Re-thinking morbidity and mortality

Despite the breadth of patient safety initiatives, physicians talking about their mistakes to other physicians is a difficult thing to do. This difficulty may be exacerbated by a limited exposure to how to analyze and discuss mistakes and respond in a productive way. At the University of Virginia, we recognized the importance of understanding cognitive biases for residents in both their clinical and personal professional development. We re-designed our resident led morbidity and mortality (M&M) conference using a model that integrates dual-process theory and metacognition to promote informed reflection and analysis of cognitive diagnostic errors. We believe that structuring M&M in this way builds a culture that encourages reflection together to learn our most difficult diagnostic errors and to engage in where our thought processes went wrong. In slowly building this culture, we hope to inoculate residents with the habits of mind that can best protect them from harmful biases in their clinical reasoning while instilling a culture of self-reflection.