Current residents: Autopsy numbers for boards and ACGME case log system

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I did a search for this, and it didn't turn up anything, so I apologize if this has been asked before. I understand the autopsy requirement for board eligibility is 50. So far, I have been keeping track of ALL of my autopsy cases including adult, fetal, partial autopsies, gross only, etc. with the intention of sorting out at a later time which ones I can can count for boards purposes. However, I was just wondering, for boards purposes, which ones I'm actually going to be alowed to count.

There seem to be quite a few differing opinions here at my program as to what one should be logging on the ACGME case log system. For example, one former resident was adamant that one could not count ANY autopsy that did not have histologic sections submitted. But, come on, that would mean you couldn't count 95% of the forensic cases, because they almost never submit sections, at least not at the coroner's office here. So, even though I am doing 3 or 4 full autopsies a day this month, I might only get to count maybe 8 for the whole month since that's probably about how many they will need histology on. That seems like total nonsense to me.

Another gray area for me is fetal autopsies. I know that it's common practice at many programs to count fetal autopsies towards numbers, but what about ones where we do a dissection but do not submit histologic sections (because the organs were too autolyzed)? On the one hand, it seems a little iffy to me. But at the same time, fetal autopsies in general seem a little suspect as far as counting them, and if you can count fetals at all, who cares if you throw some autolyzed tissue on a slide or not? It's usually pointless.

I'm just curious what others have been doing with regards to this. Have these issues come up for anyone else?

 

[deschutes]

I did a search for this, and it didn't turn up anything,

Nice work. At least you tried. And the reason you didn't turn up anything is because we haven't talked about this before.

Yes, continue keeping track of them. So far I have counted ALL my autopsy cases - adult, fetal, partial (heart only/brain only). Haven't done any forensic but I know for a fact that the seniors have counted those. Not so sure about gross-only: maybe that is why we scoop even some autolyzed tissue into the cassette? (Side note: am told that it costs over $1k to do an autopsy, but minus the brain and it becomes about $800. Silly, but there you have it.

Another thing for fetals:
Before 20 weeks they are processed as surgicals (i.e. the surgical pathologist signs out the case, the patient's mum gets billed).
After 20 weeks they are processed as autopsies (i.e. the autopsy pathologist signs out the case, and the hospital absorbs the cost.)

CPT codes for autopsies in the ACGME case log system are as follows:

88028 Necropsy (autopsy), gross and microscopic; infant with brain
88029 Necropsy (autopsy), gross and microscopic; stillborn or newborn with brain
88025 Necropsy (autopsy), gross and microscopic; with brain
88027 Necropsy (autopsy), gross and microscopic; with brain and spinal cord
88020 Necropsy (autopsy), gross and microscopic; without CNS
88040 Necropsy (autopsy); forensic examination

If any of the newbies are starting an autopsy rotation and haven't figured out the ACGME case log system amongst the piles of other orientation stuff, just make sure you keep a personal record of:

1) the case number, and
2) the site (if your institution has more than one site).

That way you can always go back and look it up at a later date.

 

[djmd]

While you are keeping track of case numbers and sites..

Might as well note the principle cause of death, patient age.
So making your list for the American Board of Pathology is easier...

 

[pathstudent]

The resident log also keeps track of BMs and FNAs. How many of those do we need to do to be board eligible?

 

[yaah]

It's also good to save copies of your reports, either just the main findings or the whole report. I did that for my PSF autopsies and it is coming in handy (I was in the last year that they are allowed to count).

I hear different things on forensic cases counting. Some say you can only count a certain number (that is, you can't have too many of your 50 cases as forensic cases). I heard 10, maximum, but others have heard differently.

 

[deschutes]

Not dissing the other suggestions, but I was talking like bare minimum CYA when you're charging out the door to the next month's rotation site. The rest you can figure out later with those 2 bits of info.

Dunno what the min. # for BMs is - I don't think there is one. We've discussed that before. Not so sure about FNAs.

 

[camtber]

I heard 10, maximum, but others have heard differently.

I have heard the limit is 10 forensics autopsies also. Has anyone heard any info. as to shared autopsies?

