Bridging the gap: Assessing death certification competency in Bulgarian healthcare education
- Authors: Kolev Y.G.1,2, Valentinova T.1, Stefanovski P.H.1, Tumbeva E.1, Mirochnik N.M.1, Kolev P.Y.3
-
Affiliations:
- Medical University of Pleven
- Department of Forensic Medicine, District hospital MBAL
- Medical Faculty of Sofia University
- Issue: Vol 9, No 4 (2023)
- Pages: 391-401
- Section: ORIGINAL STUDY ARTICLES
- URL: https://journals.rcsi.science/2411-8729/article/view/251333
- DOI: https://doi.org/10.17816/fm14219
- ID: 251333
Cite item
Abstract
BACKGROUND: In Bulgaria, procedural protocols following a citizen’s death are governed by an intricate network of normative documents. Despite the presumed alignment between international and national guidelines, practical experiences reveal shortcomings in the proficiency of healthcare providers, particularly in cases involving prior medical interventions or systemic vulnerabilities.
AIM: This study aimed to assess the readiness of final-year medical students and early-career physicians in navigating death certification intricacies, including their responses, documentation precision, and postmortem procedures for bereaved families, with implications for national health statistics.
MATERIALS AND METHODS: By employing a mixed-methods approach, this study distributed questionnaires to sixth-year medical students and practicing physicians, including those in emergency medicine centers and general practice. Data collection included paper-based and digital questionnaires, ensuring anonymity and ethical compliance. Statistical analysis, employing parametric (t-test) and nonparametric (Chi-square) tests, forms the basis for actionable recommendations and educational material development.
RESULTS: This study included 143 participants, of which 41% expressed apprehension about managing out-of-hospital deaths. Approximately 44% claimed familiarity with death certification regulations, with students displaying higher theoretical confidence but lacking practical knowledge. Remarkably, 74% of physicians never received formal training in death certification. Discrepancies in issuing death certificates, timing, and notification procedures were identified.
CONCLUSION: Findings reveal varying practices among physicians according to their specialties. Issues related to documentation, timing, and notification were prevalent. The study emphasizes the need for improved training, particularly for medical students. Emergency medicine doctors exhibited higher preparedness levels. Medical students and early-career physicians urgently require enhanced education in death certification preparedness. Incorporating these topics into medical curricula, offering specialized courses, and disseminating instructional materials can significantly enhance effectiveness. Future studies should assess the quality and accuracy of recorded causes of death, which affect healthcare statistics, public service, and legal procedures, underscoring the societal and administrative significance of death certification practices.
Full Text
##article.viewOnOriginalSite##About the authors
Yanko G. Kolev
Medical University of Pleven; Department of Forensic Medicine, District hospital MBAL
Email: drforensic@gmail.com
ORCID iD: 0000-0003-2958-1702
MD, Dr. Sci. (Med.), Assistant Lecturer
Bulgaria, Pleven; GabrovoTsvetelina Valentinova
Medical University of Pleven
Author for correspondence.
Email: tsvm2002@yahoo.com
ORCID iD: 0000-0001-7095-5572
MD, Assistant Professor
Bulgaria, PlevenPetko H. Stefanovski
Medical University of Pleven
Email: p.stefanovski@gmail.com
ORCID iD: 0000-0002-9676-3605
MD, Assistant Professor
Bulgaria, PlevenElka Tumbeva
Medical University of Pleven
Email: e.tumbeva@abv.bg
ORCID iD: 0000-0003-0292-7347
Assistant Lecturer
Bulgaria, PlevenNikolay M. Mirochnik
Medical University of Pleven
Email: nikolaimirochnik@gmail.com
ORCID iD: 0009-0004-0115-9985
Bulgaria, Pleven
Preslav-Geo Y. Kolev
Medical Faculty of Sofia University
Email: preslavgeo1@gmail.com
ORCID iD: 0009-0008-7679-1124
Bulgaria, Sofia
References
- Martin M.P. Medical certificate of cause of death: Looking for an European single standard // J Forensic Leg Med. 2020. N 75. P. 102052. doi: 10.1016/j.jflm.2020.102052
- Madadin M. Medical students’ knowledge of the cause-of-death certification: A descriptive, cross-sectional study from Saudi Arabia // Int J Gen Med. 2021. N 14. P. 9663–9669. doi: 10.2147/IJGM.S343787
- Nyondo T., Msigwa G., Cobos D., et al. Improving quality of medical certification of causes of death in health facilities in Tanzania 2014–2019 // BMC Health Serv Res. 2021. Vol. 21, Suppl. 1. P. 214. doi: 10.1186/s12913-021-06189-7
- Kotabagi R.B., Chaturvedi R.K., Banerjee A. Medical certification of cause of death // Med J Armed Forces India. 2004. Vol. 60, N 3. P. 261–272. doi: 10.1016/S0377-1237(04)80060-1
- Hart J.D., Sorchik R., Bo K.S., et al. Improving medical certification of cause of death: Effective strategies and approaches based on experiences from the Data for Health Initiative // BMC Med. 2020. Vol. 18, N 1. P. 74. doi: 10.1186/s12916-020-01519-8
- Joshi R., Hazard R.H., Mahesh P.K., et al. Improving cause of death certification in the Philippines: Implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths // BMC Public Health. 2021. Vol. 21, N 1. P. 563. doi: 10.1186/s12889-021-10542-0
- Midelfart J., Aase S. The value of autopsy from a clinical point of view. A survey of 250 general practitioners and hospital clinicians in the county of Sør-Trøndelag, Norway // APMIS. 1998. Vol. 106, N 7. P. 693–698.
- Filippatos G., Andriopoulos P., Panoutsopoulos G., et al. The quality of death certification practice in Greece // Hippokratia. 2016. Vol. 20, N 1. P. 19–25.
- Myers K.A., Farquhar D.R. Improving the accuracy of death certification // CMAJ. 1998. Vol. 158, N 10. P. 1317–1323.
- McAllum C., George I.S., White G. Death certification and doctors’ dilemmas: A qualitative study of GPS’ perspectives // Brit J General Pract. 2005. Vol. 55, N 518. P. 677–683.
- Suzat B., Charvin M., Gouriot M., et al. [What are the obstacles to drawing up a death certificate in a home setting? A survey of doctors in Normandy. (French)] // Rev Epidemiol Sante Publique. 2022. Vol. 70, N 6. P. 259–264. doi: 10.1016/j.respe.2022.07.004
- Aung E., Rao C., Walker S. Teaching cause-of-death certification: Lessons from international experience // Postgraduate Med J. 2010. Vol. 86, N 1013. P. 143–152. doi: 10.1136/pgmj.2009.089821
- Gamage U.S., Mahesh P.K., Schnall J., et al. Effectiveness of training interventions to improve quality of medical certification of cause of death: Systematic review and metaanalysis // BMC Med. 2020. Vol. 18, N 1. P. 384. doi: 10.1186/s12916-020-01840-2
- Isotalo A. Medico-legal aspects of medical certification of cause of death // Bull World Health Organ. 1960. Vol. 23, N 6. P. 811–814.
- National Academies of Sciences, Engineering, and Medicine [интернет]. Improving the quality and accuracy of death certificates in assessing mortality among U.S. working-age adults. 2019. Режим доступа: https://nap.nationalacademies.org/resource/25976/Death-Certificate-brief.pdf. Дата обращения: 15.11.2023.
- Ali N., Hamadeh R. Improving the accuracy of death certification among secondary care physicians // Bahrain Med Bulletin. 2013. Vol. 35, N 2. P. 56–59. doi: 10.12816/0000523
- Villar J., Pérez-Méndez L. Evaluating an educational intervention to improve the accuracy of death certification among trainees from various specialties // BMC Health Serv Res. 2007. N 7. P. 183. doi: 10.1186/1472-6963-7-183
- Pandya H., Bose N., Shah R., et al. Educational intervention to improve death certification at a teaching hospital // Natl Med J India. 2009. Vol. 22, N 6. P. 317–319.
- Weckbecker K., Bleckwenn M. [The postmortem examination and death certificate by the general practitioner: Problems with certification on site. (German)] // Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019. Vol. 62, N 12. P. 1446–1451. doi: 10.1007/s00103-019-03044-3
- Pritt B.S., Hardin N.J., Richmond J.A., Shapiro S.L. Death certification errors at an academic institution // Arch Pathol Lab Med. 2005. Vol. 129, N 11. P. 1476–1479. doi: 10.5858/2005-129-1476-DCEAAA
- Brooks E.G., Reed K.D. Principles and pitfalls: A guide to death certificationь // Clin Med Res. 2015. Vol. 13, N 2. P. 74–82; quiz 83–84. doi: 10.3121/cmr.2015.1276
- Gupta N., Bharti B., Singhi S., et al. Errors in filling WHO death certificate in children: lessons from 1251 death certificates // J Trop Pediatr. 2014. Vol. 60, N 1. P. 74–78. doi: 10.1093/tropej/fmt059
- Madadin M., Alhumam A.S., Bushulaybi N.A., et al. Common errors in writing the cause of death certificate in the Middle East // J Forensic Leg Med. 2019. N 68. P. 101864. doi: 10.1016/j.jflm.2019.101864
- Akhade S.P., Dash S.K., Akhade K.S. The knowledge assessment and reducing the errors of medical certificate of cause of death with sensitization training of physicians: A quality improvement intervention study // J Educ Health Promot. 2022. N 11. P. 19. doi: 10.4103/jehp.jehp_502_21
- Anand A., Khanna D., Singh P., et al. Evaluation of medical certification of cause of death in tertiary cancer hospitals in Northern India // Health Inf Manag. 2023. N 18333583221144665. doi: 10.1177/18333583221144665
- Rao C. Medical certification of cause of death for COVID-19 // Bull World Health Organ. 2020. Vol. 98, N 5. P. 298–298A. doi: 10.2471/BLT.20.257600
- Veeranna C.H., Rani S. Cause of death certification in COVID-19 deaths // Indian J Crit Care Med. 2020. Vol. 24, N 9. P. 863–867. doi: 10.5005/jp-journals-10071-23561
- Juyal D., Kumar A., Pal S., et al. Medical certification of cause of death during COVID-19 pandemic: A challenging scenario // J Family Med Prim Care. 2020. Vol. 9, N 12. P. 5896–5898. doi: 10.4103/jfmpc.jfmpc_1435_20
- Bogdanović M., Atanasijević T., Popović V., et al. Proper death certification in the time of the COVID-19 pandemic: Forensic perspective // J Infect Dev Ctries. 2022. Vol. 16, N 6. P. 966–968. doi: 10.3855/jidc.16556
- Aung E., Rao C., Walker S. Teaching cause-of-death certification: Lessons from international experience // Postgrad Med J. 2010. Vol. 86, N 1013. P. 143–152. doi: 10.1136/pgmj.2009.089821