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In the JRSM, last year, Baron1 lamented the decline of the necropsy. As a senior house officer in histopathology working in a district general hospital, I have managed to attend only four post-mortems in the past twelve months. Most of my colleagues in this region are in a similar predicament: Royal College of Pathologists training requirements for the first-year trainee include twenty post-mortem examinations. What can be done to improve matters?
Do we need to perform necropsies at all? Rutty and colleagues2 looked at the ability of pathologists to predict a cause of death from the available clinical history without conducting a postmortem examination, and found an error rate between 61% and 74%. This was not acceptable to replace coroner's necropsies. According to Home Office statistics, deaths reported to the coroner now account for one-third of all deaths in England and Wales, having risen from 130 000 in 1970 to 201 000 in 1999. In 1999 62% of the total referrals underwent post-mortem examination under the legal authority of the coroner3. These examinations could provide valuable opportunities for histopathology trainees and are widely used for this purpose in North America. Maintenance of regional databases of post-mortem examinations in hospitals without trainees could enable trainees on day release to attend or perform post-mortems. This would be a good way to use a dwindling resource for training. Another, and underexplored, approach is to use simulators. Simulator software is available on several pathology websites, but its usefulness needs to be evaluated properly. The Royal College of Pathologists must address this issue of training, or trainees will be emerging with serious skill shortages.