Is training doctors in medical certification effective? Evidence from a prospective study in the Philippines.

Background: Correct certification of causes of death by physicians according to International Classification of Diseases (ICD) rules is essential to generate mortality statistics of the quality needed to guide public health policy debates and reliably monitor the impact of health interventions. Several efforts to train doctors have been undertaken in the Philippines to improve Medical Certification of Causes of Death (MCCOD). However, there is very little evidence about the long-term effects of training interventions for medical certification.

Objective: To test whether there were measurable long-term impacts of this large-scale training intervention for improving medical certification and reducing different types of certification errors.

Method: We assessed the quality of 2100 MCCOD completed before face-to-face training with those written by the same doctors 6 months after the training. An assessment tool was used to evaluate the quality of MCCOD.

Results: Less than 1% of the 2100 MCCOD assessed prior to the training were completely error-free, increasing to 19.2% 6 months after the training. On average, the number of errors per certificate fell from 2.2 pre-training to 1.3, six months after training. Importantly, there was a 38% decrease in writing ill-defined causes on the last line, which is particularly important for the policy utility of data.

Conclusion: Training doctors in correct medical certification can have a long-term impact on medical certification practices.

Implications: Shorter, more focused, trainings that address the most common medical certification errors could have an even greater impact on medical certification practices.