American Society of Clinical Pathologists--Resident Physician Section. Results of autopsy survey (Winter 1994-1995)

Graduate Medical Education in Pathology: A Scoping Review

CONTEXT.—

Pathologists have produced a substantial body of literature on graduate medical education (GME). However, this body of literature is diverse and has not yet been characterized.

OBJECTIVE.—

To chart the concepts, research methods, and publication patterns of studies on GME in pathology.

DATA SOURCES.—

This was a systematic scoping review covering all literature produced since 1980 in the PubMed and Embase databases.

CONCLUSIONS.—

Research on GME in pathology is evenly dispersed across educational topics. This body of literature would benefit from research based on theory, stronger study designs, and studies that can provide evidence to support decisions on educational policies.

Through the lens of the clinician: autopsy services and utilization in a large teaching hospital in Ghana

Background

Declining hospital autopsy rates in many countries have generated considerable concern. The survey determined challenges of the autopsy service in a large Teaching Hospital in Ghana, from the perspective of clinicians.

Methods

This was a cross-sectional study of doctors at the Korle-Bu Teaching Hospital (KBTH) over in 2012. The data was collected using a 69 item self-administered structured questionnaire. In all a total of 215 questionnaires were sent out and 119 doctors responded. Data was collected on the challenges of the autopsy services and barriers to autopsy request from the perspectives of clinicians. Survey data were analyzed by simple descriptive statistics (i.e. proportions, ratios and percentages. Data from survey was analyzed with SPSS version 21.

Results

The most common reasons for requesting autopsies were to answer clinical questions, 55 (46.2%) and in cases of uncertain diagnosis, 54 (45.4%). Main demand side barriers to the use of autopsy services by clinicians were reluctance of family to give consent for autopsy 100 (84%), due to cultural and religious objections 89 (74.8%), extra funeral cost to family53 (44.5%) and increased duration of stay of body in the morgue 19 (16%). Health system barriers included delayed feedback from autopsy service 54 (45.4%), difficulties following up the autopsy process 40 (33.6%) due to uncertainties in the timing of particular events in the autopsy process, and long waiting time for autopsy reports 81 (68.1%). More than a third of clinicians 43 (36.2%), received full autopsy report beyond three weeks and 75 (63.1%) clinicians had concerns with the validity of reports issued by the autopsy service (i.e. reports lack specificity or at variance with clinical diagnosis, no toxicological, histological or tissue diagnoses are performed).

Conclusion

The autopsy service should restructure itself efficiently and management should support the provision of histological and toxicological services. Strengthening internal and external quality improvement and control of autopsies in the Hospital are essential.

Clinical utility and impact of autopsies on clinical practice among doctors in a large teaching hospital in Ghana

BACKGROUND

Autopsies can provide a good indication of the quality of patient care, in terms of the accuracy of clinical diagnosis and the quality of treatment given.

DESIGNS

This was a cross-sectional study among clinicians at the Korle-Bu Teaching Hospital (KBTH) in 2012. Data were collected with a 69-item, self-administered, structured questionnaire. A total of 215 questionnaires were sent out and 119 clinicians responded. Data were collected on the benefits and utility of autopsies for medical practice, care of patients, and management of clinical wards. Survey data were analyzed by simple descriptive statistics (i.e. proportions, ratios, and percentages). Data were analyzed using SPSS version 21.

OBJECTIVE

This study examined the views of clinicians regarding the utility of autopsies and their influence on clinical practice in a large teaching hospital in Ghana.

RESULTS

Overall, clinicians in KBTH agreed that autopsy reports are useful in answering clinical questions (55/119; 46.2%), confirming or verifying clinical diagnoses (54/119; 45.4%), providing information on unsuspected diagnoses (40/119; 33.6%), and for medical education (90/119; 75.6%). Overall, 70/119 (58.8%) of clinicians agreed that autopsy findings improve completeness and reliability of death certification and provide information on clinical effectiveness of treatment and patient management. However, only 23/119 (19.3%) of sampled clinicians had personal interactions with a pathologist during autopsy processes and 93/119 (78.2%) had not attended any autopsy demonstrations in the past 6 months. Attendance of pathologists at clinicopathological meetings of clinical departments of KBTH was minimal. Unfortunately, the use of autopsy reports for auditing clinical diagnostic performance was not seen as essential.

CONCLUSION

Strengthening the interaction between doctors and pathologists is essential in improving the autopsy process and utilization in the hospital. KBTH should create opportunities for doctors to attend autopsy demonstrations and for pathologists to attend clinicopathological meetings in the hospital.

Informed evaluation of pathology residency programs

OBJECTIVES

To identify resources and summarize important issues in anatomic and clinical pathology training and to assist the pathology resident candidate in evaluating potential training programs.

DATA SOURCES

Published guides for medical residency applicants, recent literature discussing pathology education, and World Wide Web sites.

STUDY SELECTION

Resources perceived by the author as valuable for the pathology resident candidate.

DATA EXTRACTION

Key issues in pathology education are identified.

DATA SYNTHESIS

Issues are discussed from the perspective of a pathology resident candidate, and resources for further information are provided.

CONCLUSIONS

The pathology residency candidate faces unique challenges in the residency search process because of the breadth of pathology training and the limited exposure to the practice of pathology in medical school. General guides for residency applicants include little discussion of pathology-specific issues. Recent literature discussing pathology education is fragmented but provides invaluable insights for resident candidates. This review seeks to identify a wide variety of issues and resources as a starting point for evaluating potential training programs.

A survey of general practitioners' views on autopsy reports

AIMS

To study the views of general practitioners on the quality and utility of autopsy reports, and on autopsies in general.

METHODS

For a period of six months, a questionnaire was enclosed with each autopsy report sent to a general practitioner from the mortuary at Manchester Royal Infirmary.

RESULTS

Most (93.3%) general practitioners found the autopsy report useful, and many (66.7%) thought the bereaved relatives would do so too. However, only a minority (25.2%) would discuss the report with the relatives. A considerable proportion (20.0%) found the cause of death surprising, and a significant number (10.4%) felt the report would modify their future clinical practice. There was approval of autopsies in general, with most (88.6%) agreeing that autopsies reveal lesions not detected in life, and many (74.4%) indicating that loss of the autopsy would impair severely the monitoring of clinical standards.

CONCLUSIONS

General practitioners appreciate autopsy reports, which may have a significant impact on clinical practice. Autopsy reports provide both case audit and information for relatives.