AMA Wire

Wednesday, May 22, 2013

For Residents

Study: Residents need better cause-of-death training

Despite the importance of death certificate data as a source of public health data, a new study indicates that resident physicians are not being properly trained for completing death certificates.

The survey study, published by the Centers for Disease Control and Prevention, analyzed the death reporting experiences of 521 multi-specialty residents in New York City. Only 33.3 percent of all respondents believed that cause-of-death reporting is accurate. Even more concerning, 48.6 percent had knowingly reported an inaccurate cause of death.

The most popular reasons for entering an incorrect cause of death included that the system would not accept the correct cause, that office personnel had instructed them to "put something else" and that the medical examiner had provided specific instructions about how the cause of death should be reported. Cardiovascular disease was the most frequently and inaccurately reported diagnosis.

This inaccuracy is cause for concern because the implications of cause-of-death certificates have implications even beyond those for the deceased patient. Data from death certificates are used by public health researchers to identify leading causes of death, track disease patterns and pinpoint disease outbreaks. Some aspects of public health funding and clinical research priorities also are determined based on death certificate data.

The authors believe cause-of-death reporting can be improved by expanding the acceptable causes of death to all inpatient diagnoses codes and refining the training of resident physicians. They also believe improvements in care transitions would support greater accuracy in cause-of-death reporting.

The AMA's patient handoffs Web page offers resources to help residents improve their handoff skills.

Residency programs grapple with use of smart devices

An estimated 85 percent of residents have smartphones, which they use an average 2.1 hours per day—including for clinical work. While such smart devices as phones and tablets promise advances in medical efficiency and functionality, there may be unintended consequences as well.

In a recent article in the Journal of Graduate Medical Education, Robert Wu, MD, argues that the medical community also should pause to consider the consequences of smart device use, including risk of technology-caused medical errors, privacy concerns and the impact of what he calls "distracted doctoring."

Dr. Wu recounts the story of a resident caught browsing Facebook while an attending physician discussed a recently diagnosed cancer with a patient. He argues that more research is needed to evaluate the impact of mobile technology on the clinical setting.

The rise of smart devices will inevitably change how we educate young physicians, he explains, and there should be a thoughtful discussion about how this technology is impacting patient care and professionalism. Dr. Wu states that new technology may require the creation of a new competency: digital professionalism.