Morbidity and mortality conference: enhancing delivery of surgery residency curricula

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.

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.

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%).

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.