Improving Death Certificate Completion: A Trial of Two Training Interventions

The death certificate is an important medical document that impacts mortality statistics and health care policy. Resident physician accuracy in completing death certificates is poor. We assessed the impact of two educational interventions on the quality of death certificate completion by resident physicians. Two-hundred and nineteen internal medicine residents were asked to complete a cause of death statement using a sample case of in-hospital death. Participants were randomized into one of two educational interventions: either an interactive workshop (group I) or provided with printed instruction material (group II). A total of 200 residents completed the study, with 100 in each group. At baseline, competency in death certificate completion was poor. Only 19% of residents achieved an optimal test score. Sixty percent erroneously identified a cardiac cause of death. The death certificate score improved significantly in both group I (14±6 vs 24±5, p<0.001) and group II (14±5 vs 19±5, p<0.001) postintervention from baseline. Group I had a higher degree of improvement than group II (24±5 vs 19±5, p<0.001). Resident physicians’ skills in death certificate completion can be improved with an educational intervention. An interactive workshop is a more effective intervention than a printed handout.