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Education and securing talent for
forensic pathologists in Japan
: Investigation system for cause of death and elderly society in Japan

Shin-ichi Kubo, MD, PhD
Department of Forensic Medicine, Faculty of Medicine, Fukuoka University

1. Investigation system for cause of death in Japan
The doctor or the general public informs the unnatural deaths to the police department. First of all, the police investigate these unnatural deaths. And then, the general physician or forensic pathologist does a postmortem investigation at the scene. If the death is suspected as a criminal case, a forensic autopsy will be performed. However, an autopsy is not performed if there is no possibility of a crime, even if the cause of death is unknown. Also in Japan, there is a medical examiner's system.
However, it is limited to only five regions, such as the Tokyo metropolitan area, Yokohama, Nagoya, Osaka, and Kobe city. Therefore, there is no autopsy system for non-crime-related cadavers in almost all areas of Japan. That is a great problem with the cause of death investigation system in Japan. However, this problem will not be discussed here.

2. Transition of number of deaths, unnatural deaths, and forensic autopsies
Japan is an aging society now. And, the number of elderly people will increase more and more in the future. In this section, I will explain the changes in vital statistics in Japan. After World War II, in the first half of the 1970's, the number of births peaked at 2.09 million, and then decreased. Last year, in 2014, the number of births was one million, and it is predicted that it will fall below one million people next year. The number of deaths is increasing every year, and was 1.27 million people last year. The population of Japan has decreased by about 270,000 people. About 70% of these deaths are elderly people 75-years-old or older. The cause of the increase in the number of deaths is the increase of this elderly population. The number of unnatural deaths delivered to the police is increasing rapidly as the number of people dying increases, too. Unnatural deaths reached 170,000 people in 2013. The number of the deaths and unnatural deaths increased by 124% in these 10 years. Forensic autopsy cases increased by 168% in 10 years. In the next 45 years, the population will decrease by about 40 million. The 75-years-old or older population will increases to 23 million, and will occupy about 27 % of the total population. It is reasonable to predict that the number of autopsy cases will continue to increase.

3. School education in Japan
Before starting school, children aged 3 and up to school age can receive education in kindergarten. Compulsory education at elementary and lower secondary schools is for children aged from 6 to 15, for a total of nine years. Upper secondary school is for 3 years. Then, to become a medical doctor, students must learn for 6 years in university or medical college. The total entrance capacity for university and medical college in 2015 is 9,134.

4. Medical education system for forensic pathologists
After graduating, if the students pass the MCAT, they acquire the qualification to be a medical doctor. Afterwards, clinician's qualification can be acquired by finishing postgraduate clinical training of two years. Then, forensic medicine is learnt for four years in graduate school. The doctors acquire the qualification of autopsy from the Ministry of Health, Labour and Welfare, while attending graduate school. It is possible to become a recognized forensic pathologist of JSLM with the experience of four years or more including graduate school. The number of autopsies, the number of the case reports, and achievement tests are decided for recognition. In addition, advisory forensic pathologist qualification can be applied for after ten or more years. In Japan, it is a necessary condition to complete graduate school to become a staff of a university as a forensic pathologist. This condition is a great stumbling block. The JSLM has been preparing teaching material for forensic pathologists, such as a manual of postmortem examination, and video recordings of actual postmortem examinations. And JSLM has also enacted a forensic autopsy standardization indicator according to the national medical examiner’s association. The promotion and education of forensic pathologists had been left up to the advising doctors and professors. However, we should introduce a united tutoring system in addition to personal education.

5. Graduate school students and forensic pathologists in the past, present, and future
Within the last 10 years, from 2005 to 2015, 27 forensic pathologists retired.
Furthermore, within the next 10 years, 57 forensic pathologists will retire. In Japan, the number of autopsy cases will increase, and the number of the forensic pathologists will decrease. Securing and the promotion of young forensic pathologists is a pressing need.

6. Measures in the future
Potential pathologist applicants are recruited from the new students. The applicant is followed continuously for the medical education period. Professional education in addition to research is done during graduate school. Qualification acquisition is recommended and supported. A united educational system is introduced for more effective education. A solid educational base should be completed to do a more intensive education.

  • Education Center for Forensic Pathology and Science Symposium
国立大学法人 長崎大学  
法医学分野 (長崎大学医学部法医学)
〒852-8523 長崎市坂本1丁目12番−4号 基礎棟6F
tel. 095-819-7076 / fax. 095-819-7078