Autopsy
Duration: 2-3 Months
Rotation Director(s): Roger Smith, MD
Faculty Instructor(s):
Amy Frey, DO
Matthew Hagen, MD
Ady Kendler, MD, PhD
Fred Lucas, MD
Shagufta Khan, MD
Julie Qualtieri, MD
Jiang Wang, MD, PhD
Description of Rotation
The function of the autopsy service is to perform autopsies on individuals who die at UC Health University Hospital. In addition, autopsies are performed occasionally on individuals dying outside of the hospital but who were followed by physicians from UC Health. Occasional autopsies are performed on individuals from other hospitals, such as Adams County Hospital, and private autopsies requested and paid for by the families of the deceased.
There are numerous reasons for performing autopsies on individuals. They include determination of the cause and mechanisms of death, providing quality assurance for diagnostic procedures and therapy and providing information for families of the deceased. The autopsy also provides a unique learning opportunity for clinicians, clinical house staff, pathologists, pathology residents, medical students and other hospital personnel.
The goal of the pathology resident rotating through the autopsy service should be to develop understanding of disease processes and to be able to correlate the clinical course of the patient with the pathologic findings. The resident will be expected to develop technical expertise in postmortem dissection, but that expertise is secondary to the development of pathophysiologic understanding of the disease processes encountered.
It is expected that the resident starting on the autopsy service will possess knowledge of the fundamentals of pathology as taught in a basic medical school curriculum. Deficits in fundamental knowledge in pathology will need to be rectified by the individual resident through individual study.
Rotation Objective
By the end of the rotation, the resident should khow:
- Mastery of the Rokitansky autopsy technique (the technique of complete evisceration).
- Ability to completely dissect and display the internal organs of an uncomplicated case within two to three hours.
- Capably to remove the skull cap, brain, and spinal cord using the Stryker saw.
- Familiarity with the methods of removal of the testicles.
- Proficiency in evaluation of a medical record in determining the clinically pertinent material.
- Ability to obtain additional necessary information by communicating with clinical residents, attendings and accessory computerized patient data.
- Ability to give a smooth, concise dictation of clinical findings, and the gross and microscopic autopsy findings.
- Proficiency in ability to organize and complete uncomplicated cases in 30 working days.
- Mastery of the presentation of concise and pertinent autopsy data at the autopsy conference.
- Ability to select appropriate tissue samples for microscopic examination.
- Appreciation of basic normal gross and microscopic findings and recognition and interpretation of pathology grossly and microscopically.
- Proficiency in preparing high-quality photographs of gross and microscopic specimens to accurately document pathologic alterations.
- Ability to review pertinent up-to-date literature on topics applicable to each autopsy.
- Familiarity with available special procedures and stains relevant to each autopsy.
- Ability to effectively communicate with clinical faculty regarding autopsy findings in context of clinical presentations and cause and mechanism of death.
- Ability to select important case material for presentation at meetings and preparation of manuscript for publications.
- Ability to teach medical students pathology and clinico-pathologic correlation.
- Ability to summarize autopsy findings in layman’s language for letters to family members of deceased patients.
- Fulfill ABMS and ACGME requirements for pathology training.
Level of Training
PGY1: It is expected that by the end of the first month on the rotation, the resident should be able to give a smooth, concise dictation of clinical findings and gross and microscopic autopsy findings. By the end of the initial rotation on the autopsy service, the pathology resident should be able to completely dissect and display the internal organs from an uncomplicated case within two to three hours. Complicated cases with extensive disease processes or post-surgical cases, of course, may take longer to dissect.
The resident should also display proficiency in evaluation of a medical record in determining the clinically pertinent material. Autopsy dictation should be made in clear, concise English using complete sentences with proper grammar and punctuation.
PGY 2-4: The pathology resident should become proficient in organizing and completing uncomplicated cases within 30 business days.
Daily Responsibilities
It is expected that the pathology resident rotating on the autopsy service will be physically present in the Department of Pathology from 8 a.m. to 5:30 p.m. on all work days unless he/she has specific commitments elsewhere in the medical center. If the resident needs to be absent from the department during the work day, he/she must be available to be contacted by pager. Furthermore, it is recommended that the resident on the autopsy service check in with the morgue office at 8 a.m. to see if there are any pending cases for autopsy that day. This enables the resident to check the autopsy permit for completeness and to instruct the pathology technician as to preparations for the autopsy while the resident is attending the morning residents' conference.
Autopsies should be performed as soon as possible after receipt of a valid permit and review of the hospital chart to prevent any delay in release of the body to the funeral home. The performance of an autopsy on an individual with a valid autopsy permit should take precedence over other activities the resident might have planned. The autopsy cannot be done strictly at the convenience of the resident.
Autopsies will be performed promptly throughout the day as valid permits are received. If a valid permit is received before 1 p.m., the autopsy will be done that day. This resident also covers VAMC autopsies from 8 a.m. to 5:30 p.m. In rare instances, it will be necessary to eviscerate the body and save some of the dissection for the following day. However, the body should be eviscerated so that it is ready for release to the funeral home.
If a valid permit is received after 1 p.m., the body will be posted the next morning unless the funeral home needs to pick up the remains prior to that time. In cases where there is a need for rapid release of the body to the funeral home, autopsies will be performed after 1 p.m. or at night.
Rarely, a case may need to be posted at night, depending on the circumstances. For instance, the necessity for adequate cultures or for adequate tissue specimens without autolysis may mandate performance of the autopsy at night. On some occasions, the autopsy may have to be performed before transplant (of the heart or liver) to rule out a neoplasm or some other contraindicating condition. The resident assigned to the autopsy service will not perform more than two autopsies on a work day, five autopsies per week.
Weekend and holiday calls – Autopsies are not routinely performed on weekends and holidays.
Evaluation
The pathology resident on the service will be evaluated continually through the rotation on the autopsy service. The evaluation will cover areas of technical dissection proficiency, understanding of pathophysiologic principles and proficiency at conference’s presentations. It is expected that by the end of the initial rotation on the autopsy service the pathology resident should be able to completely dissect and display the internal organs from an uncomplicated case within two to three hours. Complicated cases with extensive disease processes or post-surgical cases, of course, may take longer to dissect.
By the end of the rotation, the resident should display proficiency in evaluation of a medical record in determining the clinically pertinent material. By the end of the first month on the rotation, the resident should be able to give a smooth, concise dictation of clinical findings and gross and microscopic autopsy findings. The attending pathologist will review the resident's dictation and make suggestions as to content and style and make corrections before final typing.
Autopsy dictation should be made in clear, concise English using complete sentences with proper grammar and punctuation. By the end of the initial rotation, the pathology resident should become proficient in organizing and completing uncomplicated cases within 30 days.