Recommendation 281

Training in dealing with sensitivity issues around death

It is important that independent medical examiners and any others having to approach families for this purpose have careful training in how to undertake this sensitive task in a manner least likely to cause additional and unnecessary distress.

The Royal College of Pathologists and e-Learning for Healthcare have produced an online learning module to help those involved in the certification of death.  The training is open to all NHS staff along with all prospective medical examiners.

This training consists of 91 sessions within 11 modules that fully trained medical examiners will be expected to complete.  This training includes a module on interacting with the bereaved and covers topics on the bereavement office; the psychology of bereavement and loss and the medical examiner’s role; and supporting the bereaved.

Prior to application, all candidates are required to complete a core component of the 91 sessions and present the local appointing panel with a certification of its completion as part of the application process.

Where an application is successful, the medical examiner will receive face-to-face training organised by the Royal College of Pathologists and must complete the remaining e-Learning within a year.

The e-Learning is currently being reviewed and Royal College of Pathologists and e-Learning for Healthcare will consider recommendations 277, 278, 280 in taking that forward.


A number of the recommendations in Sir Robert’s Mid Staffordshire Inquiry report refer to our planned reform of the death certification system and the introduction of the role of medical examiner in England and Wales. A new system of medical examiners has been trialled successfully in a number of areas across the country. The work of the two flagship sites in Gloucestershire and Sheffield has been continued and extended to operate a medical examiner service on a city and countywide basis at a scale that will be required for implementation by local authorities when legislation is introduced. We will publish shortly a report from the interim National Medical Examiner setting out the lessons learned from the pilot sites.

The government remains totally committed to the principle of these reforms. Further progress will be informed by a reconsideration of the detail of the new system in the light of other positive developments on patient safety since 2010 and by a subsequent public consultation exercise.

The medical examiner e-learning module will be refreshed following any future consultation to ensure it reflects the relevant Francis recommendations.