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Morbidity and Mortality Conference: Its Purpose Reclaimed and Grounded in Theory
Alexander Gregor1,2, David Taylor3
1a Department of Surgery , University of Toronto Faculty of Medicine , Toronto , Ontario , Canada.
Issue:
The morbidity and mortality conference (MMC) remains a central activity within the departments of our academic healthcare institutions. It is deeply rooted in the premise that we can learn from our mistakes, thereby improving the care we provide. Recent advances in our understanding of medical error and quality improvement have challenged the value of traditional models of MMC. As a result the purpose of MMC has become clouded and ill-defined: Is it an educational conference that promotes mastery of clinical acumen, or is it a venue to drive quality improvement by addressing systems-based issues in delivering care? Or can it serve both purposes?
Evidence:
Review of the history of MMC, the literature, and critical application of education theory demonstrates the source of the confusion and the challenges in viewing it through the exclusive lens of either education or quality improvement. Application of experiential learning theory helps resolve this discord showing how the conference facilitates the development of clinical mastery while informing quality improvement programs about important and relevant systems-based issues.
Implication:
Building on this, we present a model for MMC involving five essential elements: case-based involving an adverse patient event, anonymity for participants, expert guided critical analysis, reframing understanding of the case presentation and related systems-based factors, and projection to practice change. This model builds on previously described models, is grounded in the literature, and helps clarify its role from both the educational and the quality improvement perspectives.
Insights
Morbidity and mortality conferences (MMC) can effectively enhance both clinical skills and patient safety initiatives. A new five-element model clarifies MMC's dual role in medical education and quality improvement.
Area of Science:
- Medical Education
- Healthcare Quality Improvement
- Patient Safety
Background:
- Morbidity and mortality conferences (MMC) are traditional academic healthcare activities aimed at learning from medical errors.
- Evolving understanding of medical error and quality improvement has created ambiguity regarding the primary purpose of MMC.
- The core question is whether MMC should focus on clinical acumen education or systems-based quality improvement.
Purpose of the Study:
- To address the ambiguity surrounding the purpose of Morbidity and Mortality Conferences (MMC).
- To determine if MMC can effectively serve dual roles in medical education and quality improvement.
- To propose a refined model for MMC that integrates educational and quality improvement objectives.
Main Methods:
- A review of the historical context of MMC.
- Analysis of existing literature on medical error and quality improvement.
- Application of educational theories, specifically experiential learning theory.
Main Results:
- Experiential learning theory provides a framework to reconcile the educational and quality improvement functions of MMC.
- The analysis reveals how MMC facilitates clinical mastery development.
- MMC can inform quality improvement programs by highlighting systems-based issues.
Conclusions:
- A novel five-element model for MMC is proposed, integrating case-based adverse events, anonymity, critical analysis, reframing, and practice change.
- This model is grounded in literature and educational theory.
- The proposed model clarifies MMC's value from both educational and quality improvement perspectives, enhancing patient care.
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