Based on their level of training, residents are provided increasing autonomy with close faculty supervision. The residents have the responsibility of prosecting all hospital autopsies during their monthly rotations. As described previously, this is done with increasing autonomy as the resident progresses. This includes the dictation of the clinical history, internal and external examinations and the appropriate sampling of organs and pathologic processes. The residents also participate in any special procedures performed at this time, such as gross photography, sampling of tissue for toxicology, special studies, and tissue banking.
Residents are also responsible for preparing the provisional autopsy diagnoses (PAD) on hospital cases. More junior residents prepare this with considerable help from faculty, but more senior residents prepare the PAD for faculty review. Residents also prepare autopsy tissue blocks. They preview autopsy slides and prepare a draft final autopsy diagnosis. The resident will review the cases with the faculty member responsible for autopsies. With faculty guidance, residents are responsible for directly deciding what additional ancillary studies are necessary in order to complete each case.
Each resident will be graded as to “agree, partially agree, or disagree” for each microscopic diagnosis and gross description/dissection. The resident will receive a written evaluation with summary statistics for him/herself compared to the overall resident mean. The resident can review all the cases in which he/she had a discrepancy with the faculty pathologist by requesting a print-out of such cases from Mr. Ed Grey, the informational technology specialist for Co-Path. The number of cases reviewed independently and the accuracy of both gross descriptions and final diagnoses as measured by percentage agreement and the rotation evaluation are expected to increase with increasing resident seniority.
Surgical Pathology fellows may rotate through the autopsy service and follow basically the same schedule as residents, however they should assist in teaching more junior residents in the Gross Room. In addition, fellows may preview their cases and hand these to the supervising faculty when completely worked up. They do not need to review them with the attending faculty. However, fellows will be expected to function with minimal discrepancies with the faculty.