427 Optimization of Morbidity and Mortality Conference: Results of a Multi-center Pilot at Neurosurgical Training Programs

Abstract

INTRODUCTION: Neurosurgical morbidity and mortality (M&M) conference is essential to resident education and to quality control. Training programs use different methods for executing the conference, with variability in presentation format, case inclusion criteria, adjudication of findings, and follow-up strategy. Optimal format for this conference is debated. METHODS: Ten ACGME-accredited neurosurgical training programs participated in a 3-month pilot to optimize M&M conference. A standardized format was implemented, using a broadly inclusive strategy for case selection, with morbidities selected by residents. Each neurosurgical complication was defined, in group discussion, according to type of error: indication; technique; procedure; judgment; nature of disease. Follow-up intervention was drafted for each case. Surveys were distributed to trainees and attending neurosurgeons before and after the pilot to assess the new format compared to historical standard. RESULTS: A total of 302 surveys were returned from attending and resident physicians. Seventy-four % of respondents found the new format to be an improvement (“slightly improved” or “much improved”) and Eight-five % expressed preference for the new standardized format. Fifty-two % of resident respondents believed engagement at the conference was increased. Twenty-six % responded that significant process improvements resulted from the standardized format. CONCLUSIONS: This 3-month pilot to optimize neurosurgical M&M conference, undertaken at ten neurosurgery training programs, received favorable reviews by survey. Respondents endorsed high levels of faculty & resident engagement. Case categorization by error was favorably reviewed. Significant process improvements were only noted by a minority of respondents, however, perhaps related to the short duration of the pilot. Overall these results suggest that future amplification of a standardized M&M format across neurosurgical training programs could yield high satisfaction and enhanced resident engagement. Additional attention focused on process improvement will be critical.