摘要：Objectives. In fall 2008, the New York City Department of Health and Mental Hygiene collaborated with Albert Einstein College of Medicine residency program directors to assess the effectiveness of an e-learning course on accurate death certificate completion among resident physicians. Methods. We invited postgraduate year 1 and 2 (PGY1 and PGY2) residents (n = 227) to participate and administered a pretest, e-learning module, posttest, and course evaluation to PGY1 residents; PGY2 residents completed a pretest and survey only. Results. In all, 142 residents (63%) participated. The average pretest scores for PGY2 residents (61%) and PGY1 residents (59%) were not significantly different. The PGY1 residents’ average test score increased significantly after taking the e-learning module (59% vs 72%; P < .01). The participants rated course length, delivery method, and utility highly. Conclusions. Results suggest that e-learning can effectively integrate public health–oriented training into clinical residency programs. The epidemic of preventable chronic diseases, the ongoing gap in health disparities, and the continued emergence of infectious diseases are among the 21st century’s leading public health challenges. To adequately respond, physicians require not only clinical skills, but also a basic understanding of population health. 1 In the United States, requirements for certification in the primary care specialties include competence in selected public health–oriented topics such as disease prevention, epidemiology, and systems-based practice. 2,3 In addition, all licensed physicians are expected to understand the role of the public health system and to comply with requirements for disease reporting and for certifying vital events. However, because integrating population health concepts into hospital- and clinic-based residency training can be challenging, physician knowledge of public health is often inadequate. In 2006 through 2008, 34% of graduating medical students believed that their medical school curricula did not devote sufficient attention to key public health topics. 4 Completing death certificates correctly is a task for which residents receive little or no formal training. 5–7 Instead, they often learn on the job, with informal guidance provided by more senior colleagues or administrative staff. 5 A small pilot study found that 66% of the medical students (n = 68) studied received no training in death certificate completion, and 91% of medical residents (n = 21) first encountered the process during their residencies. 5 Without training, physicians are unlikely to accurately record the causes of death or to understand the broad implications of poorly completed death certificates. Cause of death data are critical to health policy development, resource allocation, and population-level assessments of disease burden, treatment, and prevention. A random review of death certificates from January through June 2003 in New York City suggested that the city’s unexpectedly high rate of death from coronary heart disease may be attributable to misreporting on death certificates. 6 In response, the New York City Department of Health and Mental Hygiene (Health Department) developed an e-learning module to teach correct completion of death certificates. 8 In fall 2008, the Health Department collaborated with Albert Einstein College of Medicine residency program directors to evaluate the effectiveness and acceptability of this course among resident physicians.
