Morbidity and Mortality Conferences of the Philippine General Hospital Department of Surgery: A Survey on the Perception of Surgical Trainees to Improve Patient Safety.

Abstract

Background and objective: Morbidity and mortality conferences (M&M) have been an important part of the hospital governance since the early 1900s. It has been shown to improve overall quality of care, minimize adverse occurrences and preventable fatalities, and provide chances for educational learning. However, medical trainees have different perceptions of M&M conferences which may affect its effectiveness in improving patient outcomes. The aim of this study is to determine the perception of surgical trainees towards M&M conferences.

Methods: The study is a questionnaire-based survey among surgical trainees of the Department of Surgery, Philippine General Hospital (PGH), for the training year of 2023. The survey consisted of 24 questions on their perception regarding the conduct of M&M. A Likert scale was used by the respondents to rate their perceptions (1 - negative, 10 - positive). Descriptive analysis and ANOVA were used to summarize the responses to the survey.

Results: A total of 64 surgical trainees from the Department of Surgery responded to the survey (response rate = 71.9%). Most respondents (68.8%) reported that the ideal frequency of M&M conferences is once a month. 78.1% were not aware of the inclusion criteria of the cases discussed in the departmental M&M conferences. Most reported (64.1%) that M&M conferences did not regularly include data on outpatient events. A mean rating of 5.2 was observed among surgical trainees on how judgmental they feel about the environment of M&M conferences. Surgical trainees were willing to talk openly about their complications (mean rating 7.1). They were fearful of criticism (mean rating 4.4) and the negative repercussions of their presentations (mean rating 4.1) during M&M conferences. The respondents perceive M&M conferences to be conducive for learning and service improvement with both having a mean rating of 7.8. Most felt that M&M conferences focused on the individual performance (mean rating 7.3) while participants were divided regarding the focus on systems and processes (mean rating of 5.6). In terms of dissemination, about half (45.3%) mentioned that they did not know how the discussions/outcomes were disseminated following an M&M conference. The mean rating of willingness to talk openly of complications were significantly higher among senior residents (7.7) compared to junior residents (6.3) (p=0.008).

Conclusion: This study observed variability in the perceptions of surgical trainees on M&M conferences. Surgical trainees tend to feel fear of criticism and negative repercussions during M&M conferences. There are opportunities for improving the format of M&M in terms of clarity of inclusion criteria and dissemination, and focusing on systems and processes rather than individual faults.