 

[DarksideAllstar]

It's also good to save copies of your reports, either just the main findings or the whole report. I did that for my PSF autopsies and it is coming in handy (I was in the last year that they are allowed to count).

Doh! Are you serious? Man, that blows. I looked at the ABP website earlier this year but couldn't find an explicit statement where it said that the PSF posts do not count toward BC. If you've got a link share it, por favor.

 

[yaah]

Doh! Are you serious? Man, that blows. I looked at the ABP website earlier this year but couldn't find an explicit statement where it said that the PSF posts do not count toward BC. If you've got a link share it, por favor.

It depends when you did your PSF. One of our current second years did a PSF in 2002-3, and his will not count. Mine was in 2001-2 and will. You can write to the ABP, which is what I did, and they will tell you how the rules apply to your specific situation.

 

[cytoborg]

The resident log also keeps track of BMs and FNAs. How many of those do we need to do to be board eligible?

There's no min. # for these (so what is the point of entering them, really?) as far as I know.

I have not heard of any minimums for shared or forensics autopsies. I am counting every single autopsy I ever laid a finger on, and hoping they count in the end.

10 for forensics seems pretty harsh - without the ME rotation lots of us would not make adequate #'s...

 

[b&ierstiefel]

We are allowed to count up to 20 autopsies done at the ME office.

 

[deschutes]

Re: autopsy numbers - I talked to our chief who is also on the CAP Residents' Forum. A lady from the ABP told the delegates to "just get fifty", the Board doesn't care what they are or where they come from. And remember, you can share.

And before you ask "What if I get 50 brain-only's? Can I count them all?"... seriously, it's pretty difficult to get 50 brain-only's or anything-only's.

Because if you are worried about your autopsy numbers, believe me there are a lot of smaller programs out there with even fewer.

 

[pathdoc68]

Re: autopsy numbers - I talked to our chief who is also on the CAP Residents' Forum. A lady from the ABP told the delegates to "just get fifty", the Board doesn't care what they are or where they come from. And remember, you can share.

And before you ask "What if I get 50 brain-only's? Can I count them all?"... seriously, it's pretty difficult to get 50 brain-only's or anything-only's.

Because if you are worried about your autopsy numbers, believe me there are a lot of smaller programs out there with even fewer.

This is basically what Betsy Bennett of ABP announced at last years CAP RF in Chicago

 

[deschutes]

Thanks for the corroboration!

Among all my stupid questions, I never actually voiced this one: I thought that by the end of residency, you have to know how to do an autopsy, which I took to mean "completely unassisted". The thought made me want to

"If you wiggle your fingers down in here...< insert disgusting farting noise >... and snip there just so - là là et là - voilà, the prostate is freed!"

I'm making this up - none of the PAs I've worked with have been remotely Belgian - but you know what I mean.

But now that I've rotated at the U and at the county hospital where there are PAs and ME techs who do the eviscerating, leaving me to dissect the organs, I'm starting to think "I can do this". With the adults, at least.

And there are always templates.

 

[SLUsagar]

no official word on # of forensic cases, but from people that have been audited in the past, i'd recommend definitely not having more than 20/50.

BM's: my understand is that no official #, basically just "competency," whatever that means. Your program probably might have a # req. that supercedes it.

FNA's: i've heard 5, and also again, just "competency." Just find 5 people to stick needles in and you'll be find (patients preferrable, and esp. if there's a lesion in question).

Sharing: If you participated, you count it. If a resident at the end of their autopsy month did the prosecting, but didn't s/o slides, and the next resident comes in, well than he/she gets credit just as well as the prosector. And count both as primary.

Weirdo: Again, if you participated, you count it. Fetal? yup. Brain/heart/organ specific? Yup. Hell, EVEN IF YOU REMOVE JUST THE L-VAD (left ventricular assist device), you count it. Hilariously, we've had autopsies where the just wanted nail clippings for fungal analysis, and well, you guessed it, you count it.

THE POINT: do all you can to get to 50, within an honest perspective. If the system allows it, let it.