in Psychiatry”
College Seminars Series
Royal College of Psychiatrists

Moon J (2002).  "Learning Journals".
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Pamplin CF (2023) “Pro bono Experts”
Your Witness, Newsletter of the UK Register of Expert Witnesses
Issue 114: 7

Rix KJB Eastman N Haycroft A and Adshead G (2017)” The Poole Judgment has not changed the law of Expert Evidence “
Br J Psychiatry Dec 21196):398

Rix K (2001). "Expert Psychiatric Evidence".
Royal College of psychiatrists Publications.

Schon DA (1987) "Educating the reflective practitioner".
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Spoto G (2018) "Medicolegal training for Doctors. Impact on recruitment of Tribunal Medical Members". Mental Health Tribunal. Spring Journal.

Spoto G (2020) “ More Doctors to serve as Expert Witness  says MPS. A short Commentar”y
Medicolegal Journal 13

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Wenger D (1999) “Communities of Practice: learning, meaning and identity”
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Allen D (2012) "We need it by next Thursday. The joys of writing Psychiatric Reports".
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Rutherford J and James A (2022)” Guidance for Detaining Authorities and Tribunal Panels about Medical Evidence for 1st Tier Tribunals –Mental Health “
First Tier Tribunal (Health Education and Social Care) Mental Health

Rix K, Eastman N Adshead G, Briscoe J and Hallett N ( 2015 ) “ Responsibilities of Psychiatrists who provide expert evidence to courts and Tribunals”( Revised March 2023)
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Many thanks are due to the following:
G Kelly‎ for editorial support
A Exner for website design and development
D Venn for legal advice
M Rubinson ‎and J Higgins for Accountancy advice
Dr G McKay for critical friendship
‎N Larsen for administration and management

GS Medical Group has received no financial support for the research, authorship and publication of the material quoted on this website.

Mission Statement About GS Medical Group Some Principles and Values Evidence Base New Directions in Medicolegal Education Jurisdictions References Further Reading Social Media Useful Links Acknowledgements Dedication Funding Grands, Donations and Legacies Collaborations, Endorsements and Reviews Placeholder box

Overview

GS Medical Group is an independent medical organisation providing medicolegal services in the UK.

GS Medical Group has a strong interest in medical education. GS Medical Group takes its name from the Medical Director and Founder, Dr G Spoto, FRCPsych MA FAcadMEd a Consultant Psychiatrist and Medical Educator with over 30 years' experience in the NHS and the Independent Sector.

Dr G Spoto is a Member of Council of the Medicolegal Society ( Formerly the Medicolegal Society of London) and a member of the Independent Doctors Federation ( IDF ) where he sits on the Education Committee. He is an Expert Witness and was as Medical Member of the 1st Tier Tribunal (Mental Health) between 1995 - 2021.

MissionStatement

Medicolegal Education and Services are a neglected area of practice and the role and function of the Expert Witness is poorly understood

The issue is nowhere more problematic than in Psychiatry where recourse to litigation is often necessary, not always as a last resort.

GS Medical Group are passionate about the medicolegal interface and determined to drum up interest in this exciting area of practice amongst doctors in training as early and by as many means possible.

About GS Medical Group

Compared to medicolegal services generally medicolegal services in the UK are plagued by outdated practice.

It is clear for example that educational practice in the medicolegal system is still to this day based on classroom work, a most unsuitable way of teaching and learning for the clinical settings.

Bizarrely, in the medicolegal system training appears to be largely aimed at experienced Consultants and experts with an established medicolegal practice rather than medicolegal trainees.

Experts are also in short supply with services unable to meet demand, the spiralling costs of expert evidence, delays in service delivery and poor quality of medical evidence, including psychiatric notwithstanding. GS Medical Group believes the issues to be interrelated.

GS Medical Group aims to challenge outdated practice in the medicolegal system by making excellent up to date medicolegal education, including Supervision and Mentoring. available to the more inexperienced Consultants and higher psychiatric trainees, rather than the usual suspects as it is the case now, the Group also being created with the intention of also making better medicolegal services available as a result.

Some Principles and Values

Compared to medical services generally, medicolegal services in the UK are to this day plagued by outdated practice.

It is clear for example that educational practice in the medicolegal system is still based largely on classroom work a practice which is unsuitable for the clinical settings (De Cossart and Fish, 2005) and as a way of teaching and learning also a practice that was abandoned elsewhere in medicine a very long time ago.

Yet this view which is based on the underlying principle being that knowledge can be “transmitted“ to the learner underpins most of the education available in the medicolegal system and remains the prevailing view to this day (+). GS Medical Group aims to challenge this view which is according to the standards now universally accepted in medicine, positively ante-diluvian.

Outdated views and prejudices further affecting medicolegal education detrimentally in the medicolegal system also apply to the notion of “experience“ (+)(+)deemed to be necessary to be an Expert Witness. Again, such views and opinions which GS Medical Group believe to be misguided continue to be prevalent to this day.

