Accurate Completion of Death Certificates: The Need for Formalised Training in the Nigerian Medical Curriculum

Research of medical schools initiative attempting to orient medical students towards future role in society can only serve in pursuance of WHO objectives for medical education. Medical teachers see the natural process of death as an anathema and pay little attention to the subject in both pathology and clinical courses. Doctors and consequently medical students have the notion that their primary responsibility is to save lives and if possible prolong life possibly in perpetuity. The death of a patient is seen as an indictment. Therefore, in the medical school curriculum little emphasis is placed on the training of last offices. A medical school has responded to the need in this area by the use of a dynamic curriculum in which as part of the medical jurisprudence course the future role of doctors are highlighted. A cross sectional survey of 127 final year medical students aptitude to filling the death certificate was carried out by administering a 14 item self administered questionnaires with the filling of a death certificate. These were Medical and Dental Students of the College of Medicine, University of Lagos, who had completed rotations in pathology and Clinical medicine. The aim of the study was to assess the knowledge in performance of last offices and test skills in death certification. Results show that about 96% of the students had no formal teaching in the filling of death certificates. A large percentage, over 70% of them had never seen a death certificate filled. Among the 38 students who had seen or had been taught how to complete death certificates, 23 (18.1%) of the total students surveyed and (61%) of those who had seen certificates filled did this at the Third Year 400 Level of their studies during pathology posting while less than 1% or only 10/38 (27%) of them had seen this event during their clinical years. Of the cadre of medical staff who the students had observed filling death certificates, more Registrars (72%) were responsible for this activity than others. Over 85% of the students were aware of the importance of death certification. We recommend the inclusion of formal training on death certificate completion in Medical School curriculum in Nigeria to enhance the accuracy of health statistics. KEY WORDS: Death certificate, medical students, medical education, Nigeria Nigerian Journal of Health and Biomedical Sciences Vol.4(1) 2005: 76-8