Morbidity and mortality rounds in the medical literature: A text based analysis of shifting knowledge regimes

Abstract

In this study, we explore knowledge regimes shaping the ongoing transformation of medical identities. We accomplish this through a text-based analysis of published studies reporting on interventions into the membership, content, or process of morbidity and mortality rounds. Historically a site for physicians to discuss medical error, these rounds still feature strongly in efforts to improve patient safety. In this way, changes to morbidity and mortality rounds offer a window into shifting knowledge regimes being realized in clinical workplaces and sites of medical education. Following a systematic search process, our dataset included 54 studies published between 1992 and 2020. Using Foucault's concept of governmentality as a sensitizing device in our analysis of these texts, we found that morbidity and mortality rounds were being changed to align with the rationales and identities associated with evidence-based medicine, quality improvement/patient safety practices, or a combination of both. However, those combinations were not always smooth. In some ways, our analysis confirms the ongoing penetration of evidence-based medicine rationales in the profession of medicine. Our analysis also shows the competing dynamics of quality improvement and patient safety regimes. If the identities available for participants enrolled in evidence-based medicine include engaging as librarians or researchers, then the identities invited in the quality improvement/patient safety regimes centre around the notion of “safety scientists”. The future question is whether these belief systems and associated knowledge practices compete, complement, or mix together in some new configuration. Ultimately, we argue for further explorations of the changing nature of knowledge practices and associated knowledge regimes intersecting with the profession of medicine.