Hospital Autopsy

Goals and Objectives

Level: PGY-1, PGY-2, PGY-3, PGY-4 and PGY-5

In the CBD cohort, junior residents are considered to be PGY-1 and PGY-2 while senior residents are considered to be PGY-3 and PGY-4.  PGY-5 CBD residents are also considered to be senior residents and within the CBD curriculum. The overall goal is to allow for eventual independence in the form of independent sign out and supervision of junior residents.

During a hospital autopsy rotation, there is no separation of cases based on complexity or training year.  Due to the nature of hospital autopsy (all cases are ultimately supervised, reviewed and finalized by a supervising staff), a resident in any training level can review may participate in a hospital autopsy. 

It is expected that the first hospital autopsy pathology rotation by a junior resident will result in the mastery of normal anatomical landmarks used during autopsy, knowledge of the autopsy dissection techniques and the strengths and weakness of each, learn the techniques of evisceration, and knowledge of the components of a preliminary hospital autopsy report.

Based on experience and acquisition of skills, the tasks will be become progressive with a goal by the end of the rotation that the resident is able to complete a hospital autopsy under the supervision of the staff pathologist.

It is also expected that the junior residents will review the electronic medical record and provide a summary to the supervising staff pathologist (EPAs: F#4, TTD#2).

Subsequent hospital autopsy pathology rotations will build on the above foundation and include the ability to perform a complete hospital autopsy, including evisceration, gross dissection of organs, identification of gross autopsy pathology findings and summarizing the findings to the supervising staff.  The more experienced resident should be able to produce a draft preliminary autopsy report which should be free of typographical errors.

The PGY-5 year is one of senior leadership and the resident should be able to assume responsibility for organizing the service and supervising junior residents and students. The resident should have mastery of the information contained in standard texts and be prompt in using the literature to solve specific problems. The PGY-5 should begin to have an understanding of the role of the practitioner in an integrated health care delivery system and to be aware of the issues in health care management facing patients and physicians. 

Based on the Royal College guidelines and recommendations, independent sign out is the current goal for the future CBD PGY-5 resident.

In the event that there are no hospital autopsy cases, the resident may be required to participate in any forensic case for the day (depending on availability and whether there is another resident on the forensic service).

Medical Expert/Clinical Decision-Maker (EPAs: F#4, C#6; PGY5: TTP#1, TTP#2)

General Requirements

  • Demonstrate technical and diagnostic skills as required for hospital related post-mortem examinations
  • Correlate findings with clinical information
  • Convey information effectively

Specific Requirements

  • Review the autopsy consent and medical record
  • Know the basic dissection technique as well as special techniques
  • Properly dissect organs, sample tissues
  • Properly recognize normal and abnormal findings at the gross and microscopic levels
  • Properly describe all findings and prioritize the diagnoses according to their importance
  • Elaborate a relevant gross diagnosis
  • Produce quality written reports detailing autopsy examination findings and interpretation and complete them within accepted guidelines
  • Understand the basics of tissue fixation, decalcification and processing
  • Recognize the importance of adhering to existing legislation pertaining to human tissue and remains (Human Tissue gift Act, Morgue Act, Coroner’s Act and Public Hospital Act)
  • Understand the purpose and value for the autopsy and differing goals between academic/hospital and medical legal/coroner’s cases.
  • Be capable of taking good quality gross and microphotographs when indicated
  • Present autopsy findings in a concise and relevant manner at rounds, and promote discussion with colleagues
  • Understand, and be able to interpret host responses to different forms of cellular injury and fluid and hemodynamic disturbances
  • Know the Workplace Hazardous Materials Information System (WHMIS) and principles of lab safety
  • Apply principles of Universal Precautions
  • Know when to apply specific precautions in high-risk infectious cases

Communicator (EPAs: F#4, C#6; PGY5: TTP#1, TTP#2)

General Requirements

  • Obtain a relevant clinical history, including relevant laboratory and imaging results and interpreting this information in light of the clinical information and providing a summary to the supervising staff pathologist (EPA: TTD#2)
  • Discuss cases with members of the health care team correlating the post-mortem findings with pre-mortem clinical evolution

