Post-mortem external examination competence, education and accuracy of general practitioners in a metropolitan area
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Post-mortem external examination competence, education and accuracy of general practitioners in a metropolitan area. / Schröder, Ann Sophie; Wilmes, Sandra; Sehner, Susanne; Ehrhardt, Maren; Kaduszkiewicz, Hanna; Anders, Sven.
In: INT J LEGAL MED, Vol. 131, No. 6, 11.2017, p. 1701-1706.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Post-mortem external examination competence, education and accuracy of general practitioners in a metropolitan area
AU - Schröder, Ann Sophie
AU - Wilmes, Sandra
AU - Sehner, Susanne
AU - Ehrhardt, Maren
AU - Kaduszkiewicz, Hanna
AU - Anders, Sven
PY - 2017/11
Y1 - 2017/11
N2 - In several countries, general practitioners conduct post-mortem external examination (PMEE) and certify death in out-of-hospital cases. A possible lack of accuracy has been repeatedly criticised, although data on everyday practice of PMEE on outpatients are scarce. To evaluate medical practitioner's competence, education and accuracy regarding PMEE, we conducted a fax-survey among 1343 medical doctors in the metropolitan area of Hamburg, Germany. The results indicate considerable shortcomings in up to 63% regarding the inspection of body orifices and hidden areas, palpation of osseous structures, ectropionisation of the eyelids and use of aids. More than 5% of respondents reported to fill in a death certificate without performing a complete PMEE in the majority of cases. While theoretical teaching on PMEE was reported quite frequently (up to 78%), a considerably smaller group received practical training (32% during undergraduate and 13% during postgraduate education). To estimate the effects of training on PMEE, an individual "accuracy score" was calculated (range 1-5). Mean score was 3.63 (SD 0.81), and results differed significantly (p < 0.001) among groups of medical practitioners with or without education on PMEE and was highest among doctors who received practical training (p < 0.005). The results indicate that there are major shortcomings in a relevant portion of PMEE performed on out-of-hospital deaths that might lead to misdiagnosis of non-natural causes of deaths and homicides. Practical pre- and postgraduate education appears to positively impact accuracy and therefore quality of the procedure. Consequently, corresponding practical training should be mandatory during academic studies and ongoing education programs.
AB - In several countries, general practitioners conduct post-mortem external examination (PMEE) and certify death in out-of-hospital cases. A possible lack of accuracy has been repeatedly criticised, although data on everyday practice of PMEE on outpatients are scarce. To evaluate medical practitioner's competence, education and accuracy regarding PMEE, we conducted a fax-survey among 1343 medical doctors in the metropolitan area of Hamburg, Germany. The results indicate considerable shortcomings in up to 63% regarding the inspection of body orifices and hidden areas, palpation of osseous structures, ectropionisation of the eyelids and use of aids. More than 5% of respondents reported to fill in a death certificate without performing a complete PMEE in the majority of cases. While theoretical teaching on PMEE was reported quite frequently (up to 78%), a considerably smaller group received practical training (32% during undergraduate and 13% during postgraduate education). To estimate the effects of training on PMEE, an individual "accuracy score" was calculated (range 1-5). Mean score was 3.63 (SD 0.81), and results differed significantly (p < 0.001) among groups of medical practitioners with or without education on PMEE and was highest among doctors who received practical training (p < 0.005). The results indicate that there are major shortcomings in a relevant portion of PMEE performed on out-of-hospital deaths that might lead to misdiagnosis of non-natural causes of deaths and homicides. Practical pre- and postgraduate education appears to positively impact accuracy and therefore quality of the procedure. Consequently, corresponding practical training should be mandatory during academic studies and ongoing education programs.
KW - Journal Article
U2 - 10.1007/s00414-017-1559-9
DO - 10.1007/s00414-017-1559-9
M3 - SCORING: Journal article
C2 - 28210814
VL - 131
SP - 1701
EP - 1706
JO - INT J LEGAL MED
JF - INT J LEGAL MED
SN - 0937-9827
IS - 6
ER -