ACCURACY OF DEATH CERTIFICATE COMPLETION - THE NEED FOR FORMALIZED PHYSICIAN TRAINING

Objective.-To assess the extent to which accuracy of death certificate completion varies with level of physician training and experience. De sign and Setting.-In a classroom setting, subjects were presented with six written cases of hospital deaths adapted from materials from the National Center for Health Statistics and were asked to complete the c ause-of-death section of the New York City death certificate. Particip ants.-A total of 12 practicing general internists, 21 internal medicin e residents, and 35 senior medical students. Outcome Measures.-The und erlying cause of death recorded by each participant was compared with the correct cause determined by a nosologist. Agreement and disagreeme nt were classified as major or minor depending on concordance within t he 17 International Classification of Diseases categories. Results.-On ly one internist and five residents had received formal training in de ath certificate completion. The overall level of agreement between und erlying cause of death reported by the three groups of participants an d the correct cause was 56.9% for internists, 56.0% for residents, and 55.7% for medical students, although agreement varied with the type o f case, ranging from 15% to 99%. Conclusions.-If the misclassification observed in this pilot study were widespread, it would imply a substa ntial underreporting of mortality from both circulatory diseases and d iabetes. These data strongly support the need to include training in d eath certificate completion as part of physician education.