[On efficacy in courses of causes of death certification to physicians in specialty training]

The causes of death are the pathologies that physicians fill on death certificates. The causes of death quality is a mandatory requirement for useful mortality statistics. To train physicians is essential for the correct fulfillment of death causes. The objective of this paper was to evaluate the efficacy of courses on causes of death certification to all physicians in specialty training.

A descriptive observational epidemiological study was conducted to evaluate the efficacy of medical death certification in eighteen in-person courses using a quasi-experimental pre- and posttest design aimed to all physicians during their specialty training in Spain. We assessed: legible handwriting; logical sequence; absence of abbreviations and acronyms; causal sequence, no added causes, no omitted causes; immediate, intermediate, fundamental causes, other conditions, and underlying cause. Correct toll was the achievement of 2/3 of the maximum score; and Suitable, the achievement of the correct score in logical and causal sequences, without added or omitted causes, and the three underlying causes of initial and final paired cases. We applied bivariate statistics to paired/unpaired indicators between individual/grouped pre-posttests, and multivariate statistics adjusting for evaluator and course.

96% of cases were included, and the 85% paired pre-posttests. The individual indicators grouped into Form, Concept, Result, and Total, improved significantly from the pretest. The matched and adjusted analysis showed a 26% to 80% increase of Suitable physicians in specialty training.

The efficacy of the courses on medical certification is assessed. Systematic courses on certification of causes of death for all physicians in specialty training should be implemented.