Use of Autopsy Cases for Integrating and Applying the First Two Years of Medical Education

Objective: In a three-stage year-long program that demonstrates integration of basic science course material with clinical sciences, second-year pathology students (1) hear an autopsy case presentation, (2) view an actual autopsy, and (3) in small groups, present a preserved/dissected autopsy case. Coming at year's end, “Present-an-Autopsy” not only requires integration of diverse material but also fosters deductive reasoning as a part of clinical problem solving. Description: At the University of California, San Francisco, we require Present-an-Autopsy at the end of the second year of medical school. This component of the pathology course was first offered in the spring of 1996. The class is divided into groups of six to eight students. Each group is assigned an autopsy case and is supplied with a clinical summary, including chief complaint, history of present illness, medications, review of systems, family and social histories, admission physical exam findings, laboratory values, noninvasive and invasive procedures, and clinical course. The students are expected to review the gross organs in the morgue as well as pertinent hematoxylin and eosin-stained tissue sections with any important special stains. From the morphologic data, they are expected to develop anatomic diagnoses and correlate these findings with the clinical information. After going over the data, the students then research various aspects of the case. Each group of students organizes its findings and prepares a half-hour oral presentation. Two weeks later, each student group presents its case to a faculty member, including interpretation of the clinical history, physical exam findings, results of laboratory/diagnostic procedures, clinical course, autopsy gross and microscopic findings, differential diagnoses, and summation of the entire case. Discussion: Each student is evaluated for attendance, participation, presentation style, use of medical knowledge, deductive reasoning, and superior understanding of the pathogenesis of the disease process(es). The group as a whole is graded on a ten-point scale, with “10” representing a perfect presentation and “1” representing a very poor understanding of the material. Most student groups are given scores between 7 and 10; the mean group rating has been 9.1. Students' evaluations of this component of the pathology course have been outstanding; the item, “The Present-an-Autopsy was useful to my general medical education” received an average rating of 4.0 on a five-point scale (5 = strongly agree). Present-an-Autopsy has been very successful at encouraging second-year medical students to work as a team, use deductive reasoning, and apply their developing knowledge base to an actual clinical case. This teaching model requires carefully selecting autopsy cases that exemplify what second-year medical students are expected to have learned, recruiting faculty, and developing an objective grading scale to ensure consistent evaluation among faculty evaluators. Despite these challenges, this teaching model has been useful for getting second-year medical students to integrate and apply basic science knowledge.