The public may have considerable appreciation of the nature and purposes of necropsy,' but these attitudes could change when people are faced with requests for necropsies on members of their own family. We investigated the level of satisfaction of bereaved relatives with a clinical necropsy service. Subjects, methods, and resultsWe selected 206 consecutive requests for clinical necropsies for inclusion in our study. At least six months (range 6-14 months) after the requests had been made, a specially trained academic psychologist tried to contact the relatives whose consent had been requested. Sixty seven of the relatives were excluded because they could not be contacted, they gave incomplete information, or there were issues of confidentiality or litigation. Of the remaining 139 relatives, 75 participated in the study-31 by the preferred method of personal interview, 31 by postal questionnaire, and 13 by telephone interview. Consent for necropsy had been given by 44 (59%) of the participants and 36 (56%) of the non-responders. Our open ended survey focused on how necropsy requests were made, relatives' reasons for their response, interference with funeral arrangements, and communication of results.The doctors who made the requests were 39 house officers, 13 senior house officers, 13 consultants, six senior registrars, and four registrars. Thirteen relatives were distressed by requests, primarily because of a lack of warning, poor timing, and failure to explain the reasons for the request. Distress did not affect relatives' response to the request, nor did the requesting doctor's clinical grade. Table 1 summarises the other main findings related to request procedures.The commonest reasons for refusing necropsy consent were failure to see any purpose for an necropsy, belief that the deceased had suffered enough, and dislike of the idea of a necropsy. Religious objections were rare. The commonest reasons for giving consent were to help others, desire for more information about deaths, and to assist medical science or research. Four necropsies interfered with funeral arrangements, always because ofpoor communication between mortuary staff and funeral directors. Only 17 relatives obtained necropsy results, and in three cases these were delayed for over a month. Delay in the issue of necropsy reports was the commonest reason for relatives not receiving results. The main benefits reported by the relatives who received results were reassurance and peace of mind. Four relatives reported no benefit. CommentAlthough this is essentially a local study, many of its findings may be relevant nationally. The high number of relatives distressed by requests for necropsies is unacceptable. No guidelines currently exist about this procedure despite the fact that the best clinical care can be undermined by failure to respond sensitively to bereaved relatives.2 Any loss of public support for necropsies will compromise efforts to increase necropsy rates for research, education, and audit. Our study of relatives' satisfaction with a cl...

An opportunity sample of 98, mostly undergraduate [1], participants completed Thalbourne's Transliminality Scale (Form B) [2–3] plus three subscales from Hartmann's Boundary Structure Questionnaire [4] (sleep/wake/dream, unusual experiences, thoughts/feelings/moods) plus a psychic experiences scale which included some of Hartmann's items. The results support the hypothesis, and Houran et al.'s [5] findings, that there is a significant positive correlation between selected boundary structure subscales and a measure of transliminality (range r = .384–.615). Our results are similar to Houran et al.'s in that only certain subscales were significant predictors of transliminality when the effects of others are taken into account. In this study only the psychic experiences scale, which is not one of Hartmann's original subscales [4, 6], was a significant predictor when the effects of the three other subscales were accounted for. The theories behind the concepts of boundary structure and transliminality suggest that individuals differ according to the extent to which different areas of the brain/mind are separated.

SummaryThis article discusses the possible aims, benefits, and also the content, format and timing of training in one specific aspect of clinical practice; how to request permission for post mortems. There is increasing concern regarding the current world-wide decline in clinical or hospital post mortem rates.' The reason for this concern is that the post mortem is still ofbenefit to both medical practice and to society. The decline is believed to be due to a number of complex factors.' Clinicians, particularly junior clinicians, are usually responsible for approaching relatives for their permission2 although in some cases specially trained decedent affairs staff may undertake this task.3 These individuals therefore have a key role in determining hospital post mortem rates. This is particularly true in those countries which are now changing from a system whereby patients or relatives had to opt out of clinical post mortems to a system in which relatives' consent must be obtained.A major factor in the decline in hospital post mortem rates is that fewer requests are being made.4 This may be due to a number of reasons including a fear of confronting the relatives,' personal discomfort,5'6 an inability to explain adequately the value of the post mortem,7 a belief that relatives are becoming more reluctant to give permission,8 or a desire not to upset the relatives.69The outcome of an autopsy request is highly dependent on the manner in which it is made.'0 Thus, the process would be easier for all concerned if those involved in making the requests had received appropriate training and if the requesting procedures were well-established.3Training in requesting permission for a hospital post mortem A large number of clinicians appear to have never received any formal training or advice in how to approach relatives for permission for a post mortem.2'5"1"2 Most clinicians learn through personal experience or by accompanying senior colleagues who have had no training themselves.5"2 Initial experiences could have long-term effects on clinicians' motivation and expectations regarding future requests, particularly if these experiences are negative. This is one reason why preparation via the provision of relevant training is important.Many junior clinicians feel that there is a need for training in how to request post mortems.8" Support for this proposal has come from a wide range of clinical and non-clinical sources.479"' It has been suggested that most basic skills required for medical practice should be acquired during the pre-registration year when supervisors have a responsibility to ensure that adequate training is provided. 14 Content of training

A postal survey of 434 clinicians at four local hospitals was undertaken in order to identify the methods by which clinicians learn how to request permission for hospital autopsies and to assess the preferred techniques and timing of relevant communication skills training. The majority of 128 responding clinicians had learnt through personal experience with some assistance from senior colleagues and peers. Few clinicians appeared to have learnt through formal training. The preferred methods for the provision of communication skills training were training in small groups (such as seminars or tutorials) and observation of clinicians at work. The most desirable time for the provision of this training was considered to be between the beginning of the final undergraduate year and the end of the pre-registration house officer year. The communication skills training provided within medical education is in need of improvement. More emphasis should be given to clinical-task- or situation-specific applications such as requesting permission for autopsies.