(*) The view that knowledge is transmitted from the teacher to the learner as it were by osmosis rather than being constructed by the learner is no longer accepted in postgraduate medical education , the prevailing view now being that knowledge is always constructed The idea that Knowledge is constructed by the learner rather than being “ transmitted “ was introduced by the Constructivist School (Vigotsky 1978) whose challenge to the Orthodoxy was very successful In medicine the view of the infant as a “ tabula rasa “is also now completely discredited and has lost any traction

(+) A distinction ought to be drawn between “ experience “ and “expertise“, which is acquired over time The distinction has been eloquently made by Rix and colleagues with regard to the registration of Experts (Rix , Eastam , Haycroft and Adshead (2017)

Doctors in training according to the prevailing opinion are thought to be lacking the experience needed to undertake medicolegal work or take instructions and are therefore deemed to be unsuitable to act as an Expert Witness. This view is manifestly false for at least two reasons.

First, It goes without saying that all Doctors qualify for independent practice upon completing their studies and prior to entering higher training in any of the specialties.

Secondly, with regard to Psychiatry doctors in training demonstrate that they possess the required experience on a regular basis, their ability “ to diagnose and treat mental Disorder” being even certified by the Secretary of State routinely, subject to certain criteria , the process known as Section 12 Approval ( +)

A Section 12 Approved Doctor of course need not even be a Psychiatrist and the role is discharged regardless of status. The provision to approve doctors as having the required experience to diagnose and treat Mental Disorders is enshrined in the Mental health Act 1983.

The system has repeatedly being criticised from a clinical Indemnity perspective as well as incurring the displeasure of judges on many occasions and is a far cry compared to the clinical services which have expanded and developed exponentially over the years ( Ikkos and Bouras 2021 ) supported by a robust educational system.

Poor outcomes with regard to the delivery of Justice under the current system have of course been noted for some time as it has been the appalling shortage of Experts in the medicolegal System.

Criticism from the Judges with regards to the standards of medical evidence (*)(*) has been increasingly open and during the last few years increasingly forthcoming . Further criticism has been expressed from point of view of professional indemnity.

(+ ) the role of a Section 12 Approved Doctor is a quasi-Judicial role .The role allows a doctor to detain patients in a psychiatric unit, thereby depriving a subject of their liberties

(*)(*) Despite the Formal training available, there are no agreed standards of practice in the current medicolegal system and there are no standards for the delivery of medical evidence currently although different templates have been suggested by different training organisations

Further issues concern access to Medical Education which with regard to medicolegal practice is either lacking or absent during training, except perhaps Forensic and when available, in the UK largely in the private sector, this is not readily accessible by trainees. Furthermore this is aimed strangely at experienced Consultants and Experts with an established practice.

On the subject of Expert Training very helpful advice has recently come in the form of a landmark Judgment ( Pinkus v Direct Line 2018 ) where the requirement never to infringe the fundamental rule of expert evidence, the Expert’s “independence “ of practice during training is categorically stated ( * )

Delays in the delivery of evidence, poor standards of practice and spiralling costs of litigation all affect services detrimentally and the issue is nowhere more problematic than in Psychiatry where vulnerable people often have no alternative but to make recourse to the law, not always as a last resort.

GS Medical Group challenges outdated practice in the medicolegal system and is committed to making medicolegal services more inclusive, more effective and more readily available.

Unlike training available elsewhere training under GS Medical Group is based on the following principles.

A ) medicolegal training should within thelaw be practice - based and based on real cases

B ) trainees make excellent ExpertWitnesses provided they are adequately trained and suitably supervised

(*) unlike other Judgments and contrary to a great many Training schemes, the Judgment directly addresses the subject of Supervision. The danger of negatively affecting the Expert’s Independence during Medicolegal Training is known colloquially as the “Pinkus Trap”.

Some Principles and Values

(+ ) the role of a Section 12 Approved Doctor is a quasi-Judicial role .The role allows a doctor to detain patients in a psychiatric unit, thereby depriving a subject of their liberties

New Directions in Medicolegal Education

Based on original research ( Spoto 2018 ) GS Medical Group believe that subject to certain conditions and provided they are adequately supervised not only doctors in training what they call“ Junior Experts” can make excellent expert witnesses in the medicolegal system.

GS Medical Group also further believe and are firmly of the view that that doctors in training should regularly act as Expert Witnesses as a matter of course and in most jurisdictions (+)Indeed they are also entirely of the opinion that provided they are suitably supervised “junior experts “ rather than experienced Consultants should be the expert of choice in most legal proceedings except in the most complex cases. (Spoto 2020)

GS Medical Group believe medicolegal education in the UK to be out of date compared to other clinical settings where practice-based approaches, rather than didactic teaching is now entirely common place.

It is the case for example that existing educational practice in the medicolegal system is still based largely on classroom work rather than the Expert’s practice, which is of course universally the case in other clinical settings(*)(*)(*) .

