Impact of Resident Education on the Performance of Morbidity and Mortality Conference

Abstract

INTRODUCTION

Surgical morbidity and mortality (M&M) conference is a cornerstone of surgical education and quality improvement. Despite its prominence, there are no widely established guidelines for the completion of M&M, nor training for surgical residents, who are frequently responsible for root cause analysis and case presentation.

METHODS

Based on a recently published systematic review and expert focus groups with experienced surgeons, we developed a series of 10 recommendations and/or best practices for surgical M&M conference. A brief educational session was created to share the recommendations and best practices with resident presenters. Trained reviewers assessed the completion of aforementioned best practices before and after the educational session. Chi-square analysis was performed to evaluate changes after the educational initiative.

RESULTS

During the pre-education period, 49 M&M presentations were evaluated. Completion of best practice components ranged from 22.5% to 95.9%, with greater than 80% completion of 6 of 10 components. After the educational initiative, 45 additional presentations were evaluated. We observed a statistically significance increase in the number of presentations with a concise case presentation (baseline: 59.2%, posteducation: 88.9%, p = 0.002). Notable increases in completion were observed for 2 other components, although neither reached statistical significance: review of relevant, high-quality literature (baseline: 53.1%, posteducation: 66.7%, p = 0.116) and focused teaching point, with or without reference to literature (baseline: 63.3%, posteducation: 80.0%, p = 0.149). No clinically significant decreases were observed.

DISCUSSION

We used a mixed methods approach to design and evaluate an educational session to equip resident presenters with a series of evidence-based best practices for M&M conference. The findings demonstrate the potential positive impact of a brief, educational initiative on aspects of M&M conference at a single institution. The impact was ultimately limited, particularly in regard to scope and effect, which we postulate is due to the fact that the success of M&M conference is dependent on a range of factors. Nonetheless, to advance the effectiveness of M&M conference, we advocate for this initiative and related education for residents, given their principal role, as well as broader initiatives to increase the value of M&M conference.