title: B-learning training in the certification of causes of death.
abstract: BACKGROUND
  An adequate certification of causes of death is essential for Public Health. The objective of this work is to improve the professional competence of medicine students and family doctors with regard to the certification of causes of death according to the international regulations of the WHO.
  
  
  METHODS
  Intervention-formation, before and after design, addressed to students of Medicine in their last year (6th year), and Family Doctors and Interns. The blended learning or b-learning program consisted in an on-site seminar-workshop, plus basic information/documentation stored in an on-line platform, together with the preparation of Certificates of Causes of Death based on Clinical Histories of real cases.
  
  
  RESULTS
  308 students participated in the program. We observed an individual improvement in the professional competence in all certifications of death, which was significant in 3 out of 5 cases (it was not significant in a medical-legal case of violent death and the case of a pluripathological chronic patient). The intermediate causes improved in all cases. Most formal aspects of the certification improved with significant changes. In the group of 62 Family Doctors and interns who took part in the program there were improvements in the basic or underlying causes in 4 of the 5 cases and improvements in the formal quality of the assessment, although less significantly than in students, because they started with better basal indexes in their certificates in the Before stage of the study.
  
  
  CONCLUSIONS
  Blended learning training has shown to be effective in improving the professional competence, both in students of the Degree of Medicine and in practicing Family Doctors and Interns.
authors.affiliation: Department of Preventive Medicine and Public Health of the Faculty of Medicine, University of Salamanca, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Alonso-Sardón
authors.affiliation: Department of Preventive Medicine and Public Health of the Faculty of Medicine, University of Salamanca, Spain.
authors.forename: Helena
authors.initials: H
authors.lastname: Iglesias-de-Sena
authors.affiliation: Department of Preventive Medicine and Public Health of the Faculty of Medicine, University of Salamanca, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Sáez-Lorenzo
authors.affiliation: Internal Medicine, University Hospital of Salamanca, Spain.
authors.forename: Antonio Javier
authors.initials: AJ
authors.lastname: Chamorro Fernández
authors.affiliation: Department of Legal Medicine of the Faculty of Medicine, University of Salamanca, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Salvat-Puig
authors.affiliation: Department of Preventive Medicine and Public Health of the Faculty of Medicine, University of Salamanca, Spain. Electronic address: miroxx@usal.es.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Mirón-Canelo
mesh_terms: D000004:Abbreviations as Topic; D002423:Cause of Death; D002983:Clinical Competence; D003644:Death Certificates; D004502:Education, Medical, Continuing / Q000379:methods*; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006236:Handwriting; D006801:Humans; D011786:Quality Control; D009626:Terminology as Topic; D014944:World Health Organization
keywords: B-learning training intervention; Before and after intervention design; International standards of certification (WHO); Medical certificate of death; Mortality statistics