3 Questions with Meagan Chambers, MD, MS, MSc

Working her way around the world with health organizations in Mongolia, the United Kingdom, and the United Nations, Meagan Chambers, MD, MS, MSc, neuropathology fellow at the University of Washington, cultivated communication skills and importantly, empathy. As a medical student, she actively pursued diverse experiences that would help her tie together the narratives of people’s lives through the intersection of personal and public health—all of which led her to pursue a career in medical autopsy.  

Here, Dr. Chambers shares her insight on handling the challenges and emotional aspects of medical autopsy and more in this edition of 3 Questions with (and a bonus question for good measure!).  

What impact do you hope to make through your work in this field? 

There are incredible challenges and, therefore, opportunities in medical autopsy. These include the need for new ways of learning how to perform high-quality medical autopsies given the ever-decreasing exposure in residency. Medical autopsy education has long been based on the premise that high-volume, hands-on experience with the procedure provides the comprehensive training necessary to approach a wide range of pathologies encountered in medical autopsy practice. In past decades, pathology residents regularly graduated having completed hundreds of autopsies. But this has drastically changed, most recently with the American Board of Pathology’s reduction to 30 required autopsies for graduation. Pathology residents are now expected to develop competence in medical autopsy pathology with less hands-on experience.  

Given this diminished opportunity to acquire experiential knowledge in autopsy during training, resources for medical autopsy pathology education are critical for developing and maintaining competency. To meet this challenge, I have focused on several educational initiatives within medical autopsy, including co-founding TheAutopsyBook.com. “The Autopsy Book” is a freely accessible, digital, educational resource featuring a searchable interface through which residents can review and approach common pathologies (such as pulmonary embolism, atherosclerosis, etc.) that they encounter in medical autopsy. This resource is different from currently available resources in that it forgoes descriptions of medical autopsy history, reporting templates, or descriptions of pathologies in exchange for practical, on-demand guidance that a resident or inexperienced attending pathologist can tailor to almost any medical autopsy they perform. The site received grant funding from the Association for Academic Pathology and includes a set of national collaborators who are leaders in medical autopsy.  

Pathology often involves working with cutting-edge technologies and diagnostic tools. What excites you about incorporating these advancements into your daily practice?  

Some people feel that innovation is not part of the modern-day medical autopsy. But it is exactly what is required to utilize its full potential as not only a descriptive post-mortem diagnostic tool, but also a tool for discovery and investigation. Rapid autopsies, a mechanism for tissue banking and translational research, do just that. Since first hearing about these programs as a medical student I have been keen to be involved. They are autopsies for tissue donation and, as the name implies, happen as soon as possible after the patient passes to make fresh tissue available to researchers.  

As a resident, I moonlighted as an on-call pathologist for rapid autopsy programs at the University of Washington as well as cultivated a national network of contacts to understand the diversity of these programs. I will continue this work with Stanford’s Research Autopsy Center headed by Dr. Jody Hooper next year as an Assistant Professor of Autopsy at Stanford University. These programs are unique in the meaning they bring to patients at the end of their life and their contributions to emerging research in areas of tumor heterogeneity and treatment resistance. Developing these, and other initiatives, which expand the application and value of the medical autopsy is a cornerstone of my vision for its future. 

Pathology can involve challenging cases and emotionally charged situations. How do you handle the emotional aspects of your work, such as delivering difficult diagnoses or dealing with patient outcomes?  

One thing I have learned through my work is that I am not here strictly for the innovation. I am here for people. It is so easy to lose sight of that child-like inspiration to go into medicine—the first spark of wanting to help people. But it’s necessary to keep that connection to patients alive because the act of service that is medicine is deeply nourishing. I am inspired by the donors to the rapid autopsy program who are finding meaning in one of the most challenging events all of us will have in our lives: death. Their commitment to the program is why I get out of bed at 2 a.m. to do a rapid autopsy. I know that this is true for my colleagues in the room with me as well. Though I see it regularly, I can hardly comprehend the dedication it takes to watch a family member pass away and have the very next action be picking up a phone to call a research team that will come and take them away. Their passion inspires my own and, in this way, it is the emotional aspects of my work that reinforce my love of it, rather than being a barrier or a challenge.   

Pathologists often collaborate with other healthcare professionals to provide comprehensive patient care. Tell us about a situation where you effectively collaborated with colleagues from different disciplines to optimize patient management. 

Autopsy pathology is intrinsically connected to a diverse set of stakeholders. Care teams across specialties are all connected by the medical autopsy and there is direct communication with the treating physicians with every case. Additionally, participation in quality improvement activities engages hospital administrators, and after death services work with nursing teams, social workers, and chaplains. Outside the hospital, there is regular communication with funeral homes and public health institutions. 

There are also novel applications of medical autopsy that offer important mechanisms for multidisciplinary communication. In my work with the rapid autopsy program at the University of Washington, I have spent many nights in an autopsy suite with researchers, oncologists, and patient care coordinators all working together to accomplish a patient’s dying wish to donate tissue contributing to greater understanding of their disease. The conversations that have happened in this space have reinforced that pathologists are the professional custodians of the autopsy and performing this procedure in a collaborative environment allows others in the health care system to understand the care and empathy that goes into this critical medical procedure. It is a privilege and a professional duty to bring our fellow healthcare professionals into this space and facilitate their journey with skill and kindness.