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PubMed2006

The incorporation of patient safety into board certification examinations.

In response to growing recognition of the importance of patient safety in the practice of medicine, the American Board of Medical Specialties (ABMS) is encouraging its individual specialty member boards to introduce material on patient safety into certification examinations. Certification and recertification candidates, medical schools, and residency programs will likely need to prepare for the possibility that upcoming examinations will include patient safety. Due to the relative youth of the patient safety movement, some may ask whether the field is sufficiently developed and, if so, ask what would be fair to ask candidates to know. To determine what subject matter could be reliably tested, the ABMS and the Council of Medical Specialty Societies convened a panel of patient safety experts in 2003. Based on the panel's recommendations, the authors provide a brief summary of the panel's findings and an overview of current concepts in patient safety. The authors also explore which current concepts of patient safety candidates may reasonably expect to find on upcoming examinations.

Certification↗

PubMed2006

A comparison of the characteristics and examination performances of U.S. and non-U.S. citizen international medical graduates who sought Educational Commission for Foreign Medical Graduates certification: 1995-2004.

BACKGROUND: International medical graduates (IMGs) make up a substantial part of the U.S. physician workforce. Unfortunately, little is known about the demographic and performance characteristics of these doctors, especially over time. METHOD: Educational Commission for Foreign Medical Graduates (ECFMG) applicants from 1995-2004 were studied. The characteristics and examination performances of U.S. citizen and non-U.S. citizen IMGs were contrasted. RESULTS: ECFMG applications from U.S. citizen IMGs have been increasing. Compared to non-U.S. citizen IMGs, these individuals perform less well on some of the certification examinations, especially in the last 5 years, but are more likely to eventually achieve certification. Based on those medical students/graduates who took the examinations, the performance of U.S. citizen IMGs varied considerably from one medical school to another. CONCLUSION: The composition of the pool of ECFMG-certified IMGs available for graduate medical education has changed over the past 10 years. Shifts in the characteristics and abilities of IMGs are likely to have some future impact on health care delivery in the United States.

Certification↗

PubMed1996

National certification for home care nurses: bird by bird.

The opportunity to be certified as a generalist in home care nursing has been available since 1993, with the new certification as specialist available in 1996. Home Healthcare Nurse asked Janet Wilson, a nurse educator and member of our editorial board, to answer the questions: What is certification? Why should I think of becoming certified? and How do I go about it?

Certification↗

PubMed1980

Diagnosis on death certificates of sudden death due to ischemic heart disease.

This study was undertaken to evaluate the quality of diagnoses of sudden death (SD) caused by ischemic heart disease (IHD) on death certificates. A random sample of 10% (100 cases) was drawn from all such deaths which occurred in 1970 among Oklahoma City residents. The medical records of each case were reviewed and the quality of the diagnosis was rated, by the use of predetermined standard criteria, as confirmed and valid or unconfirmed and invalid. Among 100 IHD deaths, SD constitute 45%. Of these SDs, 18% were unobserved, without information as to the manifestations of the attack or the interval from onset of symptoms to death. According to criteria of the American Heart Association and WHO Expert Committee, the diagnosis in this 18% was unconfirmed and invalid. Thus there is insufficient quantitative evidence to justify the use of SD, as found on death certificates, as an indication of frequency of ischemic heart disease.

Coronary Disease↗

PubMed1999

Can investigator certification improve the quality of clinical research?

With costs and competitive pressures increasing, pharmaceutical sponsors and contract research organizations are examining the drug development process. Investigators who conduct clinical studies significantly impact research quality and, thereby, costs. This article reviews current investigator selection methods and their shortcomings. Using one organization's experience certifying clinical research coordinators and clinical research associates, the authors highlight certification as a means of assessing competency and discuss investigator certification as a potentially accurate indicator of competence for conducting research and as a predictor of inherent quality at the research site.

Certification↗

PubMed1994

Risk of multiple myeloma by occupation and industry among men and women: a 24-state death certificate study.

This cancer surveillance investigation uses death certificates from 24 states for the period 1984-1989 to identify multiple myeloma and occupation associations and to stimulate hypotheses. A case-control study of multiple myeloma was created from 3,159,417 certificates in which 12,148 male and female cases were frequency matched by age, race, and gender with five controls per case. We screened 231 industries and 509 occupations. Women demonstrated significant excess risk among managers and administrators, post-secondary teachers, elementary teachers, social workers, other sales workers, waitresses, and hospital maids. Men showed significant risks among computer system scientists, veterinarians, elementary teachers, authors, engineering technicians, general office supervisors, insurance adjusters, barbers, electronic repairers, supervisors of extracting industries, production supervisors, photoengravers, and grader/dozer operators. Men and women elementary school teachers demonstrated the most consistent, statistically significant increased risk of multiple myeloma.

