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A Critical Evaluation of Morbidity and Mortality Conference Kenric M. Murayama, Anna M. Derossis, Debra A. DaRosa, Heather B. Sherman Jonathan P. Fryer Northwestern University Medical School Department of Surgery

Morbidity & Mortality Conference Leo Gordon (1994) on the philosophy of the M&M conference… “…the golden hour of surgical education.” “…the short can outwit the tall, the not-so-intelligent can outwit the intelligent, and…the resident can outwit the attending.”

Morbidity & Mortality Conference

Morbidity & Mortality Conference Objectives of the M&M conference learn from complications and errors modify behavior and judgment based on previous experiences prevent repetition of errors leading to complications Education is the true objective of the M&M conference

Morbidity & Mortality Conference Thompson, et al (1992) JSR 52:97-100 important component of overall QA program adverse events reported that are missed by other monitoring processes Harbison, Regehr (1999) Am J Surg 177:136-139 fulfills potential as a teaching tool residents view conference less positively Hamby, et al (2000) Curr Surg 57:384-388 prospective outcome data can be incorporated and can improve quality of surgical practice

Morbidity & Mortality Conference Purpose: evaluate the impact of changes made addressing identified weaknesses in our M&M conference specific questions: Is there a change in faculty and resident perception of the conference after introduction of substantive changes? Do faculty and resident perceptions of M&M conference differ?

Morbidity & Mortality Conference Methods: pre-/post- survey design optimal criteria for evaluating M&M conference faculty opinion “Gordon’s Guide to the Surgical Morbidity and Mortality Conference” 23-item survey Likert-type scales questions addressed demographics, format, case presentations, and global statements

Morbidity & Mortality Conference Demographics: % time attended M&M? Faculty member? Academic rank? Resident? Year of training? Conference Format: Well attended by faculty? Well attended by residents? Faculty involved w/case present? Faculty contribution constructive? Questions thought provoking? Faculty adds to case facts? Faculty contribute beyond facts to teach? Format is structured? Written summary distributed? Case prediscussed w/faculty member? Conference presentation: Senior resident presents? Presenter has pertinent data? Resident brings pertinent XRAYs Resident demonstrates XRAY findings? Effective use of AV to highlight? Emphasis of clinical reasoning behind actions? Literature reviewed in context? Pertinent techniques/procedures described by residents? by faculty? Global questions: Discussion stimulates further study? Fulfills its eduational role? Most senior resident involved should present? Attendance should be required?

Morbidity & Mortality Conference Methods June 1999 - 1st administration of survey two mailings Fall 1999 - changes to conference format and content Fall 2000 - survey re-administered same group of faculty and residents 7 faculty excluded because they did not attend M&M conference descriptive statistics and Student t-tests

Morbidity & Mortality Conference Changes to M&M conference presentation style - 5-10 min. summary literature review limited to 5-10 min. faculty discussion prompted by moderator and chairman change conference time discuss all deaths and as many complications as time permits residents encouraged to discuss case with faculty involved

Morbidity & Mortality Conference Response rates: faculty: pre - 81% (n=35) post - 68% (n=19) residents: pre - 76% (n=37) post - 63% (n=31) Attendance: faculty: pre - 63%; post - 67% (NS) residents: pre - 61%; post - 83% (p < 0.001)

Morbidity & Mortality Conference Faculty: significant improvement: resident attendance (p < 0.05) written summary distributed (p < 0.01) significant decrease: pertinent literature reviews (p < 0.01) most senior resident presents ( p < 0.01) other items without significant change

Morbidity & Mortality Conference

Morbidity & Mortality Conference Summary of data Resident perception: Improvements in attendance time change for conference cases not pre-selected more cases discussed/conference Improved faculty contribution improved attendance moderator directed/prompted discussion faculty adds pertinent comments to discussion

Morbidity & Mortality Conference Summary of data (2) Resident perception: Educational value improved discussion of more cases each week stimulated to study further invoked to think analytically Conference format is more structured

Morbidity & Mortality Conference Summary of data (3) Faculty noted little, if any, improvement in the educational value of the conference QA versus education pertinent literature reviewed less frequently resident attendance improved Future areas for improvement increase discussion of case between resident and faculty prior to conference increase review of techniques and procedures

Morbidity & Mortality Conference Conclusion The perception of our M&M conference was improved by re-emphasizing its importance as the most valuable hour of education each week in our department.