Relationship Between Physicians' Knowledge and Skills in Medical Cause-of-Death Certification According to WHO Standards at Adam Malik Hospital

Background: Accurate medical cause-of-death certification is essential for producing reliable national mortality statistics. The World Health Organization (WHO) has established international standards for recording medical causes of death. One of the factors influencing the accuracy of death certification is physicians' skills, which may be affected by age, educational background, and professional experience. As a tertiary referral hospital, H. Adam Malik General Hospital plays a crucial role in providing accurate mortality data. Objective: To analyze the relationship between physicians' knowledge and skills in recording medical causes of death according to WHO standards at H. Adam Malik General Hospital, Medan. Methods: This analytical observational study employed a cross-sectional design involving 155 resident physicians enrolled in medical specialty residency programs. Data were collected using a structured knowledge questionnaire and a case-based skills questionnaire administered through Google Forms. Bivariate analysis was performed using the Chi-square test with a significance level of p<0.05. Results: Most participants had poor knowledge of medical cause-of-death certification (54.8%), while 47.7% demonstrated good certification skills. A significant association was found between physicians' knowledge and their skills in recording medical causes of death (p<0.001). In addition, medical specialty residency program and previous participation in death certification training were significantly associated with physicians' skills (p<0.05), whereas age, year of medical graduation, and residency competency level showed no significant association. Conclusion: Physicians' knowledge, medical specialty residency program, and previous participation in death certification training were significantly associated with skills in recording medical causes of death according to WHO standards. Continuous training and curriculum enhancement are recommended to improve the quality of medical cause-of-death certification.