Autopsy and Forensic Pathology
- Nahum J. Duker, MD
- Abir Mukherjee, MD
- Philadelphia Medical Examiners Office Staff Pathologists
Autopsy experience is obtained on the following rotations: 6 months at Temple University Hospital and 1 month at the Office of the Medical Examiner of Philadelphia. While on the forensic pathology rotation, residents receive instruction and perform autopsies under the supervision of staff pathologists of the Medical Examiner’s Office.
Instruction of residents in the performance of post-mortem examinations, in gross description, in selection of tissue for microscopy, in interpretation of post mortem findings, and in completion of autopsy reports is the direct responsibility of attending pathologists assigned to the autopsy service. Senior residents may also assist in resident instruction. Attending pathologists rotate autopsy coverage on a weekly basis. The majority of autopsy attending coverage is by 3 anatomic pathology-certified pathologists, one of whom is the renal pathologist. Instruction of residents on autopsy service is closely monitored by the director, who reviews gross findings on all adult cases at a conference usually held once or twice a week, and serves as autopsy attending 40-50% of the year.
Residents assigned to the autopsy service review requests for autopsies, preliminary review of the clinical history of the circumstances of death, ascertain next of kin, review chart and discuss specifics of each case with the clinical staff and autopsy attending pathologist, and perform post mortem examinations (external and internal gross examination) including review of microscopic and toxologic findings under the supervision of an attending pathologist and with the assistance of a morgue technician. Gross findings are then reviewed with the attending pathologist. The resident then prepares a provisional anatomic diagnosis which is finalized with the staff pathologist and submitted for distribution within two working days. Sections for microscopic examination are submitted by the resident, who examines them and formulates a draft of a list of final diagnoses and opinion regarding the cause of death. The final report is reviewed with the resident and autopsy attending. There is at least one intradepartmental case presentation each month, and the residents are responsible for case presentations at extra-departmental conferences as well. The attending staff supervises these presentations.
The autopsy rotation is designed to provide graded resident responsibility. Attending pathologists perform post-mortem exams with each new resident on the autopsy service until the autopsy attendings and director of the autopsy service are confident in each resident’s ability to perform the autopsy prosection with no direct staff presence or assistance. Graded responsibility on autopsy service is reflected in the progressive independence of the resident in performing his/her requisite duties. While all activities of the resident on autopsy service are supervised by the attending pathologist assigned to each case, residents are expected to show initiative in performing their autopsy duties (e.g. discussion with clinical staff, formulation of provisional diagnoses, dissection, selection of tissues for histology, etc.) with progressively less frequent and/or intense consultation with the attending.
For more information, also refer to the section on Neuropathology.