Novel Use of the ACGME Milestones and Resident Morbidity and Mortality Conference Presentation Feedback

Morbidity and Mortality (M&M) conference presentations are a microcosm of patient care providing a snapshot of a resident's understanding of clinical care and quality improvement opportunities. The effectiveness of feedback provided during M&M and its utility for identifying residents who may be struggling clinically has been less explored. The Accreditation Council for Graduate Medical Education (ACGME) milestones serve as the gold standard for evaluation of surgery residents. The aims of this study were to investigate the impact of resident feedback on M&M conference presentations and correlate resident presentation skills with ACGME milestones.

At the conclusion of each weekly M&M conference, attendees are asked to provide feedback via a secure online survey platform. Survey questions solicit both quantitative and qualitative feedback including an overall score (1-10) and an opportunity to provide comments. A second survey of presenters and attendees was used to evaluate the utility of our feedback surveys. Two authors independently selected 7 ACGME milestone competencies most consistent with the goals of the M&M conference. After further deliberation, the top three milestone sub-competencies selected were: Systems-Based Practice (SBP1), Patient Care 1 (PC1), and Patient Care 4 (PC4). Milestone scores, obtained from the most recent clinical competency committee (CCC) meeting, were compared to presenters' average overall M&M presentation score. Residents with <5 M&M survey evaluations were excluded.

A total of 368 evaluations were completed for 20 resident presenters from 36 M&M conferences, with each resident receiving an average of 18 evaluations. Presenters (78.6%) and evaluators (81.8%) found feedback surveys useful. There was no significant difference between resident and attending overall presentation scoring. A positive and significant correlation was noted between the overall presentation score and the three milestone sub-competencies selected.

This study emphasizes the importance of structured feedback within M&M conferences. Similar to Entrustable Professional Activity assessments, M&M feedback surveys can be considered a micro-assessment, and when used in conjunction with other methods of evaluation, can aid in identifying residents who may be struggling clinically.