Goals and Objectives
During training, each resident will master the following skills:
- Demonstrate uncompromising respect for human remains and foster this attitude among other personnel.
- Demonstrate appropriate respect for the confidentiality of patient information.
- Understand the significance of proper consent for autopsy examination, including the legal definition of next of kin as described in O.R.C. §2108.5 and the significance of consent to perform a limited autopsy.
- Understand the authority of a Medical Examiner to claim jurisdiction over an autopsy as defined by O.R.C. §313:11-12.
- Visit the office of the Medical Examiner to gain familiarity with technical differences between autopsies performed in Medical Examiner's cases and hospital cases by witnessing and assisting if possible in the prosection of Medical Examiner's autopsies.
- Identify artifactual findings of decomposition and embalming.
- Perform coronary angiography, including cannulation of native coronary arteries and bypass grafts, injection of contrast and operation of X-ray equipment.
- Perform gross specimen photography using handheld and stand-mounted cameras.
- Understand the proper use and interpretation of ancillary studies that must be anticipated at the time of autopsy including microbiology toxicology, chemistry, electron microscopy, cytogenetics and molecular diagnostics.
- Sample representative tissues for archival storage and histologic examination.
- Demonstrate suitable diagnostic skills using both gross and microscopic materials from cases showing common adult and pediatric diseases and malformations.
- Know the use of common special stains and immunohistochemical markers for the diagnosis of infectious diseases, intracellular and extracellular accumulations, and malignancies.
Practice-Based Learning and Improvement
- Prosect adult autopsies according to the modified Rokitansky procedure, and prosect pediatric autopsies or fetopsies according to the Virchow procedure.
- Know the limitations of the standard protocols and be able to plan special dissections that address the needs of unusual cases.
Interpersonal and Communication Skills
- Identify and contact relevant caregivers at the time of autopsy.
- Screen a chart or interview a caregiver to extract relevant information and to identify cases falling under the jurisdiction of a Medical Examiner.
- Train and supervise an assistant properly to eviscerate and prosect an autopsy.
- Succinctly present relevant history, gross findings, microscopic findings, and laboratory data to individual clinicians and pathologists, or to groups of medical students, clinicians, and pathologists at the autopsy table, by telephone, and in formal conferences.
- Know the differences between a cause of death, a mechanism of death, and a manner of death.
- Formulate the cause of death including the underlying cause of death, intervening causes of death, if any, and the immediate cause of death, as well as any other conditions contributing to the death of a patient.
- Prepare complete, concise and accurate provisional and final autopsy reports in a timely manner.
- Become independent in technical aspects of autopsy practice, including evisceration, removal of the brain and the spinal cord, the eyes, and the temporal bones.
- Know the regulations governing the safe practice of autopsy pathology including those related to exposure to bloodborne and airborne pathogens and formaldehyde.
- Know the proper use of protective equipment for the practice of autopsy pathology.
- Know the special circumstances requiring urgent autopsy examination.
- Exhibit appropriate care to protect confidential information from unauthorized access.
- Understand the general limitations of funeral cosmesis as it affects the performance of the autopsy.
- Know special circumstances related to autopsy of members of different ethnic and religious groups.
- Practice autopsy pathology for off-site affiliated hospitals providing the same levels of communication with clinicians as would be provided in-house.
- Utilize consultative services in a cost-effective fashion.
Autopsy training is integrated with the Anatomic Pathology rotation schedule and is conducted throughout the three years of training usually reserved for Anatomic Pathology. Approximately thirty percent of the Anatomic Pathology rotation is dedicated to autopsy pathology.
Duties and Responsibilities of Residents by Year
Residents are initially trained by being paired with an experienced Resident, then assume independence for their own cases. In this way, Residents achieve graded responsibility, first as apprentices, then as practitioners, then as teachers, then as supervisors.
First-year Residents are generally encouraged to concentrate upon technical skills and to collaboratively sign their cases with the Attending Pathologists.
By the PGY3 level of training, Residents are expected to bring autopsy cases for sign out in essentially complete form, ready for approval by the Attending Pathologist.
Residents in the PGY3 and PGY4 Charge Resident rotation are required to participate for one week at a time in autopsy as junior attendings for cases prosected on Monday, Tuesday and Wednesday, taking report from a resident prosector, planning the autopsy, examining the gross organs, formulating the provisional diagnoses, performing microscopic examination and supervising completion of the final report. Residents will at all times be supervised by an attending pathologist, who will retain final authority for the autopsy signout.
Supervision and Evaluation
All autopsy cases are supervised and signed out both at gross examination and microscopic examination by a member of the Anatomic Pathology Staff, or by a senior resident working under the supervision of an attending pathologist. Pediatric pathology cases, including stillborn infants, pediatric deaths, and certain adult deaths from inherited conditions, are reviewed and signed out at gross and microscopic examination by the Pediatric Pathologists. On every case where central nervous system tissue is included, a separate gross examination and microscopic examination is conducted by the Neuropathology Staff.
Resident progress toward the Core Competencies is evaluated on a monthly basis by each faculty member having significant contact with the Resident. Resident case turnaround statistics are tracked in detail and problem cases are brought to the attention of the Resident and the Residency Committee.