There are a total of five months of autopsy pathology at Cedars-Sinai, the majority in the first year and the remainder as a more senior resident. Adult and pediatric autopsies are performed at Cedars, and the autopsy faculty includes two deputized coroners, so occasional coroner's cases with medical interest are performed at Cedars as well. In-depth experience in the forensic autopsy is gained during a one month rotation at the Los Angeles County Coroner's Office later during the residency program.
The autopsy rotation provides the basis for understanding anatomy, gross pathology and histology as well as understanding and applying clinical-pathologic correlation,
which is critical to making accurate interpretations of anatomic findings. Therefore, residents have their first autopsy rotation in July or August of the first year. During this first autopsy rotation, a chief resident works one-on-one with the first year resident, guiding them through all steps of the autopsy from reviewing the clinical history, external examination, performance and interpretation of findings of the gross autopsy, selection of material for histologic sections, and review of the slides. The history and gross and microscopic findings also are reviewed with the autopsy faculty member, with whom the resident develops the provisional and final anatomic diagnoses. Gross and microscopic evaluation of the brain and nervous system are done with a neuropathologist. Senior residents on the autopsy service instruct junior residents in gross and microscopic autopsy, performance and diagnosis, and in conference presentation techniques. Senior residents have graduated responsibility in performing autopsies independently. At the end of the autopsy rotations, the techniques of organ dissection and tissue sectioning are mastered, as well as methods for correlation of pathologic findings with the patient's clinical history.
Residents present their gross autopsy findings to clinical colleagues and housestaff members at a biweekly conference, providing a stimulating forum for sharing postmortem findings. In addition, there is a formal Mors Gaudet conference presentation during a monthly intradepartmental autopsy conference, and Chief residents assist the first year residents in preparing these presentations.
Specific Autopsy Goals and Objectives:
- Read and correctly evaluate a patient chart, develop basic skills in prosection of all parts of the autopsy, in gross diagnosis and in formulating a PAD.
- Select appropriate tissue sections, develop differential diagnoses and final diagnoses based on all information and studies available.
- Explain the role of clinical-pathologic correlation in autopsy approach and diagnosis.
- Integrate all safety related aspects of autopsy pathology and practice them
- Recoginze when the medical examiners office needs to be contacted before an autopsy is performed.
- Identify when special methods are needed in autopsy performance, and recognize the special techniques required for a medical examiner autopsy performed in the hospital setting.
Interpersonal and Communication skills:
- Construct clear, cogent, accurate and properly formatted PADs, FADs and full autopsy reports.
- Demonstrate proper interaction with physicians and/or clinical support staff to obtain clinical histories and report autopsy findings.
- Present concisely and cogently at autopsy gross and Mors Guadet conferences.
- Recognize that the resident is the case physician and that assigned cases are the resident's cases.
- Reliably follow instructions to obtain additional studies or information.
- Recognize the need to sign-out PADs and autopsies in a timely manner.
- Fully participate in all mandatory conferences and other required activities.
Practice-Based Learning and Improvement:
- Correctly utilize performance evaluations by superiors, peers and others to improve practice.
- Participate in the teaching of health care professionals including residents, clinicians, faculty and others.
- Continuously read about cases, including programmed reading on autopsy pathology topics, and about specific cases. Use this information to write appropriate summaries.
- Demonstrate use of clinical information to develop an approach to an autopsy and formulate a PAD.
- Identify how autopsy practice affects other health care professionals, the health care organization and larger society as a whole.
- Utilize hospital, governmental, and other technology-based resources to enhance the practice of autopsy pathology.
- Practice cost-effective laboratory utilization and resource management that maintains quality of care.
- Describe the role of the Autopsy Effectiveness Form in quality management.
- Identify the protocols and comply with all required reporting of infectious diseases.