Abstract
Morbidity and mortality conferences are common among emergency medicine residency programs and are an important part of quality improvement initiatives. Here we review the key components of running an effective morbidity and mortality conference with a focus on goals and objectives, case identification and selection, session structure, and case presentation.
Highlights
Learning from medical errors and near-misses based on retrospective, single-case outcomes is an ubiquitous part of medical training, so much so that morbidity and mortality (M&M) conferences are a required component of graduate medical education in the United States and have been since 1983.1 Despite widespread use of the M&M conference, its format remains heterogenous with significant variation between programs.[1,2]
There has been a shift toward incorporation of quality assurance (QA) and quality improvement (QI) goals and objectives within the framework of the traditional M&M conference.[2]
To avoid the negative emphasis often associated with M&M conference, we propose that M&M conference be renamed to reflect the two goals of classroom-based education and QA/QI as well as the deliberate move away from the perceptions of “shame and blame” associated with them
Summary
Learning from medical errors and near-misses based on retrospective, single-case outcomes is an ubiquitous part of medical training, so much so that morbidity and mortality (M&M) conferences are a required component of graduate medical education in the United States and have been since 1983.1 Despite widespread use of the M&M conference, its format remains heterogenous with significant variation between programs.[1,2]. The origin of the M&M conference can be traced to the early 20th century when Ernest Codman, a surgeon and outspoken reformer at Massachusetts General Hospital, introduced the end-results system, which employed end-result cards to publicly document individual surgeon’s outcomes.[2] While this system of blame assignment was met with intense opposition at the time, it largely informed the initial iteration of the M&M conference.[2] Despite over a century of shared experience with M&M conferences among medical centers, many of the limitations of the primitive M&M conference still exist today These include haphazard retrospective collection of data, focus on isolated and anecdotal events without consideration of previous similar events, recall bias, lack of meaningful audit, narrow focus on individual performance, lack of systems-based thinking, and lack of multidisciplinary involvement.[3,4,5] Recently, there has been a shift toward incorporation of quality assurance (QA) and quality improvement (QI) goals and objectives within the framework of the traditional M&M conference.[2] In this paper, we perform a narrative review of the literature and provide best practice recommendations for goals and objectives, case identification and selection, and the structure and case presentation of M&M conferences. The manuscript was reviewed by the entire CORD Best Practices Subcommittee and posted to the CORD website for two weeks for general feedback and review from the entire CORD community
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