Depending on where you live in the United States, violent, suspicious or unexpected deaths might be investigated by a coroner, a medical examiner, or some combination of the two. Coroners are elected to their positions and need no formal training. Medical examiners are appointed, and they're usually trained physicians called forensic pathologists. Becoming a forensic pathologist requires at least two degrees, and most pathologists are also board-certified.
Like any other doctor, pathologists start their training with a bachelor's degree. Some schools offer a pre-med major, but that's rare. Students who want to go on to medical school should pick a major and coursework that meet the prerequisites for admission. Specific course requirements vary between schools, but usually they'll include English or written communications, calculus or statistics, basic chemistry, physics and biology, and more advanced work in organic chemistry, biochemistry or microbiology. Science majors are a pragmatic choice, since those courses can also help fulfill the degree requirements.
The Doctoral Degree
The second step to a career in pathology is qualifying as a doctor. That takes four more years in a medical or osteopathic college. The majority of schools follow a similar format, with the first two years spent learning science and medical theory in classrooms and laboratories, then two more years gaining hands-on experience in clinical rotations. The course work includes cellular biology, medical genetics, anatomy and physiology, human behavior and many related topics. It also covers medical ethics and law. The clinical rotations are designed to provide broad exposure to the major branches of medicine. That's useful for pathologists, who must have strong diagnostic skills that span every medical specialty.
Residency, Fellowship and Certification
Students choose a specialty before their last year of medical school and go on to a residency in pathology after they graduate. Pathologists spend four years in residency, learning how to diagnose illnesses by analyzing specimens from living patients or by performing autopsies on cadavers. It's one of the most scientifically-oriented of all medical specialties. After residency, the new doctor must take and pass board certification exams administered by the American Board of Pathology. Training in forensic pathology, the specialty of most medical examiners, requires an additional year in a forensic pathology fellowship followed by a second set of board examinations.
A 2009 report on forensic science by the National Research Council found many problems with the existing system of death investigation, and identified many reasons for having medical examiners wherever possible. Unfortunately for forensic pathologists, small jurisdictions that want their services are often strapped for cash and can't pay competitive salaries. Jurisdictions with modest populations might be able to counter that difficulty by pooling their resources to attract a qualified candidate, but for that to happen the communities must recognize the value of having a trained forensic pathologist as their medical examiner.