Insight of forensic medicine awareness, medico-legal risk perception and specialty orientation among final-year-dominant medical undergraduates in Northeast Tamil Nadu: an analytical cross-sectional study

Forensic Medicine and Toxicology (FMT) links clinical care with documentation, death investigation, injury interpretation, and accountability. Defensive medicine refers to decisions taken to reduce perceived medico-legal risk. Indian undergraduate evidence on FMT perceptions, medico-legal concern, autopsy learning, and specialty choice remains limited. An analytical cross-sectional questionnaire-based study was conducted among MBBS students exposed to FMT in participating medical colleges in Northeast Tamil Nadu. The questionnaire assessed knowledge sources, FMT awareness, medico-legal perceptions, defensive medicine familiarity, autopsy learning value, and willingness to choose FMT residency. Descriptive statistics, Spearman correlation, and multivariable logistic regression were used; significance was set at p < 0.05. Of 409 submissions, 397 consented responses were analyzed. Final Year Part I students comprised 386/397 (97.2%). The degree curriculum was the commonest knowledge source (80.1%). Awareness was highest for autopsy, medico-legal litigation, and sexual assault cases. Most students agreed that FMT defines forensic physicians’ roles (91.7%) and that practitioners should know liability laws (90.2%). Fear of litigation driving defensive decisions was reported by 71.8%, and autopsy attendance was considered important by 90.2%. Course importance and perceived sufficiency were moderately correlated (rho = 0.569; p < 0.001). In definite responders, willingness to choose FMT was associated with defensive medicine familiarity (aOR 1.42), course influence on residency choice (aOR 6.48), and liability knowledge influence (aOR 4.61). Among students, the perceived relevance of FMT was high, with > 90% agreeing that the discipline defines the role of forensic physicians and that autopsy attendance is of educational importance. Fear of litigation was reported to influence defensive practice by 71.8% of respondents and definitive willingness to pursue FMT as a residency was limited (18.4%). The results suggest that final-year-dominant medical undergraduates appreciate the clinical and medico-legal importance of FMT, but interest in the specialty remains modest. As a self-reported cross-sectional survey, the findings should be interpreted as evidence of educational needs and perceptions, rather than objective measures of competency.