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The morbidity and mortality conference: the delicate nature of learning from error
Jay D Orlander1, Thomas W Barber, B Graeme Fincke
1Boston University Residency Program, Section of General Internal Medicine and Epidemiology, VA Boston Health Care System, Boston, Massachusetts 02130, USA.
Abstract:
The morbidity and mortality conference (M&MC) appears to have sprung from the efforts of physicians to improve practice through the examination of medical errors and bad outcomes. The modern M&MC has had limited examination (and almost none outside surgery and anesthesia), but may be straying from the precepts from which it evolved. Learning from one's errors is important, but confronting them is difficult and is particularly delicate when done in conference. If the effort is successful, it can serve as a model. If unsuccessful, it can instead convey the lesson that attempting to learn from error is at best unproductive and at worst unpleasant. Thus, the M&MC is a double-edged sword, and particular attention should be given to the way that it is conducted. The authors review the historical roots and current literature on the M&MC, discusses relevant literature on medical error, and offers a definition, guiding principles, and a set of guidelines for a modern internal medicine M&MC. The ideas are presented not as a blueprint, but rather to stimulate a debate on the merits of establishing a framework for a working model, in order to refocus on the tradition of self-analysis and critical thinking in a manner that is productive for all participants.
Insights
Morbidity and mortality conferences (M&MCs) aim to improve medical practice by examining errors and poor outcomes. However, they can be challenging and require careful facilitation to ensure productive learning from medical errors.
Area of Science:
- Medical Education
- Patient Safety
- Healthcare Quality Improvement
Background:
- Morbidity and mortality conferences (M&MCs) originated as a method for physicians to enhance practice by analyzing medical errors and adverse outcomes.
- The modern M&MC format has undergone limited scrutiny, particularly outside surgical and anesthesia disciplines, potentially deviating from its foundational principles.
- Confronting medical errors in a conference setting presents unique challenges, impacting the effectiveness and perception of M&MCs.
Purpose of the Study:
- To review the historical evolution and current literature concerning morbidity and mortality conferences.
- To discuss pertinent research on medical error and its implications within healthcare settings.
- To propose a definition, guiding principles, and practical guidelines for conducting effective internal medicine M&MCs.
Main Methods:
- Historical review of morbidity and mortality conferences.
- Literature synthesis on medical error and M&MC effectiveness.
- Development of a proposed framework for modern internal medicine M&MCs.
Main Results:
- M&MCs are a "double-edged sword," capable of fostering learning or causing distress depending on their execution.
- A need exists for a structured approach to M&MCs to ensure they remain productive and facilitate self-analysis.
- The study offers a foundational model to stimulate debate and refine M&MC practices.
Conclusions:
- Effective M&MC facilitation is crucial for successful learning from medical errors and adverse events.
- A structured framework can help refocus M&MCs on critical thinking and self-analysis.
- The proposed guidelines aim to enhance the productivity and positive impact of M&MCs in internal medicine.