Teaching and learning in morbidity and mortality rounds: an ethnographic study

Area of Science:

• Medical Education
• Patient Safety
• Quality Improvement

Background:

• Canadian general internal medicine division implemented weekly morbidity and mortality rounds (M&MRs) for postgraduate trainees.
• Focus on quality improvement and patient safety is a current emphasis in healthcare.

Purpose of the Study:

• Explore teaching and learning processes within M&MRs.
• Understand the role and contribution of M&MRs in the medical education context.

Main Methods:

• Ethnographic study of M&MRs.
• Observation of rounds and interviews with staff doctors and residents.
• Triangulation of data with concurrent, iterative analysis.

Main Results:

• Staff doctors viewed M&MRs as role-modeling opportunities for skills like addressing system issues, not for teaching content knowledge.
• Residents sought content knowledge but recognized learning about process and systems issues.
• A disconnect was observed between the teaching emphasized by staff and the learning prioritized by residents.

Conclusions:

• M&MRs are effective for patient safety and quality improvement competencies.
• Rounds avoided negative functions like absolving responsibility or socially discussing death.
• A significant divergence exists between staff teaching goals and resident learning preferences.