Autopsy Pathology Rotation

Autopsies are performed as a separate one-month rotation at Moffitt during each year of AP residency. Autopsies are also performed at Zuckerberg San Francisco General Hospital and the San Francisco VA Health Care System as part of the general pathology rotations at those institutions. Autopsy cases are rotated among the two to three residents or fellows on the service. Finally, residents have a one-month rotation at the San Francisco Medical Examiners Office during the second AP year, during which time they assist in forensic autopsy cases. There are approximately 175 autopsy cases (including about 60 perinatal cases) at Moffitt Hospital each year, 40 at ZSFG, and 30 at the SFVAHCS. The Medical Examiner’s office conducts approximately 1,500 forensic autopsies per year.

Once an autopsy permit is signed, the responsible resident will review the patient’s medical record, discuss the case with patient’s clinician, and then discuss the case with attending pathologist to identify goals in this specific case and specialized techniques that may be required. The resident then performs the autopsy dissection with the aid of an autopsy assistant and reviews the gross pathologic findings with the attending pathologist. The clinicians are invited to attend both the autopsy and review of gross findings if they wish. Subsequently, the resident will sample the gross organs for microscopic examination and preview the glass slides before meeting with the attending pathologist for sign-out of the case. First-year Anatomic Pathology residents are guided through the process of reviewing the chart and performing the autopsy dissection with the help and direct supervision of the Attending Pathologist; second-year residents generally perform the medical record review and autopsy dissection independently, although the attending Pathologist is always available for unusual or complicated cases. Second-year residents are also expected to have generated a differential diagnosis before meeting with the attending pathologist for sign-out.

Residents routinely present autopsy results at clinical conferences, such as Medicine M&M Conference, Critical Care M&M Conference, and Pediatrics Chief’s Rounds. A gross conference is held weekly so that all residents can review interesting findings from the week. Once a month, a Specialty Gross Conference is held, during which a specialist attending pathologist (e.g., GI Pathologist or GYN Pathologist) presents interesting or classical cases.