title: The use of a multidisciplinary morbidity and mortality conference to incorporate ACGME general competencies.
abstract: BACKGROUND
  The Surgical Morbidity and Mortality conference has long been used as an opportunity for both process improvement and resident education. With recent heightened focus on creating environments of safety and on meeting the Accreditation Council for Graduate Medical Education (ACGME) General Competencies, novel approaches are required. With the understanding that the provision of medical care is an inherently multidisciplinary enterprise, we advocate the creation and use of a Multidisciplinary Morbidity and Mortality conference (MM&M) as a means to establish this culture of safety while teaching the ACGME General Competencies to surgery residents.
  
  
  METHODS
  A quarterly MM&M conference was implemented to foster communication between disciplines, provide a forum for quality improvement, and enhance patient care. All stakeholders in the perioperative enterprise attend, including the departments of surgery, anesthesia, radiology, pharmacy, nursing, environmental services, risk management, and patient services. Cases that expose system issues with potential to harm patients are discussed in an open, nonconfrontational forum. Solutions are presented and initiatives developed to improve patient outcomes. We retrospectively reviewed the topics presented since the conference's inception, grouping them into 1 of 7 categories. We then evaluated the completion of the improvement initiatives developed after discussion at the conference.
  
  
  RESULTS
  Over a 21-month period, 11 cases were discussed with 23 "actionable" initiatives for quality improvement. Cases were grouped by category; procedures (36.5%), process (36.5%), patient-related (9%), communication (9%), medication (9%), device (0%), and ethics (0%). All cases discussed addressed at least 4 of the 6 ACGME General Competencies.
  
  
  CONCLUSIONS
  Like the practice of medicine, the occurrence of adverse outcomes is frequently multidisciplinary. An MM&M conference is useful in its potential to meet ACGME General Competencies, engender a culture of patient safety, and rapidly achieve quality improvement and systems health care delivery initiatives in a large academic medical center.
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2730, USA. rondi.kauffmann@vanderbilt.edu
authors.forename: Rondi M
authors.initials: RM
authors.lastname: Kauffmann
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Landman
authors.forename: Julia
authors.initials: J
authors.lastname: Shelton
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Bledsoe
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Hickson
authors.forename: R Daniel
authors.initials: RD
authors.lastname: Beauchamp
authors.forename: Jeffery B
authors.initials: JB
authors.lastname: Dattilo
mesh_terms: D000068:Accreditation / Q000592:standards*; D002983:Clinical Competence; D003226:Congresses as Topic; D004503:Education, Medical, Graduate / Q000592:standards / Q000639:trends; D013502:General Surgery / Q000193:education*; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D008297:Male; D009017:Morbidity; D009026:Mortality; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States