Mixed-Methods Assessment of Incivility During Surgical Mortality and Morbidity Conference

Abstract

INTRODUCTION: A psychologically safe environment at Surgical Mortality and Morbidity Conference is critical for open discussion to improve care. This study sought to assess incivility during Mortality and Morbidity (M&M) Conference in an academic Department of Surgery. METHODS: We used a convergent mixed methods design to collect quantitative data through standardized survey instruments and qualitative data through non-participant observations. The Positive and Negative Affect Schedule Short-Form (PANAS) and the Uncivil Behavior in Clinical Nursing Education (UBCNE) survey instruments were distributed to all the Department of Surgery faculty and residents with three reminders. RESULTS: Among 147 eligible participants, 54 (36.7%) responded (residents: 27.5%, faculty: 37.6%). Junior faculty had a 2.60 higher Negative Affect score (p value = 0.02), a 4.13 higher Exclusion Behavior score (p value = 0.03), and 7.68 higher UBCNE score (p value = 0.04) compared to senior faculty. Females had a 2.71 higher Negative Affect score compared to males (p Value = 0.04). We observed 11 M&Ms, involving 30 cases, over 4 months. Cases were presented virtually detailing the clinical scenario, decision making, operative management, complications, and complication management. There was no standard structure for case discussion such as root cause analysis. Uncivil communications observed implied the treating team was incompetent or blamed the team for the complication. This was demonstrated by comments that categorically stated decision-making or management were unequivocally wrong (Fig. 1). Other examples were questions posed highlighting only part of the clinical story supporting a contrary view.Figure 1CONCLUSION: Unstructured discussion led to biased, uncivil comments. Structuring discussion to shift focus to improving care may create more generative comments.