Adult↗

PubMed1998

A death certificate-based study of occupation and mortality from reproductive cancers among women in 24 US states.

We conducted a study of occupation and mortality from reproductive cancers among women, based on death certificates from 24 US states for the period 1984-1993. There were 9,523 cervical cancer deaths, 12,335 endometrial cancer deaths, and 25,212 ovarian cancer deaths. Usual occupation and industry, which were obtained from death certificates, were coded using the 1980 Bureau of Census classification system. Mortality odds ratios (MORs) and 95% confidence intervals (CIs) were calculated, using all non-cancer deaths as the referent disease category. In general, jobs involving professional or administrative occupations were related to increased risk of mortality from endometrial and ovarian cancer, while cervical cancer mortality was increased among women employed in manufacturing, service, farm work, and health care technician and aide occupations. Associations with some occupations involving exposure to chemicals and metals, such as the associations between cervical cancer and employment in printing, typesetting, and machine operating occupations, deserve further attention. Similarly, further investigations should be made into the excess of ovarian cancer observed in several occupations in health care, an industry that has numerous hazardous exposures, including radiation, chemotherapeutic drugs, and viruses. The study results reflect, in part, socioeconomic factors and reproductive patterns but may also indicate a possible etiologic role for occupational chemical exposures.

Adult↗

PubMedDate not supplied

UNC certificate program in core public health concepts: lessons learned.

OBJECTIVES: Public health workers need to be trained in the core public health sciences. The University of North Carolina at Chapel Hill School of Public Health created a Certificate in Core Public Health Concepts to meet the training needs of public health workers, primarily those working in state or local public health agencies. METHODS: This article examines the demographic, educational, job classification, and workplace characteristics of certificate program applicants from the first 3 years of the program. In addition, this article assesses student performance and graduate satisfaction with the program. RESULTS: Among the 273 applications reviewed, the majority were from females. They worked in a variety of job classifications: 19% were public health agency workers, 64% were public health system workers, and 17% worked in other occupations. Nearly all students received High Pass or Pass grades on courses. Initial data on graduate satisfaction with the program are positive. CONCLUSIONS: Implications of the findings for training the public health workforce are discussed.

Certification↗

PubMed2005

Critical care medicine training and certification for emergency physicians.

Demand for critical care services is increasing. Unless the supply of intensivists increases, critically ill patients will not have access to intensivists. Recent critical care society recommendations include increased graduate medical education support and expansion of the J-1 visa waiver program for foreign medical graduates. This article proposes additional recommendations, based on strengthening the relationship between emergency medicine and critical care medicine. Demand for critical care services is increasing. Unless the supply of intensivists increases, critically ill patients will not have access to intensivists. Recent critical care society recommendations include increased graduate medical education support and expansion of the J-1 visa waiver program for foreign medical graduates. This article proposes additional recommendations, based on strengthening the relationship between emergency medicine (EM) and critical care medicine (CCM). Critical care is a continuum that includes prehospital, emergency department (ED), and intensive care unit (ICU) care teams. Both EM and CCM require expertise in treating life-threatening acute illness, with many critically ill patients often presenting first to the ED. Increased patient volumes and acuity have resulted in longer ED lengths of stay and more critical care delivery in the ED. However, the majority of CCM fellowships do not accept EM residents, and those who successfully complete a fellowship do not have access to a U.S. certification exam in CCM. Despite these barriers, interest in CCM training among EM physicians is increasing. Dual EM/CCM-trained physicians not only will help alleviate the intensivist shortage but also will strengthen critical care delivery in the ED and facilitate coordination at the ED-ICU interface. We therefore propose that all accreditation bodies work cooperatively to create a route to CCM certification for emergency physicians who complete a critical care fellowship.

Certification↗

PubMed2005

A new approach to rater training and certification in a multicenter clinical trial.

