Table 5.

Application of AAMC Core EPAs Within a Structured Autopsy Pathology Experience.

	AAMC Core EPA	Autopsy Activities Relative to EPA	Frequency Found
1	Gather a history and perform a physical examination	History: Obtained from scene, police and EMS reports, interviews of family, witnesses, recent contacts; medical, social history, and social medial presence. Physical: Autopsy performance; any supplemental imaging; may have correlation with some physical diagnosis finding.	Common
2	Prioritize a differential following a clinical encounter	Goals of autopsy reviewed with faculty prior to start Observed forensic/autopsy pathologists form differentials and evaluation during autopsy—observed change of technique and exam as appropriate during gross examination with new differentials identified. Differential diagnosis based on gross findings and history—Formation of PAD and preliminary cause of death; use of PAD and communication postautopsy. Steps to narrow a differential Seeking additional history and scene findings Microscopic confirmation and/or delineation Role of toxicology, microbiology, or other testing Final autopsy findings and diagnosis Differential was part of autopsy presentation requirement	Common
3	Recommend and interpret common diagnostic and screening tests	Role of toxicology in forensic autopsy Postmortem toxicology interpretation Use of additional testing, ie, microbiology, clinical chemistry testing, hazardous gas detection, genetic, and other testing as appropriate Screening and communication to family, ie, unexpected atherosclerotic disease, thrombotic events, other potential genetic risks.	Occasional
4	Enter and discuss orders and prescriptions	Use of Prescription Drug Monitoring Program—becoming standard with patient prescription practice in many states Use of medication for likely medical history or confirmation/rebuttal of history obtained by family. Uncommon medication errors, side effects, adverse interactions; rare but powerful clinical lesson.	Occasional—Rare
5	Document a clinical encounter in the patient record	Students must prepare presentation of the case within a specified format and time limitation Strict limit of slides and time forces decisions on important aspects of presentations Oral communication and defense to group and faculty regarding case Structure of slides “forced” consideration of EPA’s without labeling them as such.	Common; Positive unsolicited response from students
6	Provide an oral presentation of a clinical encounter	Student teams present their patient within a 10-minute time frame Scripted PowerPoint® presentation on areas to be covered; Structured to maximize exposure to EPA’s Question period after presentation for clarification and assessment of knowledge learned Oral defense of death certification wording	Common; Positive unsolicited response from students
7	Form clinical questions and retrieve evidence to advance patient care	Clinical findings listed as part of presentation Students formulate medical issues and must explore one finding from autopsy as part of presentation Some autopsies had findings suitable for case report or presentation Students who desired working on case report or presentation (especially those interested in pathology) provided examples from these or other autopsy cases. Funding for national meeting if accepted and manuscript drafted.	Common; Enhanced opportunities for interested students
8	Give or receive a patient handover to transition care responsibility	Direct observation of case handoff between faculty and between investigators and faculty Death information summaries reinforced succinct and relevant summary needed Postautopsy tasks of PAD, calling family/agencies/others.	Uncommon; less directly applicable
9	Collaborate as a member of an interprofessional team	Autopsy and forensic pathology is a team sport. Investigators, police, EMS, medical records (from multiple sites), PDMP, scene investigation—all needed Some worked with FAA, NTSB, other agencies	Common but needs pointed out.
10	Recognize a patient requiring urgent or emergent care and initiate evaluation and management	Cases occurred where emergent care not recognized or the care plan not successful or not implemented with adverse outcomes Decisions in emergent care often documented in trauma cases and effects seen at autopsy	Uncommon but powerful examples
11	Obtain informed consent for tests/procedures	Discussion of forensic vs consented autopsy Religious and cultural objections discussion in forensic autopsies; importance of cultural awareness and sensitivity Components of valid autopsy permit	Discussion point; rare reconsent of autopsy needed
12	Perform general procedures of a physician	Death certification Family communication and cultural sensitivity Recognition and referral of appropriate cases to medicolegal system	Common
13	Identify system failures and contribute to a culture of safety and improvement	All groups had to document at least ONE unexpected finding at every autopsy; most were diagnostically trivial but usually provided learning opportunity. Expected findings in any autopsy: 40% with unexpected finding; 104 significant finding Cases with significant diagnostic findings at autopsy: Reporting mechanisms/peer-review/QA review in health systems Internal discussion of what might have altered course Routine exposure to other quality review agencies, ie, FAA/NTSB, accident reconstruction, OSHA, Consumer Product review, etc in many forensic autopsies. Experienced focus for improvements and safety.	Common discussion; powerful but uncommon examples

Abbreviations: AAMC, American Association of Medical Colleges; EPA, entrustable professional activity; EMS, emergency medical services; FAA, Federal Aviation Administration; NTSB, National Transportation Safety Board; OSHA, Occupational Safety and Health Administration; PAD, preliminary autopsy diagnosis; PDMA, prescription drug monitoring program; QA, quality management.