Morbidity and Mortality (M&M) Conference is a traditional forum that provides residents with an opportunity to discuss medical errors, adverse events and near misses. Conventionally, most of the allotted time is spent on case presentation, unexpected outcomes and therapeutic debates. We demonstrate a unique approach to M&M, where we refocused the content by emphasizing principles of patient safety and evidence-based medicine.
The purpose was to revamp the current M&M conference to focus on patient safety, quality improvement and evidence-based medicine.
We describe two educational innovations implemented at two large academic medical centers. Both innovations were designed and implemented by academic hospitalists who have teaching roles with the residency programs. For the first innovation, cases were specifically chosen after comprehensive review for identifiable systematic errors and potential actionable improvements for preventing future errors. Residents were tasked to complete a systemic analysis of error using: 1) Modified fishbone diagram to conduct root cause analysis, 2) Quality appraisal review and incorporate best practices based on quality evidence, 3) Process debrief to create action plan from identified stakeholders. Post surveys were conducted to assess residents’ perception of the educational activity. In addition, data was collected and analyzed for classification of errors and the number of systems improvement as a result of M&Ms.
In the second innovation, mortalities were reviewed in small group sessions with each resident responsible for reviewing and presenting 1-3 cases. Cases are presented to the hospitalist with a focus on quality improvement and patient safety. The mortalities are used to generate PICO style questions which are then researched. The next session starts with a recap of the PICO question followed by a critical appraisal of the evidence.
A total of 58 residents participated in the first innovation. Post survey demonstrated high resident satisfaction with the patient safety learning objectives. 90% of the residents ‘agreed’ or ‘strongly agreed’ that the safety concepts they learned would likely improve the quality of care they provide to future patients. We also found that cognitive errors were the most commonly identified error in all of the cases.
Since the start of the academic year, 40 residents have participated in the second innovation and have reviewed over 130 mortalities. These cases have generated 20 PICO questions each of which have led to the critical appraisal of 1-3 articles.
We demonstrate that M&Ms can be used to effectively teach principles of patient safety, quality improvement and evidence-based medicine. These innovations have been successful in two different residency programs. M &M conferences require a distinct educational approach with the main focus on how to learn from previous errors/near misses to prevent future harm.