Revised December 26, 2008
GOALS AND OBJECTIVES
RESIDENT CURRICULUM FOR FORENSIC PATHOLOGY ROTATION
Rotation Director:
Lary Simms, DO, MPH
Forensic Pathologist & Medical Education Coordinator
Clark County Coroner’s Office
1704 Pinto Lane
Las Vegas, NV 89106
Office 702-455-4269 or Cell 702-561-8793
OVERVIEW
Educational Purpose
Internists are often confronted with the complex issue of determining the
necessity for an autopsy and requesting the autopsy from a family member or
power of attorney. Completing a rotation in Forensic Pathology will allow the
Internal Medicine resident to achieve better insight into autopsy practice and the
role of the medical examiner. It will introduce the student to the modern practice,
of forensic medicine, which is primarily a subspecialty of pathology. Residents
will:
 Attend and become familiar with autopsy practice and forensic autopsies
especially.
 Perform selected autopsy dissections.
 Reach an understanding of forensically and clinically relevant autopsy
anatomy.
 Correlate the level of clinical knowledge the student/resident possesses
with pathological findings at autopsy in relation to both natural disease
and injury
Teaching Methods
The rotation will be under the supervision of the attending pathologist. The
resident will attend autopsies. If the resident desires, attendance at death scenes
can be arranged through the Investigative Division of the Clark County Coroner’s
Office. If the resident desires, s/he may attend as a spectator at court testimony
by a forensic pathologist relating to both civil and criminal matters.
Mix of Diseases
Not applicable.
Patient Characteristics
Not applicable, as no direct patient care will occur.
Types of Clinical Encounters
Not applicable.
Common Clinical Presentations
Not applicable.
Procedures
The resident will observe the pathologist perform autopsies and participate as directed by
the attending pathologist.
Resident Supervision
Residents are supervised by the attending pathologist.
Didactic Teaching
Morning Report and Noon Conference
Residents are excused from these conferences when they are required to be on site
at conflicting hours. Residents are expected to attend Morbidity and Mortality
Conference, however.
Attending Teaching
Didactic discussions will be held regarding pathologic specimen consultation.
Core Reading Materials
1. Spitz and Fisher's Medicolegal Investigation of Death: guidelines for the
application of pathology to crime investigation, 4th edition, by Spitze et al (CC
Thomas, 2006)
2. Harrison’s Principle’s of Internal Medicine, 16th ed., Kasper DL, ed. McGraw
Hill
3. Robbins & Cotran Pathologic Basis of Disease, 7th ed. Kumar J, ed. Elsevier
Ancillary Educational Materials
Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology,
Endocrinology, Infectious Diseases, Rheumatology as well as General Medical
References (Harrison’s Principles of Internal Medicine, Cecil’s Textbook of
Medicine) are available 24 hours a day, seven days a week in the resident lounge.
Savitt Medical Library On-Line
Residents have access to the on-line services of Savitt Library (the main library of
the University of Nevada - Reno) via their computer in the resident room, Suite
300 of the 2040 W. Charleston Building. Access to this room is available 24
hours a day, seven days a week.
Full text is available for many peer-review journals including, but no limited to:
ACP Journal Club
Annals of Internal Medicine
British Medical Journal
Cancer
Circulation
Journal of the American College of Cardiology
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The Lancet
New England Journal of Medicine
Stroke
Also available on-line:
Harrison’s Principle’s of Internal Medicine, 14th ed.
Merck Manual, 17th ed.
Guide to Clinical Preventive Services, 2nd ed.
The Cochrane Library
Medline and Grateful Med Databases
Pathological Material and Other Educational Resources
As above
Training Sites
Clark County Coroner’s Office; Death Scenes; Clark County Judicial Court
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Competency-based Goals and Objectives
Learning Venues
Evaluation Methods
1.
2.
3.
4.
5.
Clark County Coroner’s Office
M&M Conference
Self Study
Death Scene
Judicial Court
A. Attending evaluation
B. Self Evaluation
Competency: Patient Care
Gathers information from investigators, family
members, caregivers, or clinicians prior to the autopsy
when appropriate
Understands the use of the death certificate and the
proper method of death certification
Understands the scope of investigations of sudden,
suspicious, or unnatural deaths
Competency : Medical Knowledge
Develops a general understanding of the purposes of
and approaches to medicolegal death investigation.
Develops a basic understanding of traumatic death
(gunshot wounds, stabbing, blunt force, burns, etc),
causes of sudden natural deaths (myocardial infarction,
pulmonary embolism, ruptured saccular aneurysm,
sudden infant death syndrome (SIDS), ruptured aortic
aneurysm, etc), and drug-related deaths.
Can cogently describe various anatomic abnormalities,
including injuries caused by various physical agents
Is able to effectively integrate and analyze information
to put together a cohesive picture of case, correlating
autopsy findings with the clinical history and cause of
death
Can follow a complete autopsy or external examination
and correctly assign the cause and manner of death as
well as the underlying mechanism
Competency: Practice Based Learning and
Improvement
Understands proper method of identifying patients.
