Challenges in autopsy training for pathology residents: A survey of autopsy directors

Resident training in autopsy provides a foundation of knowledge and skills for forensic pathologists and anatomic pathologists, but obstacles are present in ensuring quality training. A survey of US autopsy service directors at sites with pathology residency programs was used to identify common challenges in resident autopsy training. Respondents (n = 29) largely believed that negative attitudes from residents, faculty, training programs, and/or the medical system at large (34%) and time limitations (34%) were the most significant challenges for residency autopsy training. Regarding the Accreditation Council for Graduate Medical Education's decreased autopsy requirements from 50 to 30 required cases, respondents noted decreased difficulty (38% to 7%) for residents to achieve the minimum of cases but increased concerns regarding competency at this minimum (7% to 76%). Other impacts of this reduced requirement included decreased interest from residents after meeting minimum requirements, shortened autopsy rotations, increased resident-free autopsies, and increased use of pathologist assistants. Two programs (7%) described a decreased need for residents to share cases, but no other potential benefit was described. In addition to the value provided to the community through autopsies, autopsy training during residency provides knowledge and skills relevant to anatomic pathologists generally and forms a necessary foundation on which forensic pathology fellows and future autopsy attendings can develop proficiency. Continued effort is needed to promote the importance of autopsies to pathology residents and others and to provide sufficient training to produce pathologists competent in autopsy pathology.