Australian Doctors’ FundRescuing Medical Education

The Death of the Autopsy and Oslerian Principles

P W Allen

Department of Anatomical Pathology

Flinders Medical Centre

South Australia

Sir William Osler aged 63 in 1912From Bliss, R. “William Osler. A life in Medicine.” Oxford University Press. 1999

Sir William Osler: 1849 - 19191874 – 1884. Lecturer, Institutes of Medicine,

Magill University, Montreal, Canada

1884 – 1888. Professor of Medicine, University of Pennsylvania, Philadelphia, USA

1888 – 1905. Professor of Medicine, Johns Hopkins Hospital, Baltimore, USA

1905 – 1919. Regius Professor of Medicine, Oxford University, England

Sir William Osler. Philadelphia Dead House, 1888

From Bliss, R. “William Osler. A life in Medicine.” Oxford University Press. 1999

Sir William Osler and students. Philadelphia Dead House, 1888From Bliss, R. “William Osler. A life in Medicine.” Oxford University Press. 1999

• Sir William Osler and studentsFrom Bliss, R. “William Osler. A life in Medicine.” Oxford University Press. 1999

International Association of Medical Museums (IAMM)

Osler was present at the first meeting held at the Army Medical Museum, the precursor of the Armed Forces Institute of Pathology (AFIP), in Washington DC on May 6, 1907

Sir William Osler

• Appointed IAMM Councillor for England in 1913 

• Persuaded Lord Strathcona (Don Smith) to donate US$5,000 to the IAMM

• This gift sustained a moribund IAMM from 1914 (WW1) to its rejuvenation in 1955 (post WW2), when the name was changed to the International Academy of Pathology (IAP)

Oslerian Principles

• Pathology is the basis of clinical medicine

• Clinical teaching is best if case based

• Autopsies provide the final answer

Results of the application ofOslerian Principles

• Clinico-pathological correlations

• Clinico-pathological conferences

• Pathology museums• Good clinicians

Results of the death ofOslerian Principles

• No autopsies• No clinico-pathological

correlations• No clinico-pathological

conferences• No pathology museums• No case based teaching• Bad clinicians

Reasons for the Death of the Australian Hospital Autopsy

• Removal of recognition of 12 months pathology training from physician training in the ’70s

• Unenthusiastic pathologists• Hospital funding cutbacks• Body parts “scandals’’• Journalistic and political

sensationalism• Patients’ rights advocates

Proposals for the Resurrection of Oslerian Principles

• Insist on a teaching hospital autopsy rate of 10%, with death reviews, for hospital accreditation

• Provide funds and staff for autopsies

• Encourage CPCs (accreditation)

• Encourage case based teaching

Proposals for the Resurrection of Oslerian Principles (cont)

• Fund and insist on more undergraduate pathology teaching by qualified pathologists

• Facilitate appropriate organ and tissue retention

• Include the new RCPA pathological sciences exam as a universal segment of part 1 exams for Australasian Royal Colleges

Proposals for the Resurrection of Oslerian Principles (cont.)

• Encourage physicians and surgeons to recognize 6 months autopsy, surgical pathology or radiology training as part of their specialist training

• Create an adequately documented, national, electronic, autopsy, surgical pathology and radiology museum using digital technology