How do clinicians learn to request permission for autopsies?

Abstract

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.

Breaking bad news: experiences, views and difficulties of pre-registration house officers

“…24 Many qualified doctors would benefit from training since most of them have never received educational sessions on bad news whilst at the same time they act as role models for their younger colleagues and thereby influence actual clinical practice.6,25 Last but not least it has to be taken into account that organizational and structural factors can either assist or undermine doctors in their efforts to put into practice ethically sound and skilled communication when disclosing bad news. Given that organizational factors and work pressures make it hard to maintain the highest standards which we are teaching undergraduates to aim for, there needs to be both a recognition of these constraints, efforts to change those which could be changed and opportunities for postgraduate education to build upon the undergraduate teaching and to address the situations of bad news that doctors are now dealing with.…”

Death of the teaching autopsy

“…Without exposure to autopsy, clinicians are unlikely to become advocates of autopsy6 10 or have the skills necessary for sensitively requesting postmortem examinations 18. The public generally accepts the need for autopsy, but families are unlikely to grant consent if they feel stressed or do not fully understand why a postmortem is required 19.…”

Autopsy Rates in the Department of Veterans Affairs Comparisons by Treating Specialty and Venue

“…Attitude surveys have found that trainees find the task unpleasant, are concerned with upsetting families, and believe they have been inadequately prepared to conduct inquiries and answer family questions [19,20]. Sherwood and colleagues in a survey of practicing physicians found that few had any formal instruction in how to inquire about an autopsy [21].…”