Horowitz Richard E, Naritoku Wesley Y
Department of Pathology and Laboratory Medicine, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073, USA.
Hum Pathol. 2007 May;38(5):688-695. doi: 10.1016/j.humpath.2007.01.001. Epub 2007 Mar 21.
A survey of pathology training programs about current operations and attitudes revealed that the autopsy is underused in medical student and pathology resident teaching, is inadequately reported, often does not have a dedicated faculty, is not championed by pathologists or clinicians, is not valued as a performance measure, and is barely used as a resource for medical research. The autopsy can be reestablished as a teaching tool and performance measure, but this will require that the autopsy be recognized as a credible and valuable medical procedure. The autopsy must then be funded; and new sources of both volume and funding, such as incorporating autopsies into payment schedules, into clinical trials, and in pay-for-performance initiatives, must be solicited. Once there is reimbursement for autopsies, pathologists, clinicians, and health care administrators will embrace the autopsy as a new source of revenue and as a valid measure of physician, hospital, and health system performance. Pathologists and the pathology specialty societies must take the lead in the reestablishment of the autopsy and must, at the same time, encourage innovations such as centralization, greater use of Pathology Assistants, and application of molecular techniques. New tools for using the autopsy in medical student teaching should be embraced, and the role of the autopsy in pathology residency programs must be reevaluated.
一项关于当前病理学培训项目运作情况和态度的调查显示，尸检在医学生和病理学住院医师教学中的应用不足，报告不充分，通常没有专门的教员，病理学家或临床医生不支持，未被视为一项绩效指标，也几乎未被用作医学研究资源。尸检可以重新确立为一种教学工具和绩效指标，但这需要将尸检视为一种可靠且有价值的医疗程序。然后必须为尸检提供资金；必须寻求新的尸检数量和资金来源，比如将尸检纳入付费计划、临床试验以及绩效付费倡议中。一旦尸检能够得到报销，病理学家、临床医生和医疗保健管理人员将会把尸检视为一种新的收入来源以及衡量医生、医院和医疗系统绩效的有效指标。病理学家和病理学专业协会必须带头重新确立尸检的地位，同时必须鼓励诸如集中化、更多地使用病理学助理以及应用分子技术等创新举措。应该采用在医学生教学中使用尸检的新工具，并且必须重新评估尸检在病理学住院医师培训项目中的作用。
