Autopsy Senior Resident Rotation (AP-2 and AP-3)
- Dr. John Sinard and Faculty
Senior residents rotation on the autopsy service manage the day-to-day medical issues of the service, and should think of the autopsy service as "their" service. Proper handling of autopsy cases, training of residents, and coordinating the dissemination of autopsy findings through communication with clinical teams and presentation of cases at conferences is the responsibility of the senior resident on the service. This is not to say that this resident should actually present each and every case himself or herself. Learning how to properly train and delegate these responsibilities to the junior residents while at the same time assuring the quality and completeness of those tasks is an important part of the senior resident's training while on the service. Issues which the senior resident does not feel qualified to address directly should be referred to the attending pathologist (if it is a case related issue) or to the director of the autopsy service.
Additional Resident Duties and Responsibilities
- This service MUST be covered by a senior resident at all times.
- Keep your beeper on at all times so that you can be contacted. Be available and prepared to address any and all medical issues that arise while assigned to the service. Matters for which you do not have the proper experience should be referred to the attending on the case (for case specific concerns) or the director of the autopsy service.
- Contact autopsy technical staff each morning (usually just after morning conference at 9:00 am) to check on status of cases; keep informed throughout the day of any changes, pending cases, etc.
- Monitor the junior residents to be sure they are progressing at an appropriate pace and fulfilling their responsibilities.
- Assign cases to the residents on the service in an equitable manner.
- Assist junior residents in interpreting clinical record, seeking additional information (e.g. lab, radiology) and contacting clinicians involved. On the basis of information obtained, determine the best approach to each particular autopsy. Pay particular attention to clinical questions to be answered, viral and bacterial cultures to be obtained, and any other special tissue requirements (e.g. fresh tissue for EM, tumor or genetic studies, liver for Carnoy's, lymph nodes for B5).
- Make sure that the attending for the case is appropriately notified (attendings vary in the degree to which they wish to be involved in the autopsy, and this may change on the weekend). It is advisable to discuss this with each attending at the beginning of their rotations on service. Most attendings would like to be called after the clinical information has been gathered but before the autopsy starts. (NB: The attending for weekend autopsies is the attending on service the following Monday.)
- When necessary due to case load or junior resident staffing, the chief resident should assume primary responsibility for cases, including completing all of the paperwork/reports for such cases. Usually, after each junior resident assigned to and present on the service has received two cases on any given day, and there is still another case to do, the chief resident should take a case.
- Supervise any post-sophomore fellows on the service. In some instances, the post-sophomore fellow may be allowed to assume primary responsibility for a case, but the chief resident must supervise the post-sophomore fellow during every aspect of the case.
- Be available to discuss the case with the resident prior to performing the autopsy. Provide advice as to technique and special procedures.
- Make sure the technicians have contacted a member of the Yale Pathology Tissue Services tissue procurement team prior to the beginning of the case. This is particularly important in cases in which neoplasms are suspected. You should be familiar enough with the case to be able to give an initial assessment as to which tissues are likely to be available from the case for research purposes.
- Be available to assist the junior resident(s) during the autopsy, train them in appropriate autopsy techniques, and encourage the use of special procedures such as frozen section and specimen x-ray where indicated.
- Gradually transfer increasing responsibility for the case to the AP-1 resident.
- Act as diagnostic consultant for the junior residents, discussing differential diagnoses for any lesions encountered.
- Make a special effort to teach any medical students or other visitors who may be present in the room during the autopsy.
- Be sure tissue is frozen, where appropriate, for diagnostic and research purposes. This includes all tumors. Tissue should be frozen either by a Yale Pathology Tissue Services representative or by yourself. These tissues must be transported to the -80C freezer the day of the autopsy or left in the cryobath since the cryostat goes through a thaw-refreeze cycle every evening.
- Review the case with the junior resident after he or she has laid out the organs but before the attending arrives to review the case. Be sure everything has been dissected properly and completely, and that the room is in a presentable state for review of the case.
- Assist in the preparation of the PAD. Be sure it is accurate, complete, and in the proper format. Be sure to discuss with the attending what your role in the signout of the PAD will be.
- Be available to review the slides for the case with the junior resident and to assist them in preparing any conference presentations of the case within or outside of the department.
- Review the final report with the resident before it goes to the attending for review. Assure that the report is complete, accurate, and in the proper format. Remember, your name is on this report as well.
- "Encourage" the junior resident, as needed, to have the final autopsy report completed and ready for the attending within 3 weeks of the autopsy.
- If at all possible, the weekend chief-on-call should be present for the Monday morning review of the case with the attending and follow through with assisting the junior resident in preparing the PAD. When responsibilities of another service make this impossible, be sure to "sign-off" on the case with the autopsy chief resident so that they can perform these tasks.
- Coordinate interdepartmental morbidity and mortality conferences as necessary.
- Coordinate the weekly gross conference, including case selection. The Conference may be conducted on autopsy or surgical material on an alternative basis, depending on the availability of cases.
- Be responsible for coordinating Wednesday brain cutting.
- Bring up any issues regarding technical support and facilities with the Manager of the Autopsy Service and/or the Director.
- Assist with regular extradepartmental conferences as needed; slides and reports will be pulled for you and in your box sometime in the morning. If you have any questions about the arrangements for this conference, see the Report Generation Supervisor.
Additional Goals and Objectives for the Autopsy Senior Rotation
- Training junior residents in the techniques of autopsy evisceration and dissection
- Obtaining experience running a medical service
- Mediating as needed between the attending pathologist and junior residents on the service
- Being fully aware of the details of on-going and pending cases
- Understanding what constitutes a medical examiner reportable case and appropriately bringing such cases to the attention of morgue staff
- Proofreading junior resident write-ups in a timely fashion, providing direction, constructive criticism, and assistance
- As needed due to case load or junior resident staffing, taking primary responsibility for cases, including writing the report for such cases
Practice-Based Learning and Improvement:
- Intervening in complicated cases to assist the coordination of obtaining history and special studies
- Selecting and preparing material for the weekly gross conference
Interpersonal and Communication Skills:
- Coordinating communication with members of the clinical team and/or private primary care providers to provide feedback as to autopsy findings
- Learning to delegate responsibility to junior residents and technical staff without compromising patient care
- Effective teaching of junior residents, pathology assistant students, and medical students in various aspects of autopsy practice and the pathologic evaluation of organs and tissues