Morbidity and mortality conference: Enhancing delivery of surgery residency curricula

Abstract

Purpose

To determine the exposure of surgical residents to educational subjects contained in the APDS 2000 Curriculum from a weekly Morbidity and Mortality (M&M) conference.

Methods

The departmental quality assurance data base was queried for content presented in a residency program’s M&M conference. The presentation topics, the services involved, and the occurrence causation were all cataloged to assess the extent of material covered. The topic was logged if the case occurrence generated discussion beyond a superficial notation. An attending moderated the discussions, with resident and faculty interaction on causality determination. Imaging studies were available as appropriate to the case discussed.

Results

At least 95 discrete topics in 149 separate occurrences were covered in the weekly M&M conference in 1 academic year from July 1999 through June 2000. Common topics included wound infection (9), deep venous thrombosis (7), small bowel obstruction (5), and pulmonary embolus (4). Five topics were discussed 3 times, 23 were discussed twice, and 63 were discussed once. Although many occurrences had multiple causes, Pareto analysis of causation determined that nature of disease was prominent in 78 (52.4%), diagnostic difficulty in 31 (20.8%), technical error in 27 (18.1%), and error in judgment in 13 (8.7%). Pareto analysis of the surgical domains addressed included trauma (37, 24.8%), general surgery (35, 23.5%), common issues independent of service (32, 21.5%), vascular (20, 13.5%), cardio thoracic (11, 7.4%), critical care (9, 6.1%), and all other services (5, 3.4%).

Conclusions

A weekly M&M conference in a residency program provides broad exposure to material contained in the APDS 2000 curriculum. A peer-reviewed M&M conference provides ongoing examination of common problems encountered in the delivery of surgical care. By so doing, it promotes interactive teaching of the most relevant surgical problems.

Introduction

A Morbidity and Mortality (M&M) conference is a key component in the training and education of surgeons. Many residency programs use the weekly M&M conference for peer review of surgical judgment and outcomes.¹ Other departments approach the M&M conference as a statistical, quality management tool.2, 3, 4 Both of these approaches allow for significant teaching in surgical diagnosis and management. However, the ability of a structured M&M conference in helping a residency program fulfill a defined curriculum is not well described. In 2000, the APDS released its 2000 edition residency curriculum that covered knowledge and performance competency objectives in 6 discrete sections ranging from anatomy to practice economics. Furthermore, specific competencies were identified for both junior- and senior-level residents in each unit in each section. An analysis of 1 M&M conference format was undertaken to assess the level of exposure it provided to the APDS residency curriculum competencies and objectives.