Multidisciplinary Quality Improvement Conference (MDPI)

Medicine-Pathology Interdepartmental Autopsy Conference
This conference involves discussion of completed autopsy cases at Berkshire Medical Center. The conference
occurs every month. The format is modeled after the Case Records of the Massachusetts General Hospital, as
published regularly in the New England Journal of Medicine, and involves active participation by both the Department
of Medicine as well as the Department of Pathology. Typically one to two autopsy cases are presented within the
hour-long conference timeframe. Cases may be selected by the Medicine or Pathology Department Chief Resident,
Residency Director or Associate Residency Director, with preference given to more academically interesting cases.
The presenting residents from both Medicine and Pathology Departments, along with an attending preceptor,
Program Director, Associate Director or chief resident, will meet together approximately 3-4 weeks prior to the
conference in order to compare their respective presentations.
The Medicine Chief Resident will ensure that Medicine and Pathology residents are provided the premortem clinical
summary of the autopsy case(s) (with patient name or other identifiers withheld) ahead of time, prior to the
conference, so that they may come prepared with an informed differential diagnosis. All information presented is
treated as confidential and protected and the Department Chair periodically reminds attendees of this.
Medical Residents
Dept. of Medicine Chair & PD or Associate PD
Dept. of Medicine Staff (Specialists; as-needed depending on case)
Pathology Residents
Dept. of Pathology Chair & PD or Associate PD
(Staff from Depts. of Medicine and Pathology are welcome to attend but not required)
Core Competencies:
This experience will integrate several of the core clinical competencies including: patient care, medical knowledge,
practice-based learning and improvement, professionalism, interpersonal and communication skills, and systems
based practice.
Goals and Objectives:
 Gain expertise in assimilating clinical data/information into a logical, well thought-out differential diagnosis
 Gain expertise in performing literature searches
 Gain comfort in presenting to a group of educated listeners
 Learn to work effectively with a multidisciplinary group
 Learn the roles the Pathology/Laboratory service can assist in diagnosis and patient care
 Learn to use multimedia / computers / PowerPoint
 Learn about the importance of autopsy in assisting with unresolved pre-mortem differential diagnoses
 Case chosen by Chief Resident, Program Director or Associate Program Director of either Medicine or
Pathology Department.
Conference occurs every month during hours on a designated day.
Presenting Resident selects a faculty member to precept (may include Chief Resident)
Resident should work with preceptor to define teaching goals
Resident should work with preceptor to define organization of talk
Resident analyzes case for clinical differential diagnosis
Resident reviews appropriate literature
Resident works with appropriate faculty and Chief Resident to create discussion (generally in PowerPoint
The presenting Medicine and Pathology residents, along with case preceptors (generally the respective
Program Directors or Associate Program Directors), meet ahead of time to compare each of the respective
presentations (typically PowerPoint) and work to merge the two presentations into one (see agenda below).
Format of presentation generally follows that of the Case Records of the Massachusetts General Hospital,
as regularly published in the New England Journal of Medicine.
The presenting Medicine and Pathology residents discusses appropriate details of case (using timeline
format), teaching points, and leads discussion of system changes in an interactive manner with
multidisciplinary team during the 1 hour conference.
A sample agenda is as follows:
12:10 – 12:15
Initial case presentation up to skin and GI biopsies
Medicine Resident
12:16 – 12:20
Discussion of skin and GI biopsies
Path. Resident
12:21 – 12:22
Poll housestaff for differential diagnosis
Medicine Resident
12:23 – 12:25
Clinical approach to glomerulonephritis
12:26 – 12:28
12:29 – 12:40
12:41 – 12:43
12:44 – 12:50
12:51 – 12:55
Mid hospital course up to renal biopsies
Discussion of renal biopsy and final skin biopsy
Completion of hospital course to autopsy
Discussion of autopsy findings
General case discussion
12:56 – 13:00
Brief review of the literature relating to diagnosis
Medicine Resident
Path. Resident
Medicine Resident
Path. Resident
Nephrologist, other
participants including
Program Directors
Medicine Resident
The presenting Medicine and Pathology Resident will meet with their respective preceptor, chief residents
and/or program directors following the conference and receive formal feedback on presenting skills,
organization, content, relevance of material, and any other appropriate areas.