Lessons Learned From the Surgical Morbidity and Mortality Conference

Abstract

The Morbidity and Mortality (M&M) conference is both a quality improvement and an educational conference. We sought to evaluate the educational and quality improvement value of different learners who attend the surgical M&M conference. Furthermore, we sought to evaluate if an educational intervention directed at medical students (MS) would improve their experience at this conference. Over a 2-month period, we used a third party, real-time audience polling software during 4 M&M conferences using questions concerning medical error, loop closure, learning value, applicability, and professionalism. After baseline data were obtained in Phase 1, MS attended a seminar on the subject of error as part of their orientation. Additionally, to facilitate their preparation, MS were supplied the cases to be presented at that week's conference, a few days before M&M. After this intervention, 3 additional M&M conferences were polled, as described above, as part of Phase 2. Differences between faculty (FAC) and MS experience were assessed by chi-square and ANOVA analyses as appropriate. Study was reviewed and received a waiver from the IRB. Rhode Island Hospital, Providence, Rhode Island, a tertiary care academic teaching hospital of Brown University. Audience participants were informed of the voluntary nature of this survey and asked to self-identify as MS, PA/NPs, junior residents, senior residents, or FAC. In phase 1, there were an average of 289±18.7 responses per session, while in phase 2 there were an average of 267±9.29 responses per session. In Phase 1, when asked to characterize the error as practitioner, system, both practitioner and system or neither, FAC were more likely to assign error as practitioner error than MS (15/38-39.5% vs 6/41-14.6%, p=0.021). This trend continued in Phase 2, FAC (19/33-57.6%) vs MS (8/29-27.6%), p=0.011. In terms of whether learners felt the conference was useful to their education (5 point scale - strongly agree to strongly disagree) the FAC felt conference more useful than MS (4.0 vs 3.63 p=0.005). This trend continued even after intervention (4.24 vs 3.71 p<0.001). The FAC and MS had the same opinion as to the closure of the case being "education at conference," change in policy/procedure, both, neither, no response - average: 75, 3, 9, 6, 7%. Both the FAC and the MS felt the environment was professional (Phase 1: 4.42 v 4.18, p=0.321)(Phase 2: 4.43 v 4.37, p=0.1002). Despite an educational intervention, we found FAC and MS maintained very divergent opinions as to what is practitioner error, and system error, and FAC found the M&M discussion more educational than MS. To maximize learning for MS during surgical M&M more interventions are needed.