The past 40 years have seen the publication of more than 26 000 articles on the necropsy. These deal with the usefulness and decline of the consent necropsy and the role of the necropsy in undergraduate medical education.^1–7 Therefore, it is surprising that, given intense public and professional interest in the necropsy,⁸ and the efforts expended on elucidating its roles in undergraduate education, the literature on the education of histopathology trainees in necropsy practice is virtually non-existent.

Histopathology trainees have traditionally been taught necropsy techniques by an apprenticeship process with varying degrees of supervision. We aimed to see whether videos of necropsy techniques could be used to supplement and augment training in necropsy practice.

METHODS

Videos

In 2000, the University of Sheffield (UK) learning media unit produced a series of four structured, scripted necropsy training videos for medical education with the consent of the relatives of the deceased (table 1).⁹ These were aimed at undergraduates and postgraduate histopathology trainees. The programmes were developed to be viewed individually or as a series. To our knowledge, this is the only video series of its kind in the world.

The video series was shown to delegates (senior house officers (SHOs) and specialist registrars (SpRs) in histopathology from around the UK) on the “2001 University of Sheffield short course on the autopsy” following a “live” necropsy demonstration. Because this research was intended to survey a new proposition, it was explorative in nature and used both quantitative and qualitative research methods. Consequently, the sample was not intended to be either comprehensive or representative.

Delegates who agreed to participate in our study completed a short questionnaire seeking categorical responses (strongly agree, agree, disagree, strongly disagree) to six “Likert-type” questions, and free text responses to questions about the usefulness of the videos as a teaching medium (table 2). The answers to the Likert-type questions were collated and analysed in the statistics package SPSS Version 9.0. Given the sample size, only quantitative descriptive statistics were undertaken. Free text responses were subjected to a themed content analysis in which themes were derived by aggregating similar statements from within the responses.^10,11

RESULTS

All 38 delegates who viewed the videotape presentation completed a feedback questionnaire. Eighteen were SHOs, 19 were SpRs in histopathology, and one was of unknown grade.

Quantitative analysis

Seventeen SHOs and 17 SpRs felt that the video presentations were of benefit to the course (strongly agree/agree), with 16 SHOs and 15 SpRs stating that the videos enhanced their learning experience. SHOs appeared to find the videos more beneficial than SpRs: 13 SHOs felt that it would have been difficult to learn as much about necropsies without viewing the videos, whereas 11 of the SpRs felt that this was the case. Moreover, SHOs were more likely (seven of 18 v one of 19) than SpRs to agree strongly that it would have been difficult to learn as much about necropsies without viewing the videos. Thirty four of the delegates strongly agreed/agreed that the videos were interesting and 35 enjoyed watching the videos. Tables 3–8 summarise the results.

Qualitative analysis

Twenty six themes were identified and grouped into six “metathemes”, namely: (1) the usefulness of the videos; (2) unhelpful aspects of the videos; (3) comparing the videos with mortuary based teaching; (4) how the videos could be improved; (5) how to view the videos; and (6) recommending videos to colleagues (33 delegates reported that they would recommend the videos to their colleagues). Table 9 presents the (meta)themes.

DISCUSSION

Currently, trainee histopathologists must demonstrate competence in necropsy practice in addition to surgical pathology. Such competence has traditionally been acquired via an apprenticeship in the mortuary (perhaps with little supervision) and reference to the relatively few available textbooks on necropsy practice. The continued decline in the hospital necropsy rate during the past 20 years^12,13 means that trainees may struggle to gain sufficient exposure to standard and specialist techniques, particularly if they are unable to perform medicolegal necropsies.⁸

There is an extensive literature on the uses of the necropsy in medical practice and undergraduate medical education.¹⁴ Given the increasing requirement that medical education be grounded in educational theory and research,¹⁵ it is perhaps surprising that there are only occasional studies investigating postmortem techniques.¹⁶ No study has evaluated methods of postgraduate necropsy training. Previous studies have shown the usefulness of videos, video stills,¹⁷ video links,⁵ and computer assisted learning packages^18–20 in the teaching of morbid anatomy²¹ and pathology to undergraduates. Ours is the first study to explore the use of videos as an adjunct to the mortuary based teaching of necropsy dissection techniques to histopathology trainees.

Using the survey as a research methodology,^22,23 with a questionnaire to collect a combination of quantitative and qualitative data, we have shown that structured, scripted videos may provide a useful adjunct to postgraduate training. Our study shows that such videos are acceptable to trainees, and enjoyable to watch. Furthermore, the trainees (and especially the SHOs) in our study subjectively felt that the videos enhanced their learning of necropsy techniques.

“The continued decline in the hospital necropsy rate during the past 20 years means that trainees may struggle to gain sufficient exposure to standard and specialist techniques”

Participants felt that videos demonstrating specialist techniques (techniques that all necropsy pathologists should be familiar with but which do not form part of every necropsy) were most relevant to their training. This probably reflects the declining hospital necropsy rate and concomitant decline in the opportunity to witness and perform such procedures. Moreover, it may reflect our intention when producing the videos that the demonstration of general necropsy procedures (video 2) would be mostly directed at the needs of undergraduates.

Producing the series of videos used in our study was both expensive and extremely time consuming, given the need for script writing, sound and film crews, editing, voice overs, and graphics. The four programmes were originally designed to be viewable both as a series and to stand alone. Judging from the qualitative data (metatheme 5), this objective was achieved. However, as a consequence, there was a necessary degree of repetition, which participants found distracting when viewing the programmes together (theme w). In aiming to give undergraduates an idea of what the necropsy entails, the demonstration of general necropsy techniques and eviscerations was regarded by some trainees as being too cursory to be helpful (theme f). Some technical aspects of the videos were not to the tastes of all delegates—such as the use of a colour wash over the images during the introductions to the programmes (theme h). Such issues should be borne in mind when designing future videos for necropsy teaching (metatheme 4).

Videos can be made accessible to large numbers of students at one time (via a data projector), and students may watch them on their own (or in small groups) in their own time and at their own pace (themes n and o). Videos can also deliver focused teaching on specific aspects of necropsy technique (themes k and m).

We conclude that videos can form a valuable and acceptable adjunct to mortuary based teaching when training histopathology trainees in necropsy techniques. Such videos appear most useful when demonstrating specialist techniques rarely encountered at necropsy to junior trainees, but continue to have a role for more experienced trainees revising for examinations.