Elsevier

Mayo Clinic Proceedings

Volume 73, Issue 8, August 1998, Pages 802-805
Mayo Clinic Proceedings

Special Article
The Role of Postmortem Examination in Medical Education

https://doi.org/10.4065/73.8.802Get rights and content

Historically, the postmortem examination was an indispensable diagnostic tool. Despite recommendations by the American Medical Association to continue performing autopsies, many physicians and medical institutions fail to recognize its utility in modern medicine, and autopsy rates have decreased to unacceptably low levels. In academic settings, requesting consent for autopsies is the responsibility of residents, who often lack the skills necessary to approach the grieving family, request consent, and follow up the autopsy results. Additionally, the information obtained at autopsies is often unused or is unavailable to families and clinicians. In order to improve the autopsy rate and enhance its clinical and educational benefits, the training of residents must be structured to emphasize the postmortem examination and to develop a standardized means of communication among clinicians, pathologists, and families.

Section snippets

Past

The autopsy had an important role in the development of modern medicine. It was the central means by which scientists gained an understanding of anatomy, pathology, and clinicopathologic correlation. Despite its importance, the autopsy has been criticized throughout history.

Hippocrates described it as “an unpleasant, if not cruel, task.”2 Thomas Sydcnham, a 17th-century English physician, said, “Some physicians pompously and speciously prosecute the promotion of medicine by search into the

Requesting Permission

Residents are often the first medical person to be notified of a death in the hospital. Requesting an autopsy, although often low on the list of priorities, is the most important way for residents to influence the autopsy rate. In one study, 45% of families who had “denied autopsy consent” reported that they had never been asked.13

Recently, a resident-based intervention was successfully used to increase autopsy rates at a public hospital.1 Medical residents were trained in a 2-hour didactic

The Program Director

The Accreditation Council for Graduate Medical Education requires all internal medicine residency programs to incorporate pathology into the teaching program:

All deaths must berevie wed,…autopsies should be performed on at least 15% of deaths on the medical teaching service. Residents should be present at autopsies or should review the gross pathologic specimens at the time the autopsies are performed on their patients and should review the autopsy reports. Formal teaching sessions with

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