Death certificate completion: how well are physicians trained and are cardiovascular causes overstated?
OBJECTIVE
To determine the ability of residents in completing death certificates correctly.


METHODS
A total of 4800 residents were asked to complete a survey and cause-of-death statement using a sample case of in-hospital death due to urosepsis, of whom 590 residents (12%) responded. A scoring scale designed based on instructions from the National Association of Medical Examiners and the American College of Pathologists was used to measure responses quantitatively.


RESULTS
Overall performance was poor, with only 23% (n = 137) of responses in the optimal scoring range. The average score was influenced significantly by level of residency training, as well as previous experience, prior formal training, and awareness of the guidelines regarding death certificate completion. Optimal scores correlated with level of residency training and prior formal training in death certificate completion, suggesting the benefits of experience and instruction. Forty-five percent (n = 267) of respondents incorrectly identified a cardiovascular event as the primary cause of death.


CONCLUSIONS
The residents in this study demonstrated suboptimal performance in death certificate completion. Cardiovascular events were often incorrectly identified as the primary cause of death. Formal training can improve performance and should be emphasized in medical schools and residencies.
St. Luke's Hospital--University of Missouri Kansas City School of Medicine, Kansas City, Kansas, USA.
Dhanunjaya R
DR
Lakkireddy
Manohar S
MS
Gowda
Caroline W
CW
Murray
Krishnamohan R
KR
Basarakodu
James L
JL
Vacek
D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D015982:Bias; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D002423:Cause of Death; D003430:Cross-Sectional Studies; D003644:Death Certificates; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate / Q000592:standards*; D004522:Educational Status; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D017408:Guidelines as Topic; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D016015:Logistic Models; D008297:Male; D020380:Needs Assessment; D011361:Professional Competence / Q000592:standards*; D011446:Prospective Studies; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D014481:United States