Relationship Between Physicians' Knowledge and Skills in Medical Cause-of-Death Certification According to WHO Standards at Adam Malik Hospital
DOI:
https://doi.org/10.35451/jkg.v9i1.3776Keywords:
Medical Cause-Of-Death, Adam Malik Hospital, Resident Physician, Death Certification Training, WHOAbstract
Background: Accurate medical cause-of-death certification is essential for producing reliable national mortality statistics. The World Health Organization (WHO) has established international standards for recording medical causes of death. One of the factors influencing the accuracy of death certification is physicians' skills, which may be affected by age, educational background, and professional experience. As a tertiary referral hospital, H. Adam Malik General Hospital plays a crucial role in providing accurate mortality data.
Objective: To analyze the relationship between physicians' knowledge and skills in recording medical causes of death according to WHO standards at H. Adam Malik General Hospital, Medan.
Methods: This analytical observational study employed a cross-sectional design involving 155 resident physicians enrolled in medical specialty residency programs. Data were collected using a structured knowledge questionnaire and a case-based skills questionnaire administered through Google Forms. Bivariate analysis was performed using the Chi-square test with a significance level of p<0.05.
Results: Most participants had poor knowledge of medical cause-of-death certification (54.8%), while 47.7% demonstrated good certification skills. A significant association was found between physicians' knowledge and their skills in recording medical causes of death (p<0.001). In addition, medical specialty residency program and previous participation in death certification training were significantly associated with physicians' skills (p<0.05), whereas age, year of medical graduation, and residency competency level showed no significant association.
Conclusion: Physicians' knowledge, medical specialty residency program, and previous participation in death certification training were significantly associated with skills in recording medical causes of death according to WHO standards. Continuous training and curriculum enhancement are recommended to improve the quality of medical cause-of-death certification.
Downloads
References
[1] World Health Organization. WHO recommendations for conducting an external inspection of a body and filling in the medical certificate of cause of death [Internet]. Geneva: World Health Organization; 2023
[2] World Health Organization. Medical certification of cause of death: instructions for physicians on use of the international form of medical certificate of cause of death. Geneva: World Health Organization; 2014.
[3] World Health Organization. International statistical classification of diseases and related health problems. 10th revision (ICD-10). 5th ed. Geneva: World Health Organization; 2016.
[4] World Health Organization. International classification of diseases 11th revision (ICD-11) for mortality and morbidity statistics [Internet]. Geneva: World Health Organization; 2025. Available from: https://icd.who.int
[5] Brooks EG, Reed KD. Principles and pitfalls: a guide to death certification. Clin Med Res. 2015;13(2):74-82.
[6] Schuppener LM, Olson K, Brooks EG. Death certification: errors and interventions. Arch Pathol Lab Med. 2020;144(6):680-6.
[7] El-Gibaly O, Elsharkawy A, Mahmoud SHH, Elshazly M, Abdel-Hady D, El-Sayed M, et al. Improving medical certification of cause of death in Assiut University Children Hospital: an intervention study. BMC Health Serv Res. 2024;24:1506.
[8] Aziz MM, Dous N. Challenges facing physicians in death certification of under-five mortality in Egypt. BMC Health Serv Res. 2024;24:1459.
[9] Kementerian Dalam Negeri Republik Indonesia, Kementerian Kesehatan Republik Indonesia. Peraturan Bersama Menteri Dalam Negeri dan Menteri Kesehatan Nomor 15 Tahun 2010 dan Nomor 162/MENKES/PB/I/2010 tentang Pelaporan Kematian dan Penyebab Kematian. Jakarta: Kementerian Dalam Negeri RI dan Kementerian Kesehatan RI; 2010.
[10] Kementerian Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor 50/MENKES/SK/I/1998 tentang Pemberlakuan Klasifikasi Statistik Internasional Mengenai Penyakit Revisi Kesepuluh. Jakarta: Kementerian Kesehatan RI; 1998.
[11] Wahyuni T, Rachmadhani D. Kelengkapan pendokumentasian sertifikat medis penyebab kematian dan akurasi penyebab dasar kematian. J Manaj Inf Kesehat Indones. 2018;6(1):41-5.
[12] Putri RSE, Putri W, Triani M. Identifikasi kelengkapan pengisian formulir sertifikat kematian dan akurasi kode utama penyebab kematian di Rumah Sakit X Batam. JUBIDA. 2025;1(1):278-91.
[13] Windasari N, Adibah N, Sayusman C. Gambaran pengetahuan dan keterampilan dokter tentang pengisian penyebab kematian medis (medical cause of death) berdasarkan standar ICD-10 di RS tersier di Bandung. J Kesehat Andalas. 2019;8(2):325-30.
[14] Kementerian Kesehatan Republik Indonesia. Profile Rumah Sakit—RS Umum Pusat H. Adam Malik [Internet]. Jakarta: Sistem Informasi Rumah Sakit, Kementerian Kesehatan RI. Available from: https://sirs.kemkes.go.id/fo/home/profile_rs/1275655
[15] Kementerian Kesehatan Republik Indonesia. RSUP H. Adam Malik [Internet]. Jakarta: Direktorat Jenderal Kesehatan Lanjutan, Kementerian Kesehatan RI. Available from: https://keslan.kemkes.go.id/uptkami/detail/11
[16] Rumah Sakit Umum Pusat H. Adam Malik. Tentang RS Adam Malik [Internet]. Medan: RSUP H. Adam Malik. Available from: https://rsham.go.id/profil/tentang-rs-adam-malik
[17] Nyondo TM, et al. Improving quality of medical certification of causes of death in health facilities in Tanzania: results from a pilot intervention and scale-up. BMC Health Serv Res. 2021;21(Suppl 1):214.
[18] Meilia PDI, Nugroho HSW, Pranoto A, et al. Strategy to improve electronic medical certification of cause of death implementation: an action research. J Medicoet Leg Manag Hosp. 2024;13(2):226-37.
[19] Sison EL, Aban JL. Reducing errors in hospital death certification: a two-step proposal for medicolegal triage and cause-of-death accuracy. Acad Forensic Pathol. 2026.
[20] Cirera Suárez L, Maeso Martínez S, Fernández-Somoano A, Salmerón Martínez D. On efficacy in courses of causes of death certification to physicians in specialty training. Rev Esp Salud Publica. 2026;100:e202603015.
[21] Mapoma CC, Kasonde ME, Ochieng CO, et al. Prevalence of errors in medical certification of maternal deaths in Zambia using a retrospective analysis of maternal death surveillance and response data from 2018 to 2022. Discov Health Syst. 2026;5:13.
[22] Kazemeini H, Khosravi A, Atay A, Rashidian E, Rabbani B, Elaheh K. Analysis of the quality of death certification in Islamic Republic of Iran. East Mediterr Health J. 2026;32(1):37–43.
[23] World Health Organization. Framework for audit of medical certification of cause of death at health facility. New Delhi: World Health Organization Regional Office for South-East Asia; 2022.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 dr. Imelda Sibarani, dr. Doaris Ingrid Marbun, M.Ked(For), Sp.FM, dr. Agustinus Sitepu, M.Ked(For), Sp.FM, Dr. dr. Asan Petrus, M.Ked(For), Sp.FM
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright in each article is the property of the Author.
