Pathology residents rotate for three months on the autopsy service during their first year of residency. The autopsy resident is responsible for all weekday autopsies performed at Froedtert Hospital (FH), Children’s Hospital of Wisconsin (CHW), and the Veterans Administration (VA) Hospital during their rotation. Over the last few years the average number of autopsies/year at FH has been 60, at CHW: 65, and at the VA Hospital: 15.
Autopsies performed at each hospital are usually on the patients who have complicated clinical courses, with multi-organ involvement, and significant unanswered questions about their disease processes such that the autopsy serves as a valuable educational experience for both the pathology resident as well as the hospital services. Complementary to the experience of performing autopsies on patients from a tertiary care medical center, the autopsy resident also goes to the Milwaukee County Medical Examiner’s Office to perform autopsies on days when there are none at FH, CHW, or the VA. The Department of Pathology maintains a close relationship with the Milwaukee ME Office as the pathology residents rotate with the medical examiners during their first year and then return in the senior year to complete a forensic rotation. The Milwaukee ME office is under the direction of Dr. Brian Peterson, and Dr. Agnieszka Rogalska directs the residents during their rotations. Valuable aspects of the rotation of the first year residents in the ME office are the opportunity to learn varied evisceration techniques and to experience a different “patient” population. With the opportunity to perform autopsies at FH, CHW, the VA, and the Milwaukee ME Office, the pathology residents obtain a well-rounded experience and more than sufficient numbers of autopsies to qualify for board examination.
At FH, the autopsy room is outfitted with state-of-the-art equipment. There is room for general autopsy performance and a separate room with negative pressure ventilation for all suspected infectious cases. Autopsy performance is also always assisted by an experienced autopsy technician. The general work flow of an autopsy is as follows: the autopsy resident reviews the autopsy consent and the clinical information on the patient (now obtained on the electronic medical record, EPIC) and presents this information to the autopsy attending prior to beginning the autopsy. The attending and resident discuss any special procedures that might be needed on that autopsy. On the first several autopsies performed by the first year resident at FH the attending is present for all aspects of the procedure. As the resident becomes more experienced, he/she is gradually given more independence in the performance of the autopsy. A template for the gross description of the autopsy findings is used to aid in completion of the report; the autopsy service is in the process of transferring from a traditional dictation system to the use of a voice-activated dictation system. All reports are created and maintained on Cerner Millennium Laboratory Information System. The attending and resident always review all organs at the conclusion of the dissection. A dedicated digital camera is used to document important gross pathological abnormalities. A provisional anatomic diagnosis list is created based upon the gross findings at autopsy and examination of slides from five “stat” blocks processed, cut, and stained within a day of the autopsy performance. Slides from all submitted blocks are typically available for review within a week after the autopsy completion. The resident pre-views all slides and then reviews them with the attending physician. The resident writes the microscopic description and summarizes the autopsy findings and writes the clinical-pathological correlation of the final autopsy report.
As part of the resident’s autopsy experience, selected cases are the subject of formal quarterly clinical-pathological conferences given in conjunction with the Department of Internal Medicine and the Department of Neurology, at which the resident prosector of the autopsy presents all the autopsy findings and gives a short didactic presentation on a pertinent topic.