Specific Requirements

  • Attend rounds when applicable and be able to present the clinical history and autopsy findings, and correlate the autopsy findings with the clinical evolution
  • Communicate findings to the treating physicians shortly after performing the post-mortem examination
  • Participate at morbidity/mortality rounds when requested

Collaborator (EPAs: F#4, C#6; PGY5: TTP#1, TTP#2)

General Requirements

  • Consult effectively with other physicians and health care professionals
  • Contribute effectively to interdisciplinary team activities
  • Understand the importance of contributing to educational/or research endeavors of clinical and laboratory colleagues

Specific Requirements

  • Utilize experience in clinical medicine and surgery to understand post-mortem findings in relationship to pre-mortem clinical evolution, medical treatments and surgical procedures
  • Initiate interdisciplinary educational team activities and research endeavours if the opportunity arises

Manager (EPAs: F#4, C#6; PGY5: TTP#1, TTP#2)

General Requirements

  • Utilize resources in the morgue and laboratory effectively to achieve accurate diagnoses
  • Allocate finite health care resources wisely
  • Set realistic priorities and use time effectively
  • Demonstrate knowledge of regulations regarding retention of material and reports
  • Demonstrate safe techniques for high risk autopsies, including infections (viral hepatitis, human immunodeficiency virus infection, tuberculosis, Creutzfeldt-Jakob disease, drug resistant bacteria) and exposure to noxious agents

Specific Requirements

  • Demonstrate knowledge of quality control as related to the morgue and post-mortem examinations.

Health Advocate (EPAs: F#4, C#6; PGY5: TTP#1, TTP#2)

General Requirements

  • Understand the specialist’s role to intervene via treating physicians with respect to post-mortem findings that may impact the health of surviving family members
  • Understand the principal of infection control as it pertains to individual, institutional and community prevention of infectious diseases

Specific Requirements

  • As members of an interdisciplinary team of professionals, anatomical pathologists will endeavour to help informing treating physicians and the public about issues surrounding contagious diseases and prevention
  • Understand the possibility of genetic and molecular analyses and how the autopsy may contribute to these tests

Scholar (EPAs: F#4, C#6; PGY5: TTP#1, TTP#2)

General Requirements

  • Develop, implement, and monitor a personal continuing medical education (CME) strategy with respect to CME related to autopsy pathology.
  • Critically appraise sources of medical information.
  • Facilitate learning of residents, students, and other health professionals at rounds.
  • Contribute to development of new knowledge.

Specific Requirements

  • A case report or project should be discussed with a rotation supervisor during the rotation and could be presented at any one of a number of forums ranging from autopsy rounds to national meetings.

Professional (EPAs: F#4, C#6; PGY5: TTP#1, TTP#2)

General Requirements

  • Deliver highest quality of expertise with integrity, honesty and compassion
  • Exhibit appropriate personal and interpersonal professional behaviour
  • Practice autopsy pathology ethically consistent with obligations of a physician
  • Demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to autopsy pathology

Specific Requirements

  • Act as an appropriate role model for students and others
  • Demonstrate a professional attitude to colleagues as well as to other laboratory and morgue staff
  • Have an appreciation of the crucial role of the anatomical pathologist in providing quality patient care. This will include knowledge of individual professional limitations and the necessity of seeking appropriate second opinions.

Instructional Tools

  • The resident will meet with the Hospital Autopsy subspecialty Lead and go over this document and the overall aspects of the rotation the day before the rotation starts.

Evaluation

  • Final evaluation to be completed by the Hospital Autopsy pathologists encountered during the rotation.
  • Mid-rotation evaluation to be completed by the Hospital Autopsy section head with input from other autopsy pathologists.
  • Expectations will be assessed according to the level of training

Recommended Reading

  • Robbins and Cotran Pathologic Basis of Disease
  • Autopsy Pathology: A Manual and Atlas
  • Diagnostic Pathology: Hospital Autopsy

Please refer to this website for additional information regarding the CanMEDS roles.

 

Updated April, 2022

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