Using the Morbidity and Mortality conference to teach and assess the ACGME General Competencies

The weekly Morbidity and Mortality (M&M) conference, a Residency Review Committee on Surgery required conference, is a hallmark of general surgery residency training. This conference has been used traditionally to teach and assess the ACGME General Competencies of patient care and medical knowledge. The author's department has changed the format of their weekly M&M conference so that it enables them to teach and assess residents also in terms of the ACGME General Competencies of practice-based learning and improvement, professionalism, interpersonal and communication skills, and systems-based practice.

Each Monday the chief resident on each teaching service compiles a list of patient discharges and deaths for the previous week. Although all deaths are presented, only significant patient complications are selected for the following week's M&M conference. This 2-week preparation period enables the resident, who was primarily involved in the care of the patient, to thoroughly review the case and prepare his/her presentation. At the conference, the resident presents the patient's history and discusses the complication or death, not only in terms of the patient care provided (traditional M&M model), but also it analyzes the case in terms of health-care systems problems that may have contributed to the patient's morbidity and/or mortality; patient safety issues; communication problems with the patient, family, or other health-care workers; and ethnic or ethical issues related to the care provided. The case is then reviewed by faculty surgeons. Again, not only is the patient care critiqued, but also systems problems, communication problems, and ethical dilemmas. Each resident who presents a case at the M&M conference also completes a practice-based improvement log. This form analyzes the patient's outcome including factors leading to the complication and/or mortality, opportunities for systems improvement, patient safety or communication problems, ethnic or ethical issues, what the resident would do different in his/her practice, and references consulted for this case. These forms are reviewed with the resident by the Residency Director and become part of the resident's portfolio.

The restructuring of the M&M conference so that a case is analyzed with all ACGME General Competencies has made the M&M conference more interesting and has improved the educational aspects of the conference. Analyzing a case according to the various ACGME General Competencies has provided another method to teach these competencies to their residents and a tool to determine whether the residents are meeting the competencies.