title: Post-mortem external examination: competence, education and accuracy of general practitioners in a metropolitan area.
abstract: In several countries, general practitioners conduct post-mortem external examination (PMEE) and certify death in out-of-hospital cases. A possible lack of accuracy has been repeatedly criticised, although data on everyday practice of PMEE on outpatients are scarce. To evaluate medical practitioner's competence, education and accuracy regarding PMEE, we conducted a fax-survey among 1343 medical doctors in the metropolitan area of Hamburg, Germany. The results indicate considerable shortcomings in up to 63% regarding the inspection of body orifices and hidden areas, palpation of osseous structures, ectropionisation of the eyelids and use of aids. More than 5% of respondents reported to fill in a death certificate without performing a complete PMEE in the majority of cases. While theoretical teaching on PMEE was reported quite frequently (up to 78%), a considerably smaller group received practical training (32% during undergraduate and 13% during postgraduate education). To estimate the effects of training on PMEE, an individual "accuracy score" was calculated (range 1-5). Mean score was 3.63 (SD 0.81), and results differed significantly (p < 0.001) among groups of medical practitioners with or without education on PMEE and was highest among doctors who received practical training (p < 0.005). The results indicate that there are major shortcomings in a relevant portion of PMEE performed on out-of-hospital deaths that might lead to misdiagnosis of non-natural causes of deaths and homicides. Practical pre- and postgraduate education appears to positively impact accuracy and therefore quality of the procedure. Consequently, corresponding practical training should be mandatory during academic studies and ongoing education programs.
authors.affiliation: Department of Legal Medicine, University Medical Center Hamburg Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.
authors.forename: Ann Sophie
authors.initials: AS
authors.lastname: Schröder
authors.affiliation: Department of Legal Medicine, University Medical Center Hamburg Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Wilmes
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Sehner
authors.affiliation: Department of General Practice/Primary Care, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Maren
authors.initials: M
authors.lastname: Ehrhardt
authors.affiliation: Department of General Practice/Primary Care, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.|Institute for General Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
authors.forename: Hanna
authors.initials: H
authors.lastname: Kaduszkiewicz
authors.affiliation: Department of Legal Medicine, University Medical Center Hamburg Eppendorf, Butenfeld 34, 22529, Hamburg, Germany. s.anders@uke.de.
authors.forename: Sven
authors.identifier: http://orcid.org/0000-0002-1268-5022
authors.initials: S
authors.lastname: Anders
mesh_terms: D000328:Adult; D000368:Aged; D001344:Autopsy; D002983:Clinical Competence; D003644:Death Certificates; D004503:Education, Medical, Graduate; D004504:Education, Medical, Undergraduate; D005260:Female; D005554:Forensic Medicine / Q000193:education; D058005:General Practitioners / Q000706:statistics & numerical data*; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: External examination; Forensic medicine; Medical education; Postmortem