Morbidity and Mortality Conference in Emergency Medicine Residencies and the Culture of Safety.

Emily Aaronson,Eric Nadel,Jeremiah Schuur,Kathleen Wittels

doi:10.5811/westjem.2015.8.26559

Abstract

IntroductionMorbidity and mortality conferences (M+M) are a traditional part of residency training and mandated by the Accreditation Counsel of Graduate Medical Education. This study’s objective was to determine the goals, structure, and the prevalence of practices that foster strong safety cultures in the M+Ms of U.S. emergency medicine (EM) residency programs.MethodsThe authors conducted a national survey of U.S. EM residency program directors. The survey instrument evaluated five domains of M+M (Organization and Infrastructure; Case Finding; Case Selection; Presentation; and Follow up) based on the validated Agency for Healthcare Research & Quality Safety Culture survey.ResultsThere was an 80% (151/188) response rate. The primary objectives of M+M were discussing adverse outcomes (53/151, 35%), identifying systems errors (47/151, 31%) and identifying cognitive errors (26/151, 17%). Fifty-six percent (84/151) of institutions have anonymous case submission, with 10% (15/151) maintaining complete anonymity during the presentation and 21% (31/151) maintaining partial anonymity. Forty-seven percent (71/151) of programs report a formal process to follow up on systems issues identified at M+M. Forty-four percent (67/151) of programs report regular debriefing with residents who have had their cases presented.ConclusionThe structure and goals of M+Ms in EM residencies vary widely. Many programs lack features of M+M that promote a non-punitive response to error, such as anonymity. Other programs lack features that support strong safety cultures, such as following up on systems issues or reporting back to residents on improvements. Further research is warranted to determine if M+M structure is related to patient safety culture in residency programs.

Highlights

Morbidity and mortality conferences (M+M) are a traditional part of residency training and mandated by the Accreditation Counsel of Graduate Medical Education
Further research is warranted to determine if M+M structure is related to patient safety culture in residency programs. [West J Emerg Med. 2015;16(6):810–817.]
Best practice suggests that high quality incident analysis requires robust reporting, non-punitive review, and institutionalized follow up and debriefing,[4] we found that many emergency medicine (EM) programs have not implemented these best practices in their M+M conferences

Summary

Introduction

Morbidity and mortality conferences (M+M) are a traditional part of residency training and mandated by the Accreditation Counsel of Graduate Medical Education. Morbidity and Mortality Conference tradition in medicine and play important roles in physician education and quality improvement (QI).[5] the historical culture of “blame and shame” embedded in M+M conferences is at odds with the goals of educating trainees in a culture of safety.[6,7] M+M conferences structured to teach residents to systematically analyze practice using QI methods in a non-punitive environment can help enhance emergency medicine (EM) safety culture.[8] recommended techniques include conference formats that employ anonymous case reporting, use non-punitive approaches to case review, formal debriefing of trainees with cases, and follow up of actions taken to address systems issues.[9,10,11] While there was one published survey studying the formats of M+M in EM residency programs,[12] this did not focus on the methods that M+M uses to approach non-punitive review, debriefing, and follow up

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