Report and Recommendations of the Association of Pathology Chairs' Autopsy Working Group

Abstract

Autopsy has been a foundation of pathology training for many years, but hospital autopsy rates are notoriously low. At the 2014 meeting of the Association of Pathology Chairs, some pathologists suggested removing autopsy from the training curriculum of pathology residents to provide additional months for training in newer disciplines, such as molecular genetics and informatics. At the same time, the American Board of Pathology received complaints that newly hired pathologists recently certified in anatomic pathology are unable to perform an autopsy when called upon to do so. In response to a call to abolish autopsy from pathology training on the one hand and for more rigorous autopsy training on the other, the Association of Pathology Chairs formed the Autopsy Working Group to examine the role of autopsy in pathology residency training. After 2 years of research and deliberation, the Autopsy Working Group recommends the following:Autopsy should remain a component of anatomic pathology training.A training program must have an autopsy service director with defined responsibilities, including accountability to the program director to record every autopsy performed by every resident.Specific entrustable activities should be defined that a resident must master in order to be deemed competent in autopsy practice, as well as criteria for gaining the trust to perform the tasks without direct supervision.Technical standardization of autopsy performance and reporting must be improved.The current minimum number of 50 autopsies should not be reduced until the changes recommended above have been implemented.

Keywords: anatomic pathology; autopsy; autopsy service director; entrustable activities; pathology training; rapid autopsy; residency.

Figure 1.

What was the total autopsy case volume of the service you direct for calendar year 2015? Each bar on x-axis represents 1 of the 59 programs that responded to this question.

Figure 2.

Number of available autopsies in main service per resident. 4× total autopsies on main service/residents on Accreditation Council for Graduate Medical Education (ACGME) roster. Each bar on x-axis represents 1 of the 59 programs that responded to this question.

Figure 3.

Available autopsies on main service per resident, extended by sharing. Resident × (1 + % shared). Each bar on x-axis represents 1 of the 59 programs that responded to this question.

Figure 4.

Distribution of fetal, pediatric, and forensic cases, percent of total. The order of the programs is identical to that in Figure 1. Because the categories are not mutually exclusive, some totals exceed 100%. Each bar on x-axis represents 1 of the 59 programs that responded to this question, including the space.

Figure 5.

Entrustable tasks most often taught by the autopsy service director. Numbers shown in bold text under bold text heading.

Figure 6.

Entrustable tasks most often taught by the other faculty. Numbers shown in bold text under bold text heading.

Figure 7.

Entrustable tasks most often taught by other trainees. Numbers shown in bold text under bold text heading.

Figure 8.

Entrustable tasks most often taught by support staff. Numbers shown in bold text under bold text heading.

Figure 9.

Entrustable tasks most often not taught. Numbers shown in bold text under bold text heading.

Figure 10.

What is your view of the American Board of Pathology (ABP) requirement that residents perform 50 autopsies? 58 responses; 8 skipped this question.

Figure 11.

Do your residents have trouble getting the required 50 cases? 60 responses; 6 skipped this question.