Recent evidence demonstrates that the quality of raters' applied clinical skills is directly related to study outcome. As such, the training and evaluation of raters' clinical skill in administering symptom-rating scales is essential before being certified to rate patients in clinical trials. This study examined a novel approach to rater training and certification that focused on both conceptual knowledge and applied skills. Forty-six raters (MDs = 14; PhDs = 7; MA = 5; BA/LPN/RN = 20) in a large multicenter depression study went through a 2-step Hamilton Rating Scale for Depression (HAMD) certification process: didactic training, administered online via an interactive Web tutorial, and live, applied training, where raters interviewed depressed patients while being remotely observed via 3-way teleconference. Raters' applied skills were evaluated using the Rater Applied Performance Scale (RAPS), designed specifically to evaluate critical rater behaviors associated with good clinical interviews. Raters received feedback immediately following the interviews; those receiving a failing score were given 2 more opportunities to pass. Each subsequent session was accompanied by feedback, and was conducted by a different trainer, who was blind to the results of the previous session as well as to which session number it was, to avoid bias. Raters who failed on the third attempt were excluded from rating patients in the trial. All training and testing occurred prior to the startup meeting. Results found a significant improvement pre-to-post Web training in raters knowledge of scoring conventions, P < 0.001. On the applied component, raters' RAPS scores improved significantly on the second attempt following feedback, from 9.05 to 11.58, P < 0.001, and from their second to their third session (from 9.00 to 11.00, P = 0.033. Three raters failed all 3 attempts and were excluded from the study. Results support the efficacy of the approach in improving both conceptual knowledge and applied interviewing skill.

Adult↗

PubMed1976

A validation of cause-of-death certification in 1,156 deaths.

Swedish twins have been followed for mortality since 1961, when the Swedish Twin Registry was formed. During the years 1961-73 there were 1290 deaths among twins born in 1901-25. In 1156 cases the cause of death could be established from collected records and classified according to the 1965 revision of ICD. Using the review of records as the standard, rates of detection and confirmation relating to the death certificate diagnoses were calculated. It is concluded that Swedish death certificate data are fairly valid for use in epidemiological studies and mortality statistics with regard to most cancer forms, cerebrovascular disease, ischemic heart disease, bronchitis, asthma and emphysema, accidents and suicides, but not for diabetes mellitus, alcoholism, mental diseases, rheumatic heart diseases and other heart diseases. However, in selected clinical-epidemiological studies it is often necessary to collect all available documents prior to judging the cause of death.

Aged↗

PubMed1989

Alcohol and death certification: influencing current practice and attitudes.

Forty housemen were sent a letter informing them of changes to the coroner's rules and emphasizing the importance of recording alcohol abuse. All relevant death certificates signed by the housemen over the next 3 months were selected for case note review to check details of the alcohol history taken and the consequent accuracy of the death certificate. A questionnaire was also sent to the housemen covering reasons for not recording alcohol abuse and knowledge of the coroner's rules. Comparison of the results with those from an earlier group of housemen who received no informatory letter suggest that minimal educational intervention can effect housemens' attitudes and practice.

Alcoholism↗

PubMed1992

Death certification and coding for ischaemic heart disease in Tasmania.

Official records show that the rates of mortality from ischaemic heart disease (IHD) in Tasmania have been the highest of all the Australian states for most of the past decade. This study assesses the accuracy of the official Tasmanian mortality data for IHD in 1987 and 1988 for males aged 25 to 74 years using routinely available clinical and pathological data supplemented by information from the attending doctor. Our findings show that a death officially coded to ICD 9 rubrics 410-414 (IHD) in Tasmania has 94% sensitivity and a positive predictive value of 90% for fatal definite acute myocardial infarction or possible coronary death as defined by the WHO. Comparison of our results with those of two earlier studies undertaken in Australian mainland centres indicates that differences in the official statistics for coronary mortality between Tasmania and the mainland states reflect true differences in the risk of coronary death. While the results from three Australian studies suggest that the routine system of death certification is reasonably accurate, careful monitoring of death certification and coding practices need to be undertaken regularly in all states of Australia if secular changes in regional patterns of coronary mortality are to be regarded as credible.

Adult↗

PubMed1995

The accuracy of hospital records and death certificates for acute myocardial infarction.

