Understanding Autopsy in the Digital Age

Autopsy struggles to get off the slab in many institutions across the world (1), despite its long history and involvement in medical training. At The Pathologist, we’ve aired plenty of thoughts on the topics, including a multi-author letter of its defense, and it’s clear that many see autopsy as an invaluable part of pathology education. We spoke with Meagan Chambers, co-founder of the education website TheAutopsyBook.com, about breathing new life into autopsy education.

Please introduce yourself…
 

I am a fellow in the last year of my Anatomic and Neuropathology training at the University of Washington. Next year, I will be an Assistant Professor at Stanford University on the Autopsy Service.

Why did you launch The Autopsy Book – and what’s the core mission?
 

There are many challenges to learning how to perform a high-quality medical autopsy these days, including a lack of learning resources, dwindling training requirements (we are down to 30 autopsies for graduation), and varying enthusiasm for the procedure from those responsible for teaching it. Though not true at my own program, some residents report being “left alone in the room” to perform an autopsy, armed only with the patient’s clinical history. 

We wanted to respond to these challenges by creating a freely accessible, online learning resource. The Autopsy Book is designed for residents, so that they can perform a high-quality autopsy based on the specific clinical considerations of their case.

How does The Autopsy Book specifically address the challenges faced by medical students, pathology residents, and attending pathologists?
 

The Autopsy Book takes a case-based approach to learning medical autopsy. Perhaps 30 autopsies are sufficient to get a general exposure to the field, but not to see all the diverse pathologies that are routinely encountered at autopsy. For example, I did 48 autopsies in my training, but I never saw a pulmonary embolism – and that’s a “bread and butter” pathology at autopsy. And so, The Autopsy Book allows me to either fill that gap now – through independent reading – or later when I have a case of a suspected pulmonary embolism as an early attending. 

By approaching learning from a case-by-case format, all learners – medical students, residents, and early attendings – can receive a focused review of best practices for autopsy. They can maximize the yield of the cases they do see, but also find resources later on when they come across something they didn’t see in their residency training.

How are the learning resources formatted and structure within the site?
 

The website is a place where learners go once they have compiled the history for their case. They can then use the search function on the home page to bring up relevant diagnoses they might encounter in their autopsy. For example, a significant proportion of cases will have a history of cardiovascular disease/atherosclerosis. If you were to read the article that came up when you search “atherosclerosis,” you find topics ranging from external exam findings, gross examination, sectioning, and histological findings. The topics covered on the site will continue expanding for the foreseeable future, but high-yield topics – atherosclerosis, infection and postmortem cultures, and myocardial infarction – are available now and address some of the most common diagnostic decisions made at autopsy.

What sets The Autopsy Book apart from other educational resources in the field of autopsy pathology?
 

For one, it’s freely accessible! There are a limited number of resources which approach learning from a case-based perspective, such as the textbook The Hospital Autopsy by Billie Fyfe, which focuses on pathologies related to sudden death. Then there are subscription services, like ExpertPath or PathPrimer, which tend to be expensive while focusing on the epidemiology of the pathology rather than getting into the “nitty-gritty” of what to do at the time of autopsy. The Autopsy Book, on the other hand, covers a wider variety of topics and – to repeat – is freely accessible to all. 

How has the feedback been so far?
 

I have been shocked at how enthusiastic the response has been. We have people signing up to get updates when we publish new material, we’ve had offers to help generate or enhance content from around the world. Learners are using it, and educators are finding it useful as an adjunct to their own teaching materials. We are finding that it’s not only useful to residents, but also medical students – and even attendings, who are enthusiastic to share their expertise with a wider audience. 

What is the general mood around autopsy, in your opinion?
 

You can’t talk about autopsy these days without acknowledging the challenges it faces. Lack of reimbursement and provider attitudes are major barriers to maintaining standards in the field. However, there will always be some need for medical autopsies. That’s to say, they won’t ever go to zero. And because of that we must stay committed to doing them at the highest level. Because medical autopsy is both necessary and undersubscribed, there is a huge need for easily accessible, high-quality training materials.

How do you ensure that the content on your platform remains up to date and relevant?
 

We have a peer review process for initial publication on the website where at least two pathologists need to approve (and have public authorship on) the content. On the backend, we keep track of when the article was last reviewed and we undertake a period re-review of content to make sure it is still accurate. We also welcome feedback from community members, and this has really helped with expanding the material on the page so that it reflects not just the author’s expertise, but also other perspectives and best practices. 

How do you measure the success and impact of The Autopsy Book?
 

Anecdotally, two days after I posted the first article on the site, which was about coronary artery bypass graft, I walked into our autopsy suite and the resident on the case blurted out: “Meagan, help me! I have this coronary artery bypass graft heart and I have no idea what I am doing.” To her credit, I think she did know what she was doing and was going to call the attending in to do the heart together, but we were able to pull up the article using the computers in the suite and walk through everything, focusing on what she needed to do right there and then. It was lucky that it worked out so well, but it reinforced how necessary this resource is. By the time the attending came in, the resident had a plan, and she was able to articulate her approach to grossing, necessary sections, and proper documentation of the multiple grafts. Since then I have been sure that this resource fills an important gap, and we plan to offer it for anyone who might also find it useful. 

Finally, you have a call to action…
 

Yes! The website is a vast undertaking and there are so many topics to cover – it will take years for it to be a truly comprehensive resource. We are always looking for contributors and partners to help. This can be as simple as passing along core articles they have read that helped them perform a better autopsy, contributing pictures or best practices to existing articles, or offering to draft or edit content. It takes a village to teach and we welcome any level of participation in this resource!

TheAutopsyBook.com