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  1. 1. Training of Certifiers in the United States Donna L. Hoyert Robert N. Anderson National Center for Health Statistics (NCHS)
  2. 2. US Vital Statistics System <ul><li>Decentralized system </li></ul><ul><li>State vital statistics laws and regulations </li></ul><ul><li>57 registration areas </li></ul><ul><li>Funeral directors, physicians, medical examiners or coroners </li></ul>2
  3. 3. Scale <ul><li>2.4 million deaths annually </li></ul><ul><li>700,000-800,000 practicing physicians, medical examiners, and coroners </li></ul><ul><li>Skewed distribution of certification </li></ul>3
  4. 4. Training in Decentralized System <ul><li>Not NCHS’ responsibility to train certifiers </li></ul><ul><li>NCHS helps facilitate training but does more </li></ul>4
  5. 5. Workshops on Improving Cause-of-Death Statistics <ul><li>Sponsors: NCHS & National Committee on Vital and Health Statistics </li></ul><ul><li>Attendees: </li></ul><ul><ul><li>Federal vital statistics staff </li></ul></ul><ul><ul><li>State vital statistics staff </li></ul></ul><ul><ul><li>Professional organization representatives </li></ul></ul>5
  6. 6. Workshop Recommendations <ul><li>Need broad-based educational training of certifiers </li></ul><ul><ul><li>Multiple approaches </li></ul></ul><ul><ul><li>Multiple encounters </li></ul></ul>6
  7. 7. Workshop Recommendations <ul><li>Training message: </li></ul><ul><ul><li>Importance of cause-of-death statistics </li></ul></ul><ul><ul><li>Value of statistics in improving the practice of medicine </li></ul></ul><ul><ul><li>Mechanics of completing the death certificate </li></ul></ul>7
  8. 8. Workshop Recommendations <ul><li>Training Timing: </li></ul><ul><li>Medical school- Minimal orientation to process but emphasis on importance of statistics and physician contribution </li></ul><ul><li>Internship and residency- key time to begin training physicians </li></ul>8
  9. 9. Follow through on Workshop Recommendations <ul><li>Recommendations concerning training &: </li></ul><ul><li>Medical school </li></ul><ul><li>Internship & residency </li></ul><ul><li>Licensure & board certification </li></ul><ul><li>Practicing physicians </li></ul><ul><li>Medical examiners and coroners </li></ul><ul><li>Hospitals </li></ul><ul><li>Information dissemination and software </li></ul><ul><li>Other areas </li></ul>9
  10. 10. Workshop Results <ul><li>Workshop reports widely distributed </li></ul><ul><li>Resolutions of support </li></ul><ul><li>Notices of initiative in variety of publications </li></ul><ul><li>NCHS produced additional training material </li></ul><ul><li>States may have increased efforts </li></ul><ul><li>Other promising developments withered </li></ul>10
  11. 11. Training Materials <ul><li>Instructions on death certificate </li></ul><ul><li>Laminated instructions </li></ul><ul><li>Handbooks etc. </li></ul><ul><li>Exhibits </li></ul><ul><li>Presentations </li></ul><ul><li>Web page </li></ul>11
  12. 12. Instructions on death certificate <ul><li>Examples and some instructions </li></ul><ul><li>Purpose: To make sure instructions are available to every certifier who is completing a death certificate </li></ul>12
  13. 13. Instructions in an electronic death registration system <ul><li>NCHS recommendations for help screens, prompts, and queries on an electronic death certificate developed in 1999 </li></ul><ul><li>Above recommendations were incorporated into the Death edit specifications for 2003 revision ( ) </li></ul>13
  14. 14. Laminated instructions <ul><li>2 separate pages of instructions </li></ul><ul><li>Purpose: To provide certifiers with a quick and handy reference </li></ul>14
  15. 15. Handbooks and other publications <ul><li>NCHS handbooks </li></ul><ul><li>Series report </li></ul><ul><li>CAP manuals </li></ul><ul><li>Journal articles </li></ul>15
  16. 16. Handbooks <ul><li>Text, instructions, examples </li></ul><ul><li>Purpose: To provide more detailed instructions tailored to physician or medical examiner and coroner </li></ul>16
  17. 17. Other publications <ul><li>Text, instructions, examples </li></ul><ul><li>Purpose: To distribute instructions and examples in medical professional’s own language differently </li></ul>
  18. 18. Exhibit <ul><li>Main panel, 4 table top panels, variety of educational handouts </li></ul><ul><li>Purpose: To bring and distribute training materials directly to certifiers and to educate them about the importance of accurate cause-of-death certification </li></ul>18
  19. 19. Illustration: Old Exhibit Display 19
  20. 22. Some Exhibit Locations <ul><li>American College of Physicians </li></ul><ul><li>American Academy of Physicians </li></ul><ul><li>American Society of Internal Medicine </li></ul><ul><li>American Public Health Association </li></ul><ul><li>American College of Cardiology </li></ul><ul><li>American Society of Clinical Oncology </li></ul><ul><li>National Medical Association </li></ul><ul><li>National Association of Medical Examiners </li></ul><ul><li>National Association for Public Health Statistics and Information Systems </li></ul><ul><li>American Geriatrics Society </li></ul><ul><li>American Academy of Family Physicians </li></ul><ul><li>National Funeral Directors Association </li></ul>22
  21. 23. Training Presentations <ul><li>Tailored instructional presentation and power point </li></ul><ul><li>Purpose: To train certifiers </li></ul>23
  22. 24. Web Page <ul><li>Links to training resources </li></ul><ul><li>Purpose: To help disseminate information </li></ul>URL:
  23. 25. <ul><li>Thank you for your attention. </li></ul>