CRITERION ASSESSMENT

(NOTE: Criterion Referenced Assessments listed below are samples of possible assessments that could be used.)

	Performance Objectives	Criterion Referenced Assessments
Significance
OBJECTIVE 1.1	Accurately identify the significance of data derived from death certificates.	Identify at least 3 significant uses of data derived from death certificates.

OBJECTIVE 1.2	Discuss the rules and penalties for breaking confidentiality of death certificate content.	Explain the rules underlying confidentiality on death certificates, including penalties for breaking confidentiality.

OBJECTIVE 1.3	Describe the ethical implications of inaccurate completion of a death certificate.	Describe at least 3 ethical implications that could result from completing a death certificate inaccurately.
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Procedure
OBJECTIVE 2.1	Accurately determine if death is expected or unexpected.	(Given case studies for expected and unexpected deaths) Label each instance as either Expected or Unexpected

OBJECTIVE 2.1.1	Identify circumstances which require that notification of death be sent to the Medical Examiner or Coroner.	(Given chart listing cause of death and circumstance of death) Indicate who the certifier would be in each case.

OBJECTIVE 2.1.2	Correctly identify circumstances when a natural death has occurred and filing of death certificate may proceed.	(Given a list of underlying causes) Choose the instance that is an example of a natural death. Explain your answer.

OBJECTIVE 2.2.1	Identify circumstances when a Fetal Death Certificate must be filled out.	(Given multiple "death of fetus" case studies at various stages of gestation). Which of the scenarios given would require the certifier to fill out a Fetal Death Certificate?

OBJECTIVE 2.2.1.2	Accurately describe procedures for completing a Fetal Death Certificate.	(Given a list of steps for filing a Fetal Death Certificate and possible missing steps). Which step is missing in the example filing process above? Why is it important to include that step?

OBJECTIVE 2.2.2	State the sequence of procedures for filing a Regular Death Certificate accurately.	(Given a list of steps for filing a Regular Death Certificate). What step is missing from the filing process above? _______

OBJECTIVE 2.3	Identify the proper wording to describe place of death.	(Given possible "Place of Death" statements, including several which are common errors). Identify accurate descriptors for "Place of Death".
OBJECTIVE 2.4	Explain when a death certificate may need to be amended.	(Given multiple case studies, some of which will require filing an amendment). For each case, is it True or False that you would need to file an amendment.? Justify your answer.

OBJECTIVE 2.4.1	Identify the procedures for filing an amendment to a death certificate.	(Given multiple steps for filing an amendment, several of which are not actually part of the process). Which steps are NOT part of the process of filing an amendment?
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Medical Opinion
OBJECTIVE 3.1	Discriminate between Pronoucer and Certifier.	(Given multiple choice items) Which description below best describes what the Pronouncer does?

OBJECTIVE 3.1.1	Describe the criteria for determining who is responsible for completing the cause of death portion of the death certificate.	List the criteria for determining who is responsible for completing the cause of death portion of the death certificate. or Given a case scenario) Identify the person responsible for completing the cause of death.

OBJECTIVE 3.1.	Identify the primary focus of the certifier of the COD	(Given multiple choice items) Choose the sentence that best states the primary focus of the certifier in certifying a cause of death. (The primary focus of certifiers should be on the medical and scientific content of the stated cause of death for reasons of accuracy rather than of legality)

OBJECTIVE 3.2	Identify the primary or target audience for whom Cause of Death statements are written.	(Given multiple choice items) Identify the primary or target audience for whom Cause of Death statements are written.

OBJECTIVE 3.2.3	Define the term underlying cause of death.	(Given multiple choice items) Select the item that best defines the term "underlying cause of death."

OBJECTIVE 3.2.3.1	Define the term immediate cause of death.	(Given multiple choice items) Select the item that best defines the term "immediate cause of death."

OBJECTIVE 3.2.4	Distinguish the immediate cause(s) of death from the underlying cause of death.	(Given a case scenario of a patient with events leading up to death and the COD portion of a death certificate) List the immediate and underlying cause of death.

OBJECTIVE 3.2.5	Explain the importance of accurately completing Part I of the Cause of Death portion of the Death Certificate	List 3 possible results of inaccurate completion of Part I of the COD portion of the Death Certificate.

OBJECTIVE 3.2.6	Distinguish between a well written cause of death statement and a poorly written COD statement.	(Given a case scenario that includes cause of death statements) Identify which COD statements are accurate and well written.

OBJECTIVE 3.2.7	Accurately identify the underlying cause of death.	(Given a case scenario of a patient with events leading up to death) List the underlying cause of death.

OBJECTIVE 3.2.8	Properly document the underlying cause of death, intermediate cause of death, and immediate cause of death.	(Given a case scenario of a patient with events leading up to death and the COD portion of a death certificate) Fill in the underlying cause of death on the form provided.

OBJECTIVE 3.2.9	Describe the sequential relationship of lines a through d in Part I of the COD section of the death certificate.	Describe the sequential relationship of lines a through d in Part I of the COD section of the death certificate.

OBJECTIVE 3.2.9.1	Describe the procedure for adding lines to Part I of the COD.	Describe the procedure for adding line to Part I of the COD.

OBJECTIVE 3.2.10	Recognize the conditions under which one line would be sufficient in describing the cause of death.	(Given several scenarios of events leading up to death) Select which scenario would require only one line to describe cause of death.

OBJECTIVE 3.2.10	Identify the process for determining immediate, intermediate, and underlying cause of death when it seems that two or more conditions may have added together to constitute the cause of death.	(Given multiple choice items) Select the item that best describes the process for determining cause of death when it seems that two or more conditions may have added together to constitute the cause of death.

OBJECTIVE 3.2.11	Define under what circumstance it is appropriate to list the cause of death as probable or presumed.	Define under what circumstance it is appropriate to list the cause of death as probable or presumed.

OBJECTIVE 3.3	Define the criteria for determining what information should be included in Part II of the COD portion of the death certificate.	Define the criteria for determining what information should be included in Part II of the COD portion of the death certificate.

OBJECTIVE 3.3.1	Distinguish between conditions contributing to the underlying cause of death and those having directly contributing to the underlying cause of death.	(Given a case scenario of a patient with events leading up to death and the Part I and II of the COD portion of a death certificate) Complete Parts I and II of the form provided.
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