Medical students almost always respond enthusiastically to attending autopsies, participating in the dissection, and helping work through the abnormal physiology involved in understanding clinical-pathological correlations. They enjoy seeing the anatomy of an unembalmed cadaver, and looking at histologic slides to confirm, refute or elucidate the clinical hypotheses made at the time of the gross dissection.
Despite the currently-low autopsy rate [1] this seems to be a good time to reexamine the role of autopsies in medical education in general, and basic science education in particular. There is intense interest in case-based learning, and an autopsy is a case-based experience. The autopsy affords a situation in which material from all of the basic science disciplines comes into play. Further, technological advances in capturing and manipulating images and combining them with electronically-stored patient information offer exciting flexible alternatives to the classical specimen museum and paper records.
At the Medical College of Wisconsin, we have started this year to encourage every student to attend an autopsy and present the findings to colleagues in a small-group setting. We are in the process of evaluating this exercise. A number of interesting questions have arisen in the few months we have been doing this. For example, should this experience play a major role in carrying course content, or should it be viewed primarily as a way of enriching the students’ experience in the course? As with other case-based instruction, if one relies only on case material which comes through a clinical service by chance, important topics may be missed, and yet “canned” experiences rarely have the immediacy of actual patient contracts, and therefore are more easily forgotten. What should the role of the resident-prosector be in this exercise? Should the students be required to write up the autopsy findings in a formal manner? If they do, who will read and evaluate the written work? Should they present the gross and the microscopic findings to their follow students, and if so, in how much detail? Should they be graded, and if so, how? What are effective ways to build up a library of autopsy cases? Can the autopsy material readily be used in an interdisciplinary fashion?
A number of departments of pathology have been having students attend autopsies during the basic science course in pathology, usually during the second year of medical school. This spring, I had an opportunity to visit several of them and to discuss with both the pathology faculty and residents what their experience has been. I found, not surprisingly, that they had many of the same problems and questions. It was stimulating to begin sharing ideas on this timely subject, and it seems to me that it would be helpful to a number of us to do this in a more formal fashion through the AAMC:GEA’s Basic Science Education Special Interest Group.
I would be pleased to coordinate efforts to collect and disseminate information regarding the use of autopsy material in medical education. Please consider sharing your course, departmental, or institutional goals, your current experiences, and your ideas for the future of this teaching resource. I look forward to hearing from you by phone, fax, or mail.
1. Hill, R.B., Anderson, R.E. The Autopsy – Medical Practice and Public Policy. Boston: Butterworth, 1988, p41. This reference also presents a number of interesting perspectives on the uses of autopsy in medical education.