Improvement in educational effectiveness of morbidity and mortality conferences with structured presentation and analysis of complications

Abstract

Purpose: Although morbidity and mortality (M & M) conferences are cornerstones of surgical teaching, they are not consistent in their educational quality. The current study examines the content and process of M & M presentations by surgical residents and hypothesizes that a structured format for these presentations can improve teaching and learning.

Methods: The educational effectiveness of M & M conferences was assessed through the observation of case presentations, questionnaires to residents measuring learning from presentations, and an anonymous survey of residents regarding perceptions of the effectiveness of conferences. A structured presentation format was devised to address the deficits noted from these assessments and subsequently introduced to all residents and faculty. M & M conferences were then reassessed using the 3 methods.

Results: Forty M & M presentations by surgical residents were observed before the implementation of the standardized format, and 35 presentations were observed after the changes. Observation of presentations noted significant changes in residents clearly presenting causes of complications and proposing strategies for practice change. Questionnaires of residents demonstrated improved ability to specify the causes of complications after implementation of the new format (mean rating, 4.56 vs 3.11, p < 0.05) as well as to identify specific ways to avoid the complication in the future (mean, 4.31 vs 3.42, p < 0.05). Online survey results also demonstrated improved resident perception of the specificity of content covered during M & M conferences as well as in their opinions regarding the discussion process.

Conclusions: A structured format for M & M presentations is a practical tool to help residents analyze complications systematically and identify steps for potential changes consistently in clinical practice. Such a format also leads to improved learning for other residents participating in these conferences. Without structured presentations, M & M conferences fail to deliver clear educational messages regarding surgical complications.