Bridging the gap: Assessing death certification competency in Bulgarian healthcare education

Abstract

BACKGROUND: In Bulgaria, procedural protocols following a citizen’s death are governed by an intricate network of normative documents. Despite the presumed alignment between international and national guidelines, practical experiences reveal shortcomings in the proficiency of healthcare providers, particularly in cases involving prior medical interventions or systemic vulnerabilities. AIM: This study aimed to assess the readiness of final-year medical students and early-career physicians in navigating death certification intricacies, including their responses, documentation precision, and postmortem procedures for bereaved families, with implications for national health statistics. MATERIALS AND METHODS: By employing a mixed-methods approach, this study distributed questionnaires to sixth-year medical students and practicing physicians, including those in emergency medicine centers and general practice. Data collection included paper-based and digital questionnaires, ensuring anonymity and ethical compliance. Statistical analysis, employing parametric (t-test) and nonparametric (Chi-square) tests, forms the basis for actionable recommendations and educational material development. RESULTS: This study included 143 participants, of which 41% expressed apprehension about managing out-of-hospital deaths. Approximately 44% claimed familiarity with death certification regulations, with students displaying higher theoretical confidence but lacking practical knowledge. Remarkably, 74% of physicians never received formal training in death certification. Discrepancies in issuing death certificates, timing, and notification procedures were identified. CONCLUSION: Findings reveal varying practices among physicians according to their specialties. Issues related to documentation, timing, and notification were prevalent. The study emphasizes the need for improved training, particularly for medical students. Emergency medicine doctors exhibited higher preparedness levels. Medical students and early-career physicians urgently require enhanced education in death certification preparedness. Incorporating these topics into medical curricula, offering specialized courses, and disseminating instructional materials can significantly enhance effectiveness. Future studies should assess the quality and accuracy of recorded causes of death, which affect healthcare statistics, public service, and legal procedures, underscoring the societal and administrative significance of death certification practices.