BACKGROUND: In Australia information on the incidence of acute myocardial infarction (AMI) is available from routinely collected morbidity and mortality data. Given that these data are used for monitoring AMI it is important to assess their quality. AIMS: This paper examines the accuracy of the hospital records and death certificates. METHODS: Morbidity and mortality data were compared with the Newcastle heart disease register which is part of the WHO MONICA Project for 1986-1991 and sensitivity and positive predictive values calculated. RESULTS: For non-fatal AMI the hospital diagnostic coding had sensitivity of 78.9% (95% confidence interval [CI] 77.1%-80.7%), and positive predictive value of 65.6% (95% CI 63.7%-67.4%). Sensitivity was higher for men than for women and decreased with increasing age. Sensitivity was higher in those with no history of either AMI or other ischaemic heart disease (IHD), higher in current smokers than ex-smokers or never smokers, and lower in those with a self-reported history of high blood pressure. Sensitivity also varied among hospitals. Positive predictive value varied only with hospital. Both sensitivity and positive predictive value were high for death certificate data--89.9% (95% CI 88.4%-91.3%) and 96.0% (95% CI 95.1%-97.0%), respectively. CONCLUSIONS: Although the mortality data appear to be quite accurate, the hospital data alone are not accurate enough to be used to estimate rates or trends of heart attacks. Additional data are required in order to determine numbers of non-fatal AMIs accurately.

Adult↗

PubMed1986

A validation of underlying cause of death, as recorded by clinicians on stillbirth and neonatal death certificates.

Clinical case notes and necropsy reports were used to validate underlying causes of death as recorded and coded on 590 stillbirth and neonatal death certificates. There were 55 cases ascribed to respiratory distress syndrome, in 45 this was validated, three cases were not assigned to respiratory distress syndrome which should have been. In 102 cases death was ascribed to congenital malformation, this was validated in 96, 13 cases should have been assigned to congenital malformation, but were not. Use of available clinical and necropsy information when completing death certificates would have decreased the number of deaths attributed to respiratory distress syndrome by 13%, and increased the number certified as dying from congenital malformation by 10%.

Congenital Abnormalities↗

PubMed1997

Medical causes on stillbirth certificates in England and Wales: distribution and results of hierarchical classifications tested by the Office for National Statistics.

OBJECTIVE: To produce a classification of stillbirths registered in England and Wales compatible with a previously described classification for neonatal deaths; to compare national data for intrapartum stillbirths with those for the remaining stillbirths; and to report on stillbirths with a gestational age of 24 to 27 completed weeks first made registrable on 1 October 1992. DESIGN: Algorithms were developed and tested to derive hierarchical cause classifications making use of multiple causes mentioned on stillbirth certificates. RESULTS: The additional information available since 1986 on cause and time of death of stillbirths, classified in a hierarchical fashion allows a more meaningful interpretation of the available information on the causes of stillbirth than was previously possible and does not perturb ongoing trends. Antepartum deaths without a classifiable cause contributed the majority: between 1992 and 1994 they accounted for 43% if mentions of asphyxial conditions are regarded as classifiable causes, and 82% if not considered as causal. Stillbirths described as occurring intrapartum are consistently of higher gestational age and birthweight than the remainder, lending validity to the time of death given. CONCLUSIONS: The national use of a classification including reported time of death of the fetus and mentions of asphyxial conditions is justifiable, providing a distinction is made between associated mentions and causal conditions. Better and more complete clinical information on stillbirth certificates will contribute further to understanding of their causes.

Algorithms↗

PubMed1988

Accuracy of death certificates in the diagnosis of alcoholic liver cirrhosis.

In 108 patients with alcoholic liver disease who died during a 10-year follow-up, the diagnoses from the liver biopsies were compared with that from the Death Certificates. Data show that the currently used ICD-9 category of cirrhosis with or without mention of alcohol has a 47.2% chance of missing the diagnosis of cirrhosis. On the other hand when the mention of liver disease in the Death Certificate is used for the diagnosis of cirrhosis, the percentage of undiagnosed cirrhosis decreases to 19.4% (p less than 0.0001).

Cause of Death↗

PubMed1990

Autopsies and death certificates in the chronic care setting.

All autopsies (n = 34) performed over a period from July 1, 1981 to June 30, 1988 in a teaching nursing home were reviewed to determine the autopsy rate, to evaluate premortem versus postmortem diagnostic discrepancies, and to see if educational efforts could improve each. The autopsy rate was 3.5%. Major discrepancies appeared in 47.1% of cases. Pneumonia was the most frequent and most frequently missed diagnosis. Only 23 of 34 death certificates reflected the cause of death as documented in the chart, and only 12 had concordant diagnoses with those from autopsy. After a collective educational effort, the autopsy rate increased from a rate (average of initial six years) of 2.4% to 10.8% in the last year. The autopsy rate is low, but can be improved with educational efforts. Death certificates, in this population, may be misleading when used for general statistical purposes.

Adult↗