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Autopsy Pathology Curriculum*
The basic learning objectives of the rotations in autopsy pathology are encompassed in the six competencies outlined below as well as the two skill levels that follow.
Evaluates consent form thoroughly prior to starting postmortem and makes appropriate contacts, e.g., medical examiner, administration, etc.
Gathers appropriate information from clinicians/surgeons and others prior to the autopsy and contacts them afterwards.
Carefully reviews medical record, abstracting relevant information.
Effectively uses autopsy results to educate physicians and students on pathobiology of diseases and issues of quality improvement.
Demonstrates familiarity with normal histology and basic disease processes
Effectively integrates and analyzes information to put together cohesive picture of autopsy.
Presentations and analyses demonstrate fundamental knowledge of pathology and related basic and clinical science
Becomes familiar with common microscopic stains, indications for their use, and expected results
Participates in scholarly activities including poster or platform presentations at national meetings and publications.
PRACTICE-BASED LEARNING AND IMPROVEMENT
Understands and implements proper method of identifying patients.
Takes appropriate gross photographs to document important positive and negative findings
Understands necessary components of autopsy report
Evaluates adequacy of clinical information provided on clinical record
Describes gross autopsy findings and obtain adequate tissue sections
Dissects tissues as appropriate to preserve important pathological features or anatomic landmarks
Suggests and interprets appropriate additional studies, e.g. Immunohistochemistry, electron microscopy, etc.
Investigates cases using texts, journal articles, and internet sources
Integrates clinical and laboratory data to arrive at diagnosis
Takes suitable gross and microscopic photographs to demonstrate important positive or negative findings
Understands operation of histology laboratory, equipment, organization, and procedures, e.g. tissue processing, embedding specimen orientation, and slide preparation
Effectively utilizes local computer network
Recognizes need for expedited autopsies
Knowledge of precautions to be taken against infections and other hazards in the handling of fresh tissue during autopsies
Demonstrates knowledge of the appropriate storage and disposal of tissues and fixatives.
Demonstrates knowledge of the common pathogens that can be transmitted to laboratory personnel in pathology, as well as basic safety precautions to be taken in the anatomic pathology laboratory, including universal precautions for infectious agents.
Is organized and prepared for review of organs and findings with supervising attending pathologist
Completes provisional anatomical diagnosis (PAD) within 24 hours (no later than two working days).
Signs out cases with attending pathologists and completes final anatomic diagnosis (FAD) within 30 working days (routine) to 60 working days (complex).
Communicates effectively with clinicians and other health care providers to obtain information and provide feedback following postmortem examination.
Contacts clinicians who wish to attend autopsy.
Effectively teaches other physicians, students, and health care workers
Interacts effectively with administrative, secretarial, clerical, and technical staff
Presents autopsy cases at departmental and multidisciplinary conferences.
Demonstrates effective communication skills in case presentations and other meetings
Appropriately uses and responds to e-mail and other communications
Prepares and organizes for autopsy sign-out and, if necessary, reviews previous surgical or cytopathology material
Follows up by completing unfinished cases and collecting needed information
Adheres to ethical principles, accepts responsibility for actions, admits mistakes, recognizes and addresses ethical dilemmas, maintains patient confidentiality
Recognizes limits of abilities and need to consult with others
Works effectively with members of the health care team, demonstrating courtesy and responsiveness to views of others
Is sensitive to diversity of coworkers and patients
Engages in ongoing learning; shows initiative in seeking new information; asks knowledgeable and well-informed questions
Implements improvement activities; changes behavior in response to feedback
Understands and complies with HIPAA and other regulations regarding patient confidentiality and handling of tissues for diagnosis and research
Accepts responsibility and follow through on tasks
Maintains log of autopsy cases, alerting faculty and program director to any factors impeding performance of 50 cases (autopsies may be shared but no more than two residents may count a shared case toward this standard.
Is punctual, arriving on time for sign-out sessions and conferences
Participates in institutional conferences dealing with management, quality assurance, graduate medical education, and other medical center and hospital functions
Understands the importance of cost conscious medical care; avoids unnecessary procedures but does not compromise quality of care
Attends interdisciplinary conferences
Skill Level I denotes items for which training will begin immediately upon entering the AP education track; Skill Level II denotes material that is typically covered at a more advanced level of training in the residency program)
Skill Level I
-Demonstrate knowledge of the common and basic elements of the autopsy report
-Demonstrate competency in selecting and staining representative tissue samples
-Know the procedures for the reporting of untoward incidents occurring during the autopsy
-Demonstrate knowledge of the basic recommendations/requirements (JCAHO, CAP, regional legal requirements) pertaining to retention of pathology specimens and records.
-Demonstrate knowledge of the basic principles of informatics in anatomic pathology, and ability to effectively utilize the local computer network.
Skill Level II
-Demonstrate the ability to effectively construct a complex autopsy report with appropriate narrative.
-Be able to independently assess the histopathologic aspects of routine and complex cases, including cases prepared by junior residents and/or pathology assistants, with attention to organization of diagnostic format, development of differential diagnosis, and ordering of necessary special stains and other ancillary techniques.
-Demonstrate knowledge of quality control pertaining to histologic sections and special stains, including trouble-shooting of mistakes in accessioning, labeling, & misidentification of specimens.
-Demonstrate proficiency in digital imaging techniques.
*Adapted from ADASP Working Group.Curriculum content and evaluation of resident competency in anatomic pathology, 2003.