(*)supervised medical evidence is provided regularly by doctors in training in 1st Tier Tribunal ( Mental health ) where it is routinely accepted

(+)(*) Practice based learning as an alternative to classroom first introduced by KSS Deanery in 2007 in the South East Region ( KSS Deanery 2007 ) under the guise of New ways of teaching and learning Is now common place in postgraduate medical education. In Psychiatry once a week supervision is mandatory but only a recent development

(+)(+)(*) The place where learners engage for the first time in supervised practice away from the classroom is called a “Practicum “ , a safe place where practice is the priority rather than the Lecture The term “Practicum” was originally introduced in undergraduate education , as a place where the real world of professional practice is simulated In the clinical settings the “ Practicum” was originally introduced in the training of Surgeons ( De Cossart and Fish , 2005 ). The concept of a “ Practicum “ in the medicolegal system is unknown

GS Medical Group believe the lack of practice based teaching and learning in the current medicolegal system to be likely to be a hangover from established practice the London Teaching Hospital, a practice of teaching and learning which dates back to the 18C (+ ).

Unlike other training organisations, GS Medical Group is therefore making now available to Experts by private arrangement a number of up to date practice-based approaches to medicolegal education such as Supervision and Mentoring as well as rare opportunities for Experts to engage in Case based Discussions.

Furthermore GS Medical Group makes teaching and learning available on real cases, as it is the case in other clinical settings.

Unlike the legal system the approach In the medicolegal system is relatively unknown and the practice is systematically introduced into the medicolegal system for the first time (*)(*)

(+) In the traditional Teaching Hospital students are allowed to “ walk the wards “ ( Heaman 2003 ) but the lecture is king Today “ ex cathedra “ teaching is described as teacher centered and practice based teaching is described as learner-centered ( De Cossart and Fish 2005)

( *)(* )Practice based learning has been present in the legal system since time immemorial For example in the training of Lawyers a Barrister is required to undertake duties under supervision for several years before being called to the Bar, a system known as “pupillage “.

Interestingly the correct title of a barrister is that of a “ Junior “ Barrister until they become a QC, a process known as “ taking silk”

At the start of the NHS, when Consultants agreed to undertake teaching responsibility largely undergraduate in the Teaching Hospital in exchange for services undertaken by their academic colleagues in the medical School, they only agreed to do so provided support by a Junior Doctor was available.

This was agreed with the Hospital Authorities somewhat reluctantly, provided the Junior doctors were supervised , to this day always a contentious issue in the medical specialties.

Honorary titles were granted to Consultants and Senior Academics, namely those of Honorary Senior Lecturer and Honorary Consultant respectively.

In the clinical settings practice based teaching was relatively unknown , and trainees pick up their skills essentially as they went along.

In the medicolegal system practice based learning based on real cases is still relatively unknown although practice based leaning is available in the form of “ mock “ Court room skills

Uniquely, and for the first time in the UK GS Medical Group also provides Experts with access to a Library of medicolegal reports and other training materials and a Forum is also available for Members to engage in dialogue thus further enhancing the training experience (*)

GS Medical Group otherwise does not provide any formal didactic training and again contrary to other training organisations in the medicolegal system , a reflective approach to teaching and learning is being followed and active learning very strongly encouraged at every stage (*)(*)

Assessment is regularly undertaken and formative and summative instruments used at regular intervals underpin training progression.

(*)The Forum is intention is to reduce the social isolation a risk which is endemic in medicolegal practice and to foster the development of a Community of Practice (Wenger 1999)

(+)(*) The model which under GS Medical Group is strictly adhered to hails back to Vigotsky’s idea of“ scaffolding “ ( Vigotsky 1978 ) which demands complete abstinence from any kind of classroom work Indeed any attempts by either the learner or the Teacher to go back to the lecture suggesting the model is “ reverting to type “ and forcefully resisted

Jurisdictions

Training is available in the area of Personal Injury, Clinical Negligence and Employment Law, in relation to patients of working age. Family Law in relation to parenting and Immigration are also areas of interest, and evidence is provided regularly both in relation to Claimants or the Defendant.

GS Medical Group has a further interest in the area of Mental Capacity including capacity to engage in litigation and in certain aspects of crime, including Fitness to Plead or stand trial, and provides services in such areas.

Useful Links

Compared to medical services generally, medicolegal services in the UK are to this day plagued by outdated ideas and practice.

It is clear for example that educational practice in the medicolegal system is still based largely on classroom work, a practice which is unsuitable for the clinical settings (De Cossart and Fish ,2005) and indeed a practice that was abandoned elsewhere in medicine a very long time ago. Yet this view underpins much of the education available in the medicolegal system and is the prevailing view to this day.

The underlying principle from the point of view of teaching and learning is that knowledge can be “transmitted" to the learner .GS Medical Group aims to challenge this view which according to the standards of good medical practice is positively antediluvian (Box 2)

(Box 6) There are several potential reasons why outdated practice is still prevalent in the medicolegal system such as the following:
vested interests

fee paying structure

contractual constraints

conflicting educational objectives equating for example Forensic and Medicolegal practice

social isolation

fragmentation due to the many training organisations providing medicolegal training in the UK

the role and function of Reporting Agencies in the medicolegal system including administration and marketing of expert services exceedingly legalistic as opposed to clinical views and priorities in medicolegal education