The educational value of autopsy in a residency training program

Background: Historically, the autopsy has been an indispensable educational tool. Over the past several decades, however, the national autopsy rate has declined and the educational role of autopsy in modern medicine is being questioned. Objective: To assess the educational value of autopsy attendance in an internal medicine residency program. Methods: We performed a retrospective review of all autopsies performed on the general internal medicine teaching service between October 1996 and September 1998. Premortem and postmortem diagnoses were determined and compared and attending physician surveys were reviewed. Results: Eighty-eight deaths occurred during the study period. Twenty-nine (33%) patients underwent autopsy. All autopsies were observed by the primary team and the attending physician completed an autopsy survey on each patient. An unexpected pathological diagnosis directly contributing to death was detected in 10 (34%) patients at autopsy. Additional unexpected pathological diagnoses were discovered in 23 (79%) cases. Attending physician surveys revealed that all 10 unexpected diagnoses contributing to death were observed by the primary team at the time of autopsy. Autopsy attendance was rated as a valuable educational experience in 27 cases (93%). Conclusion: Autopsy is a valuable educational tool and autopsy attendance should remain an integral part of internal medicine residency training.