Understands necessary components of forensic autopsy
report
Learning
Venues
1
Level Specificity
Not applicable, as the
rotation will occur
once during residency
Evaluation
Methods
1,3
1,3,4,5
Learning
Venues
1, 3,4,5
Evaluation
Methods
A, B
1, 3,4,5
A, B
1,3
A, B
1 ,2,3,4,5
A, B
1,3
A, B
Learning
Venues
1,3,4,5
1,3,4,5
Evaluation
Methods
A, B
A, B
4
Learning
Venues
1
Evaluation
Methods
A, B
1, 3
A, B
1,3, 4
A, B
1,3, 4
A, B
1,3, 4
A, B
1,3, 4
A, B
Competency: Interpersonal and Communication
Skills
Learning
Venues
Evaluation
Methods
Communicates effectively with family members,
caregivers, clinicians and other health care providers to
obtain information
Interacts effectively with investigative, administrative,
secretarial, and technical staff
Demonstrates effective communication skills in case
presentations and other meetings
1,4
A, B
1,4,5
A, B
1
A, B
Competency: Professionalism
Learning
Venues
Evaluation
Methods
Demonstrates respect for human remains and fosters
this attitude among other personnel
1,4,5
A, B
Adheres to ethical principles, accepts responsibility for
actions, admits mistakes, recognizes and addresses
ethical dilemmas, maintains confidentiality
1,4,5
A, B
Recognizes limits of abilities and need to consult with
others
1,4,5
A, B
Describes gross and microscopic autopsy findings as
appropriate and obtains adequate tissue sections with
supervision
Investigates cases using texts, journal articles, and
internet sources
Demonstrates knowledge of precautions to be taken
against infections and other hazards in the handling of
fresh tissue during autopsies
Learns proper techniques for photography,
documentation, and collection of samples from
clothing and body for use as evidence
Learns proper procedures for retrieving projectiles at
autopsy to preserve their value as ballistic evidence
Learns proper techniques used for sampling fluids and
tissues for forensic toxicology
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Learning
Venues
Evaluation
Methods
Works effectively with members of the health care
team, demonstrating courtesy and responsiveness to
views of others
1,4,5
A, B
Is sensitive to diversity of coworkers and patients
1,4,5
A, B
Engages in ongoing learning; shows initiative in
seeking new information; asks knowledgeable and
well-informed questions
1, 3,4,5
A, B
Is punctual, arriving on time for autopsies, conferences
and other meetings
1,2,4,5
A, B
Competency: Systems-Based Practice
Learning
Venues
Evaluation
Methods
Understands the role of the medical examiner or
forensic pathologist in the legal system and in public
health
Understands the criteria by which the medical
examiner has authority to claim jurisdiction over an
autopsy
Participates as warranted in forensic pathology
conferences dealing with management, quality
assurance, and graduate medical education
1, 3,4,5
A, B
1, 2, 3,4,5
A, B
1, 2
A, B
EVALUATION
A. Of Residents
At the completion of each rotation, all supervising faculty are required to
complete the standard ABIM resident evaluation form. All faculty are
encouraged to provide face-to-face feedback with the residents. In addition,
residents may receive interim feedback utilizing the ABIM’s Praise and Early
Warning cards.
B. Of Rotation and Preceptor
All residents are encouraged to evaluate the rotation, and the clinical faculty
member, at the completion of the rotation. This evaluation form is available on EValue. These evaluations are then converted to type and shared anonymously
with the clinical faculty. The program director also discusses the rotation with the
residents to ensure rotation quality and satisfaction.
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Forensic Pathology Rotation Requirements
1.
2.
3.
4.
5.
6.
7.
Rotation Schedule
a. Due to the volume of trainees, each resident will be issued a schedule
which will most likely include at least one weekend day per week.
b. The rotation begins at 8am daily and commonly finishes between 11am
and 1pm.
c. Attendance on holidays or weekend days is NOT required to pass the
rotation.
Death Scene Attendance
a. If the student/resident desires, attendance at death scenes can be arranged
thru the Investigative Division of Clark County Coroner’s Office
Court Testimony Attendance
a. If the student/resident desires, attendance as a spectator at court testimony
by a forensic pathologist relating to both civil and criminal matters
Attendance of the Medical Education Coordinator
a. There are two or three pathologists in autopsy every day of the week
b. Residents are free to circulate between the two pathologists during their
rotation
c. On days when the medical education coordinator is absent, the residents
will rotate with the pathologists assigned to autopsy on that day
d. If these pathologists do not facilitate the objectives of the rotation, the
residents should report this problem to the medical education coordinator
as soon as is reasonably possible
Absences
a. In order for the preceptor to certify the resident as passing the rotation, the
student must attend the scheduled days for the rotation.
b. If the resident has multiple unexcused absences, s/he will fail the
rotation. Exceptions may be granted only by the Medical Education
Coordinator for extenuating circumstances. Attendance at continuity
clinic and departmental assignments are excused.
Grading
a. Your evaluation papers will be completed by the pathologist with whom
you spent the most time.
b. Since grading is predominantly subjective, the resident is encouraged to
ask questions and make clear for themselves what is required to obtain a
minimum passing grade or a higher grade.
Completion of Documents
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8.
9.
a. Written certification of completion of the rotation and grading will NOT
be performed more than 2 weeks after the rotation is completed; therefore,
the resident is urged to submit all documents that need to be completed for
her/his educational institution PRIOR to the last day of the rotation.
Please mail the EXIT INTERVIEW FORM to the address listed at the
beginning of these goals and objectives.
Please return your VISITORS BADGE ID on the last day of rotation; if you
forget, then mail to the address listed at the beginning of these goals and
objectives.
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Forensic Pathology Rotation Checklist
1. Evaluation reviewed at mid-month and end of rotation by the supervising faculty
member and resident.
2. Complete assigned readings
3. Attended all assigned activities (excluding scheduled time away, required clinics and
emergencies).
4. Completed required case report abstracts and/or posters if assigned by the supervising
faculty member.
5. Demonstrated understanding of the basic principals of forensic pathology.
6. Receive verbal feedback from attending at end of rotation.
Intern/Resident Signature_________________________
Date___________________
Supervising Attending Signature___________________
Date___________________
All items must be completed for rotation credit.
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