Introduction : Accurate and complete medical certification of cause of death certificates (MCCD) are crucial for the medico-legal handling of individual cases of death. Currently the quality of cause of death certification in forms has been poor. Object of this intervention was to assess the knowledge and enhance the professional skills of the trainees for certifying causes of death.
Methods : We conducted a quasi-experimental intervention study among doctors in a two days training in two districts in Tamil Nadu 2024 with a before and after design without a control group conducted. Form 4A which is used by registered medical practitioners for certifying non- institutional deaths was filled by doctors before and after cause of death training which was audited using the Bloomberg Medical Certification of Cause of Death MCCD assessment tool was entered in Excel and analyzed using Statistical Package for the Social Sciences(SPSS). All variables were compared using proportions, differences and Mc Nemar’s & Fischers exact test for ToT and DLT for completeness, correctness, and minor & major errors.
RESULTS : Overall completeness in filling form 4A increased by 30% in Training of Trainers(ToT) and 19% in District Level Training (DLT). The most notable improvements were in the capture of cause of death (96% in ToT, 98% in DLT) and time intervals (96% in ToT). Legibility errors decreased by over 20% in both systems (ToT: 45%, DLT: 44%). The most significant reduction was in the error of “incorrect or clinically improbable chain of events,” which decreased from 57% to 19% in ToT and from 65% to 12% in DLT. When comparing major and minor errors, records with major errors decreased from 57% to 19% in ToT and from 65% to 12% in DLT. Minor errors decreased from 84% to 51% in ToT and from 99% to 58% in DLT. Overall, records with any type of error reduced significantly in both groups (ToT: from 98% to 55%, DLT: from 100% to 58%).
CONCLUSION : The intervention resulted in significant improvements in both the completeness of death certification records and the reduction of errors. These findings highlight the importance of training and its methodology for certifiers in ensuring high-quality and accurate cause-of-death certificates.