(The following is a slightly refurbished reprise from a previously published oldie but goodie Practice Pearls -from way back in July 2018 entitled: Comprehensive Public Health Education for the Clinical Practitioner: Mission Impossible?)
The school bell has rung and school has been out to the glee of many except for the fresh-faced, eager resident physicians who have recently embarked on a brand new journey, the first post-graduate year, AKA PGY-1. Others have advanced onward to the years that follow as required by their chosen specialty.
Medical education provided to those destined for clinical practice emphasizes development of clinical skills for the diagnosis, treatment, and prevention of disease in the living. Public health-oriented topics including disease prevention, epidemiology, and systems-based practice are also part of the spectra of medical education. Resources for integrating public health education into all health professions abound creating challenges and opportunities for health professional schools to formulate comprehensive curricula within a defined period of time of students’ training (1,2). The clinician-in-training, especially those training in the primary care specialties, must also be taught the importance of mandated reporting of certain diseases and circumstances that may place the health or well-being of the patient or the immediate public in jeopardy. Mandatory reporting includes documentation of vital events and circumstances such as birth, abuse and neglect, impaired driving, work-related injury and communicable and other diseases (3). It is vitally important to the surveillance of public health and safety. The overall focus of public health education is on the living. Believe it or not, certain aspects of death actually aid the living.
The proper medical certification of death continues to be an important public health topic inadequately covered or lacking altogether in medical education. This is especially true for physicians, starting in medical school, where early introduction has been shown to be beneficial (4). Erroneous cause-of-death information has direct bearing on health statistics and resource allocation. Early introduction on the topic of death certification with periodic instruction and evaluation throughout and beyond medical training is needed to ensure that the most accurate cause-of-death information is entered on death certificates. For physicians-in-training especially, didactic teaching based on reference texts and e-learning tutorial platforms can be introduced into medical school curricula starting after a foundation in anatomy, physiology, pharmacology, pathology has been established and with the start of clinical rotations in the 3rd year (5). Clinical residency training programs should incorporate lectures into the curriculum with evaluation by way of in-service examinations, as effectiveness of this level of integration has been shown to be beneficial (6). Hospitals and medical societies should continue to provide lectures and tutorials for their clinical practitioners which can be counted as continuing medical educational credit (7).
Physician medical examiners and coroners are proficient in death certification and can be an invaluable educational resource for medical educators. Vital statistics professionals in each state are an added important educational resource for instruction especially in the technical aspects of death certificate completion including access to the electronic death registration system active in all but 2 states in the US (8) .
1. Public Health and Medical Education Bibliography. Available at: https://www.aamc.org/download/258062/data/publichealthbibliography.pdf .
2. Integrating Public Health in Health Professions Education: A Resource for Students, Educators, and Health Professionals. Available at: https://www.cdc.gov/learning/local/pdf/ph-education-resource-list.pdf .
3. Reportable Diseases, Medline Plus. National Institutes of Health/US National Library of Medicine. Available at: https://medlineplus.gov/ency/article/001929.htm .
4. Degani AT, Patel RM, Smith BE, and Grimsley E. The effect of student training on accuracy of completion of death certificates. Med Educ Online. 2009;14:17. Available at: http://www.med-ed-online.org .
5. Armstrong EJ. Essentials of Death Reporting and Death Certification: Practical Applications for the Clinical Practitioner. Available at: https://www.amazon.com/Essentials-Death-Reporting-Certification-Applications/dp/0998533408 .
6. Henry CH, Greene CM, Koppaka R. Integrating public health-oriented e-learning into graduate medical education. Am J Public Health. 2012;102:s353-s356.
7. Massachusetts Medical Society. Cause of Death Training for Medical Certifiers. Available at: http://www.massmed.org/Continuing-Education-and-Events/Online-CME/Courses/Cause-of-Death-Training-for-Medical-Certifiers/Cause-of-Death-Training-for–Medical-Certifiers/ .
8. Information Systems for Vital Records Stewardship. National Association of Public Health Statistics and Information Systems. (NAPHSIS). Available at: https://www.naphsis.org/systems .
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For more information on how not to get schooled on reporting and certifying deaths, check out: