The current epidemiological situation proves how the information on causes of death and co-existing health conditions are important for better understanding of health tendencies in our societies and for establishing effective health policies. But the quality of data on causes of death raises deep concerns in several European countries. This is mostly due to individual practices of medical doctors who are unaware of certification rules imposed by the World Health Organisation (WHO) and national statistical offices and, when stating the death, fill in death certificates incorrectly or carelessly. In most European countries, students of medical universities devote less than 2 hours (during the whole curriculum) to certification rules, whereas practising medical doctors have few opportunities of improving and updating their skills in filling in death certificates. As a result, in several countries of Europe considerable proportion of deaths is assigned to unknown or ill-defined causes: in 2018 it was 12% in Greece, 25% in Poland, 8% in Portugal. For several decades now, the World Health Organisation (WHO) has been establishing in-detailed recommendations about registering, coding and publishing information on causes of death, which are adopted by most developed countries, therein all EU member states.The proposed project aims at developing new innovative pedagogies that concern the rules of WHO as well as good practices introduced in selected European countries characterised by a relatively high quality of cause-of-death statistics. Its objective is twofold; first, it consists of providing an innovative learning tool (CODA) for lecturers training medical students, giving them the opportunity to improve their knowledge on WHO’s recommendations and rules concerning the certification of causes of death. Second, it creates a MOOC dedicated to trainers and professors of various universities and institutes who wish to adapt the CODA tool for their teaching purposes and share it with their students. Teaching activities performed within the project include providing e-learning courses to academics (lecturers, professors) at medical universities in Europe, in order to 1) improve their understanding of epidemiological tendencies in ageing populations, with special reference to the mortality by causes of death, 2) show the importance of good quality of mortality statistics for better understanding of epidemiological tendencies and health policy impacts within a population; 3) provide them with the WHO recommendations concerning filling in death certificates; 4) improve their competencies and skills in filling in death certificates, 5) discuss the most frequent causes of death that should not be, according to WHO, used, 6) improve their digital competencies and promote innovative e-learning. Six editions of the course will be dedicated to overall 550 participants, therein approximately 80% represented by the teachers at medical universities, and approximately 20% represented by academics in other domains (i.e. public health, epidemiology, demography) and medical doctors. At the end of the course, each participant will pass an evaluation based on the CODA tool and, if successful, will receive a MOOC Statement of Accomplishment. This will contribute to a better recognition of skills in the domain of medical documentation and WHO's certification rules. Subsequently, the participants of the course will be encouraged to create their own MOOC courses based on the CODA tool for their teaching purposes and to share it with their students, the future generations of medical doctors. Thus, the long-term impact consists of improving individual practices in cause-of-death certification, performed by medical doctors, and subsequently, improving the quality of cause-of-death data necessary for efficient health policies. The impact of the course will not be limited to trainers of medical universities enrolled in the project. We ensure that the educative materials (including CODA) are published, in several language versions (English, French, Greek, Polish, Portuguese), at the European open resource platform for free once the project is finished. Thus, the educative materials will be available to anyone willing to increase the knowledge in recent trends in mortality by causes, as well to improve the competencies in establishing the medical documentation. Also, three multiplier events organised within the project are supposed to sensibilize the wide audience (medical personnel, stakeholders, public opinion) on the importance of good, informative and correct public statistics in ageing societies, as well as to promote the knowledge on current epidemiological tendencies and processes in Europe.
The aim of the project was to address the skills and competence gaps in cause-of-death certification at the European level. We wanted to achieve this by fulfilling the following objectives: – Establish a set of good practices in cause-of-death certification and exchange expertise between researchers, academics-teachers and practitioners (medical doctors); – Train medical doctors, students in medicine and representatives of other health professions in the cause-of-death certification and the management of medical documentation; – Publish open-access educational resources relevant to the needs of cause-of-death certification; – Contribute to the improvement in the quality and international comparability of the cause-of-death data; – Establish a strategic partnership between European research institutions and universities, and between renowned experts in different fields: demographers, epidemiologists, medical doctors and specialists in e-learning methodology.
We applied for the project in order to: 1) address competency gaps in the certification of causes of death and comorbidities, 2) share our expertise in this area with medical students and medical teachers by creating open and online educational resources, 3) reward excellence in skills development and teaching, 4) promote innovative digital practices of lifelong learning. 1) Addressing competence gaps in certifying causes of death and co-morbidities: With some important exceptions, European medical universities do not offer courses on the legal and practical aspects of completing medical documentation, including death certificates. As a result, doctors usually have a vague idea of how to report the so-called underlying causes of death, medical complications (consequences of the underlying causes of death) and important but unrelated to the underlying cause of death co-morbidities. At the same time, medical doctors usually have a good understanding of the morbid process (a chain of diseases and pathologies) that led their patients to death, but they lack systematic knowledge of how to translate their medical expertise into an official document (a death certificate) that is used also for not only for medical but also for administrative and legal purposes. By providing such theoretical knowledge and practical skills, this project addressed important skills gaps and contributed to improving the quality of cause of death data provided by physicians, which is important for formulating and evaluating effective health policies. 2) Sharing the expertise in cause of death certification with medical students and medical teachers through the creation of open and online educational resources: Some of the participants in the project have considerable expertise in this area, but have never shared it with current and future ‘practitioners’ (doctors and medical students) and medical teachers (professors in medical universities). The hitherto research results were disseminated mainly in academic journals and conferences. The lack of interaction with practitioners has limited the researchers’ understanding of the practical problems of death certification. By creating open and online educational resources and receiving feedback from users of these materials, we have been able to share our expertise and follow open science practices. 3) Rewarding excellence in skills development and teaching: Participants in our e-learning courses were subject to a final online test, consisting mainly of practical exercises approved by the Advisory Board, which is made up of world-class specialists in death certification. The vast majority of participants passed the final test and received a free Statement of Accomplishment issued by all the partner institutions. Although these diplomas do not carry ECTS credits (most of our participants were no longer university students) or professional credits, such an international diploma confirms high competence in death certification. The project gave the participants the opportunity to acquire new competencies from renowned researchers and to maintain the link with the research and academic sector. As we established open-source training materials, all teachers in medical universities are encouraged to use/refer to them in their daily work with students, thus improving the skills of their students. 4) Promotion of innovative digital practices of lifelong learning: There is a need for lifelong learning and doctors are well aware of this, but not everyone has the opportunity to attend face-to-face postgraduate courses. This project contributed to the promotion of innovative digital practices, such as digital quizzes and exercises, remote communication and interaction, and the use of the CODA tool to simulate hypothetical morbid conditions and the way they should be reported in medical documentation. The project developed the practice of lifelong education (or extracurricular education in the case of students) and promoted the institutions that provide e-learning free of charge.