Child maltreatment is a significant global public health problem resulting in adverse impacts extending well beyond childhood. Paediatricians are tasked with the medical assessment of children about whom concerns for child maltreatment are held. The paediatricians’ role is important because they identify, report and manage cases of child abuse in both the community and hospital settings. As part of their medical assessment, paediatricians may be asked to provide written evidence or oral testimony in court in both the criminal justice and child protection systems.

Paediatricians who testify in child abuse cases serve the interests of the public and legal and medical professions. Testimony may increase public awareness and understanding of child maltreatment and its effects on children.1 Paediatrician testimony may also help to improve the legal system’s response to child maltreatment by providing accurate and reliable evidence around child maltreatment.1 2 From a health perspective, paediatricians who testify in child maltreatment cases can improve the quality of medical care for child abuse victims by educating media, professionals and carers about the medical consequences of child maltreatment and the long-term effects on children’s health and development.

Testifying in court can have significant impacts on paediatricians, on their personal and professional lives and on their relationships with patients, families, statutory child protection bodies, police and the courts. Testifying can also have significant impacts on the paediatric profession as a whole and broader health and legal systems which can ultimately impact child safety. Anecdotal evidence suggests that many paediatricians fear receiving a subpoena to testify in court.3–5 Even for experienced forensic paediatricians, testifying in court can be a stressful experience.2–4 6–8 Exposure to and empathic engagement with traumatised patients coupled with the stress of legal proceedings and testing of medical evidence in court can contribute to adverse psychological and physiological outcomes for paediatricians, including secondary traumatic stress and burnout.7 8 Preparing for and providing testimony can be time-consuming, disruptive, difficult and stressful.9 10 Some evidence suggests that paediatricians report that they are inadequately trained in the processes and legal frameworks of court hearings and trials resulting in them feeling poorly prepared and under-skilled for this role.11

The performance, conduct and behaviour of paediatrician witnesses also reflect more broadly on the paediatric specialty and medical profession as a whole.1 The quality of some paediatricians’ testimony has been criticised by legal and medical professionals and the media, including accusations of bias or misinforming decision-makers, thus contributing to miscarriages of justice. This has resulted in reputational and career damage, censure and restrictions on medical practice.12–17 This has also led to decreased public and professional confidence in paediatrician expert testimony.18 19 Furthermore, it has reduced paediatrician willingness to engage in this type of work impacting workforce recruitment and retention.20

Cautionary tales exist in the scientific research literature and media of the perils and pitfalls of testifying and the potential risks a paediatrician expert faces in providing evidence to the courts. Waney Squier, a paediatric neuropathologist, was temporarily removed from the medical register by the UK’s General Medical Council due to concerns that she had offered evidence in court that was in accordance with her own theories and was misleading and biased.21 Furthermore, criticism of her evidence included that she acted outside of her competence and expertise. Sir Roy Meadow, a prominent British paediatrician knighted for his services to paediatrics, experienced a similar professional downfall after it was determined that he provided misleading statistics and acted outside his expertise at trial. As quoted by the then president of the Royal College of Paediatrics and Child Health regarding Sir Roy Meadow, ‘the one thing it will do is frighten any sensible doctor away from doing expert witness work’.22 It is a little surprise that cases like these have reduced paediatricians’ willingness to engage in medicolegal work, which has downstream impacts on the Criminal Justice and Child Protection systems and ultimately on child safety.20 23

Little empirical evidence exists in the medical or legal literature to train and support paediatricians to provide high-quality medical testimony. Currently, strategies to improve the quality of testimony rely on attempts to strengthen professionals’ qualifications for serving as a medical expert and educating paediatricians about ethical practices and standards around testifying.1 11 24 In the UK and USA, endorsing and supporting medical boards and organisation regulation and disciplinary efforts have also been encouraged. Some professional societies have also developed professional expert witness affirmation statements to encourage ethical testimony of a high standard.1 11 24

This study aims to systematically identify and synthesise the published literature that examines, documents or describes the benefits and harms of providing expert testimony on paediatricians. Prior to identifying the research question, an exploratory review of the literature was performed to refine the scope and subject of this protocol.

On the basis of the exploratory search, the following research question was formulated: What are the impacts on paediatricians who testify in cases of child maltreatment?