Autopsy Service

 

Goals And Objectives

 

 

The purpose of the Autopsy Service Rotation is to educate the resident in gross and microscopic organ system pathology and to integrate these findings with the patient's clinical course and outcome. Through a 'hand's on' exposure to Pathology the resident should gain a thorough education in the pathologic basis, mechanisms and manifestations of disease. The Autopsy Rotation also aims to educate the resident in anatomic prosection through a graduated level of responsibility, and to encourage increasing independence. Experience in verbal and visual communication skills is gained through both informal discussions with the patient's physicians and through formal conference presentations to residents and attendings on the pathology service and other services.

 

 

On completing the first Autopsy rotation, the resident is expected to be able to:

 

1.      Independently perform a full post-mortem examination. Rokitansky (en-bloc organ removal) technique must be mastered on the first 10 autopsies. Virchow (removal by organ system) may be used on subsequent examinations.

2.      Identify, describe and document diseased organs and tissues.

3.      Take organ, blood and body fluid cultures when appropriate.

4.      Prepare tissue sections for fixation and processing.

5.      Interpret microscopic slides with the help of your attending to identify and diagnose pathologic tissue alterations.

6.      Synthesize all the available clinical and pathologic information to formulate a meaningful differential diagnosis regarding the patient's clinical progress and cause of death.

7.      Ably communicate the pathologic findings and conclusions to professional colleagues in pathology and clinical services.

8.      Fulfill professional obligations in an efficient, courteous and timely manner (e.g. provisional diagnosis in 48 hours; final diagnosis in 30 days).

9.      Recognize deficiencies and take appropriate corrective action.

 

On completing subsequent Autopsy rotations, the resident is expected to have mastered the aforementioned skills and should be able to:

 

1. Independently perform a full post-mortem examination using the Virchow technique.
2. Interpret microscopic slides to identify and diagnose pathologic tissue alterations to be presented to your attending.
3. Teach proper prosection and grossing techniques to more junior residents starting autopsy service.
4. Assist more junior residents in interpreting microscopic findings and correlating them into a final cause of death.

 

 

The goals and objectives for the Autopsy Pathology rotation may also be divided among the 6 core competencies as defined by the ACGME:

 

I. DIAGNOSTIC AND PATIENT CARE ACTIVITIES

 

Residents must demonstrate a satisfactory level of diagnostic competence and the ability to provide appropriate and effective consultation in the context of pathology services.

 

During the first autopsy rotation, these include:

 

·        Obtaining pertinent clinical information from the patient’s clinical record.

 

·        Knowledge of the general principles for fixation and processing of tissues.

 

·        Ability to appropriately select tissue for sectioning, so as to obtain the necessary diagnostic information.

 

·        Developing a familiarity with stains used for microscopic sections, including H&E and special stains.

 

·        Knowledge of when and how to triage tissue for special studies including flow cytometry, cytogenetics and electron microscopy.

 

·        Ability to document pathologic findings with photographic images.

 

·        Ability to generate an Autopsy report, which includes accurate patient demographics, clinical information, gross description, microscopic description, diagnosis, and Final Note interpreting the findings and making clinical-pathologic correlations.

 

·        Ability to review histologic slides with an attending and arrive at the differential diagnosis.

 

            Additionally on all subsequent autopsy rotations, these include:

 

·        Fluent understanding and use of appropriate immunohistochemical stains and ancillary diagnostic techniques such as flow cytometry, cytogenetics and EM

 

·        Ability to defend differential diagnosis relating to microscopy.

 

·        Ability to order appropriate ancillary studies, including histochemical, immunohistochemical, molecular, and electron microscopic test.

 

II. MEDICAL KNOWLEDGE

 

Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to Pathology.

 

On the first autopsy rotation this includes:

·        Understanding of clinical-pathologic correlations for MAJOR diseases/tumors encountered in autopsy cases.

 

·        Ability to obtain relevant publications via the Internet for both the resident’s own knowledge and for the purpose of educating others (for example: PUBMED).

 

Additionally, on all subsequent autopsy rotations:

·        Understanding of the clinical-pathologic correlation for less common diseases encountered in autopsy cases (hematologic/soft tissue/poorly differentiated entities)

·        Assist in the creation or dissemination of medical knowledge through writing up interesting case reports for publication or giving a presentation at conference with an in depth look at new developments in the study of a particular disease entity related to an autopsy.

 

 

III. PRACTICE BASED LEARNING AND IMPROVEMENT

 

Residents must be able to demonstrate the ability to investigate and evaluate their diagnostic and consultative practices, appraise and assimilate scientific evidence and improve their patient care practices.

 

On the first autopsy rotation:

 

·        Knowledge of JCAHO/CAP/NYS standards and requirements for the autopsy service submission.

 

·        Knowledge of JCAHO/CAP/NYS standards regarding occupational hazards and infection control. 

 

·        Ability to manage workflow, provide accurate gross descriptions, and practice safely in the autopsy suite.

 

Additionally, on all other subsequent autopsy rotations:

 

·        Knowledge of quality control pertaining to histologic sections and special stains, including trouble-shooting of mistakes in accessioning, labeling, and misidentification of specimens.

 

 

IV. INTERPERSONAL AND COMMUNICATION SKILLS

 

Residents must be able to demonstrate interpersonal and communication  skills that result in effective information exchange and teaming with other healthcare providers, patients, and patient’s families.

 

First Rotation:

 

·        Ability to communicate with clinicians and other healthcare professionals in obtaining and relaying clinical information.

 

·        Ability to communicate with attending pathologists when working up cases.

 

·        Ability to interact with the technical and clerical support staff in the laboratory in order to expedite reporting of patient’s results.

 

·        Ability to use the pathology laboratory information system (COPATH), and the hospital clinical information system (WEBCIS) including knowledge of confidentiality and security requirements.

 

·        Ability to effectively present cases in an articulate and professional manner departmental conferences and in inter-departmental conferences.

 

Second Rotation:

 

·        The resident should be able to coordinate the logistics of an autopsy by himself/herself over a call weekend (communication with clinicians, morgue, funeral home, etc).

 

Third and Subsequent Rotations:

 

·        The resident should be able to present at inter-departmental conferences (i.e. pediatrics M&M) without being accompanied by an attending.

 

 

V. PROFESSIONALISM

 

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.

 

First and Subsequent Rotations:

 

·        Knowledge of HIPAA regulations regarding patient privacy.

 

·        Respect for peers, colleagues, other medical personnel, patients, and patient’s families.

 

·        Appropriate dress.

 

·        Reliability in assigned duties

 

 

VI. SYSTEMS BASED PRACTICE

 

Residents must demonstrate an awareness and responsiveness to the larger context and system of healthcare and the ability to call on system resources to provide Pathology services that are of optimal value. 

 

First Rotation:

 

·        Understanding the need for timeliness in the turnaround of cases.

 

·        Ability to recognize and record discrepancies between clinical diagnoses and autopsy diagnoses.

 

·        Basic understanding of federal laws (including compliance), which are applicable to the performance of autopsies.

 

·        Basic understanding of regulatory agency standards for laboratory certification (JCAHO, CAP, NEW YORK STATE).

 

·         Understanding of quality assurance and improvement programs.

 

·        Understanding of basic risk management issues as they apply to the autopsy service.

 

Second and Subsequent Rotations:

 

·        The resident should be able to coordinate with admitting and the medical examiner when an autopsy may need to be directed to the medical examiner’s office.