PATU-4001 - Autopsy Service

PATU-4001 - Autopsy Service

Elective Title: Autopsy Service
Course Number: PATU-4001
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: No other requirements at this time.
Responsible Faculty Director: Judith Aronson, M.D. Periods Offered: 1-13 including holiday period 8 
Coordinator: Tracy Wilkins Other Faculty: Dr. Felicella
Location to Report on First Day:
5.144 Clinical Service Wing (CSW)

The rotation is designed to help students:
1. Gain an understanding of the autopsy procedure.
2. Begin to learn interpretation of gross autopsy specimens, with integration of microscopic sections and ancillary procedures employed during the autopsy.
3. Gain experience in correlating anatomic pathology changes with clinical history, physical findings, and laboratory results.

At the conclusion of the elective students will be able to:
1. Understand the procedures related to a comprehensive adult or pediatric autopsy.
2. Effectively summarize the clinical record and communicate this information to others.
3. Systematically examine a gross organ.
4. Diagnose common pathologic lesions based on gross examination.
5. Appreciate how to appropriately select and prepare fixed tissue blocks for histopathologic processing
6. Review microscopic appearance of normal and selected diseased tissues
7. Recognize relationship of disease manifestations in various organs and be able to describe pathogenetic sequence of disease processes leading to death in specific cases
8. Correlate autopsy findings with important clinical features or questions
9. Participate in autopsy prosection
10. Describe appropriate authorizations for autopsy
11. Articulate potential benefits and limitations of modern autopsy examinations

Description of course activities
The student should first learn the autopsy procedure by reading the procedure manual, observing one or two cases, then assisting the Resident Pathologist. Students will attend and participate in the following conferences: Gross Autopsy Conference (twice weekly), Autopsy Gross-Microscopic Conference (once weekly), Brain Cutting (once weekly), Pathology Grand Round (once weekly), Medicine Clinicopathologic Correlation Conference, Surgery Morbidity and Mortality Conference (once weekly). Students will review textbooks as well as relevant current literature to gain understanding of the clinical, pathologic, and pathophysiologic features of their cases.

Type of students who would benefit from the course
This elective would be useful for students planning careers in any field of medicine.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8-12 12-5
Tuesday 8-12 12-5
Wednesday 8-12 12-5
Thursday 8-12 12-5
Friday 8-12 12-5

 Average number of patients seen per week: 3-5
 Call Schedule: not applicable

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time 5
Self-Directed Study 10
Other work with residents on autopsy cases 25

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Daily, during their participation in autopsy dissections
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    autopsy faculty and residents
  B. Frequency / Duration of Presentation(s)?
    1-2 times during rotation
  C. Format - What guidelines are set for the student's presentation?
    Students will present clinical summaries and/or pathologic findings at divisional gross autopsy conference for at least one of the cases they participate in. Presentations consist of clinical summary, followed by presentation of the gross autopsy findings, with discussion by those in attendance.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Once during elective
  B. Format - What guidelines are set for the student's written work?
    This will be an abbreviated autopsy report describing clinical summary, gross findings, microscopic findings and clinicopathologic correlation. The student should use the student report format and the work should be their own, not that of the pathology resident.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    related to case, chosen by student
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Students are expected to attend all divisional conferences, as well as surgical M and M. They should participate in dissections for many cases that they observe. They will be asked to present clinical summaries for at least one case. Participation will be assessed based on questions and discussion at conferences and "sign-out" sessions.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Evaluation will be based on daily on observation by pathology residents and faculty. The quality of autopsy write-ups will be considered.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.