Background: Morbidity and Mortality (M&M) conferences are ubiquitous among internal medicine (IM) residency programs, but often fail to improve patient safety and foster learning.1,2 One key determinant of a successful M&M conference is the choice of patient safety event (i.e. M&M case) that is analyzed or presented. However, the characteristics of an effective M&M case have yet to be defined, which may undermine the educational and patient safety (PS) value of the M&M conference.
Purpose: To improve the outcomes of our M&M conference, we created a case selection tool to measure the qualities of an effective M&M case, defined by educational value for our residents and likelihood that the case will result in successful Quality Improvement (QI) initiatives in our health system.
Description: Using Kane’s validity framework, we began by developing selection criteria based on a review of the literature and speaking with local experts. We then tested the tool with faculty and trainees at our institution and refined the criteria for clarity and reliability. Each month, during our residency QI/PS council meetings, we evaluate cases using this selection tool to both score and then discuss the favorable and unfavorable attributes of the case as they pertain to resident education and PS. Our tool has 10 selection criteria that fall under two domains; “educational value” (i.e. a case that will foster resident learning during the M&M conference) and “safety value” (i.e. a case that will improve safety at our institution). Each criterion is rated on a 3-point scale (1=not met, 2=partially met, 3=fully met).
Conclusions: With the development and utilization of our case selection tool prior to M&M conferences, preliminary data suggests that the PS cases chosen are more engaging for our residents and have led to the creation of practice-changing QI projects within our health system. We are also able to identify special guests well in advance to help facilitate discussion of the PS event after residents present the case at M&M conference. Together, these allow for more fruitful discussions by our residents regarding contributing factors to the PS event and possible avenues of change that can be undertaken to prevent future medical errors.Having a tool with well-defined items facilitates the selection of educationally and clinically valuable M&M cases. However, not all criteria contribute equally to the success of an M&M case; some matter more than others. This emphasizes that group deliberation and the selection tool score are complementary elements when choosing an M&M case.
