Section: Autopsy

Duration: 4 months required (3 months Autopsy and 1 month Forensics)

Goals & Objectives

The autopsy service is a clinical service like any other. The majority of autopsies will be under the auspices of the Medical Examiner's Office (MEO). As part of University Hospital, we provide medical service to the physicians who refer their patients to us, as well as to members of the patient's family. It is also an educational component of the Medical Center, providing opportunities for learning not only to you, but also to other medical and paramedical students, pathology faculty and staff physicians and residents from all specialties. Furthermore it provides an indispensable quality improvement function to the institution and to the practice of medicine as a whole.

The University/Medical Examiner (U/MEO) autopsy service is under the direction of Dr. Mary Jumbelic with the assistance of Dr. Robert Schelper. The Veterans Administration (VA) Hospital autopsy service is under the direction of Dr. Henry Friedman. Attending Anatomic Pathologists are involved in the services on rotation. NOTE: Different procedures may be in place at other hospitals where you might perform autopsies.

Learn the basic steps in performance of an autopsy:

Evaluate the autopsy consent and obtain sufficient history
Evisceration, dissection, gross photography and sampling of tissues and fluids
Complete the preliminary autopsy report as well as the clinical summary and gross description in a timely fashion
Submit tissue samples for microscopy in a timely fashion
Microscopic examination and introduction to photo microscopy
Presentation at autopsy conference
Assist in neuropathology examinations
Complete an integrated and communicative report including a clinical pathological correlation

Duties & Responsiblities

Scheduling:
Chart Review
Verify that the permit is valid.
Clarify the clinical course of the patient.

Identify clinical diagnosis and problems.
Identify all physicians and students that might have interest in the case.
Contact the patient's attending physician, or if unavailable, at least one physician knowledgeable about the case.
Make a Plan. Contact the attending pathologist and discuss the case with him prior to starting.
Do the Autopsy. · During and after autopsy, photograph any findings of interest. · Cut blocks at the time of the autopsy or within 24 hours after the autopsy.
Provisional Anatomical Diagnosis (PAD).
Paperwork After the Autopsy.
Make a Preliminary Autopsy Report (PAR).
Autopsy Conference.
Completion of the Case.

During their rotation at the UH/MEO Autopsy Service, the residents will be required to read An Introduction to Autopsy Technique by Hutchins (CAP) - Two volumes, Text and Illustrated Accompaniment.

Evaluation

Resident Competencies

Patient Care

The autopsy examination is a consultation requested of the pathologist by the attending physician and/or family concerning the extent of disease. For the medical examiner the autopsy is designed to determine the cause of death. The resident must demonstrate a satisfactory level of diagnostic competence and the ability to provide effective pathologic consultation under appropriate circumstances.

Medical Knowledge

The resident will demonstrate knowledge about established and evolving diagnostic scientific practice by developing proper diagnoses and by documenting application of knew knowledge as documented in the autopsy report. In this regard, the final diagnoses rendered by the resident will be judged as to accuracy and appropriateness. Application of new knowledge will be judged by the inclusion of literature references in the report. The clinical-pathologic correlation in the report will also be used to ascertain the level of resident expertise.

Practice-based learning and improvement

The resident will demonstrate the ability to investigate complex cases, evaluate their diagnostic and consultative service, and assimilate scientific evidence into their practice for the continual improvement of their patient care. As with medical knowledge this will be documented on a case-by-case basis through the attending pathologists assessment of the written report and through conversation with the resident.

Interpersonal communication skills

In that professional interpersonal interaction and communication is paramount to a successful autopsy practice, the resident will demonstrate effective, respectful, and professional communication with staff, physicians and families. This will be fostered by close pathology attending consultation initially and will be evaluated by faculty observation of resident performance on individual cases and by requiring advanced resident to write letters explaining autopsy results to families who do not have a family physician with whom to discuss the results of the examination.

Professionalism

The resident must demonstrate a commitment to medical ethics, a sensitivity to diverse patient populations, and professional responsibilities. Completing reports in a timely manner, being sensitive to religious concerns of families, and recognizing the importance of confidentiality in medical practice are always monitored by all faculty.

Systems-based practice

The resident will demonstrate an awareness of and responsiveness to the health care system context in which an autopsy service must function. This includes and understanding of the costs and benefits of this medical practice, the importance of this practice to the quality improvement aspect other medical services and the hospital, and to society in general. The costs of requesting unnecessary tests, late completion of the report and failure to communicate appropriately with other medical services will be monitored and discussed with the resident.

Method of Evaluation

Residents will be evaluated by the attending pathologists concerning the basic fund of knowledge during signout and conference presentations. Additionally, the Resident in Service Examination concerning the area of Anatomic Pathology, will be used the residents performance. The results of the examination will be used to set training priorities in general for the Anatomic Pathology rotations, and to modify the training plan for each resident depending on the level of performance and areas of weakness.