title: Practice-based learning and improvement: a two-year experience with the reporting of morbidity and mortality cases by general surgery residents.
abstract: BACKGROUND
  The Accreditation Council for Graduate Medical Education (ACGME) core competency of practice-based learning and improvement can be assessed with surgical Morbidity and Mortality Conference (MMC). We aim to describe the MMC reporting patterns of general surgery residents, describe the adverse event rate for patients and compare that with existing published rates, and describe the nature of our institutional adverse events. We hypothesize that reporting patterns and incidence rates will remain constant over time.
  
  
  METHODS
  In this retrospective cohort study, archived MMC case lists were evaluated from January 1, 2009 to December 31, 2010. The reporting patterns of the residents, the adverse event ratios, and the specific categories of adverse events were described over the academic years. χ(2) and Fisher's exact tests were used to compare across academic years, using an α = 0.05.
  
  
  RESULTS
  There were 85 surgical MMC case lists evaluated. Services achieved a reporting rate above 80% (p < 0.001). The most consistent reporting was done by postgraduate year (PGY) 5 level chief residents for all services (p > 0.05). Out of 11,368 patients evaluated from complete MMC submissions, 289 patients had an adverse event reported (2.5%). This was lower than published reporting rates for patient adverse event rates (p < 0.001). Adverse event rates were consistent for residents at the postgraduate year 2, 4, and 5 levels for all services (p > 0.05). Over 2 years, 522 adverse events were reported for 461 patients. A majority of adverse events were from death (24.1%), hematologic and/or vascular events (16.7%), and gastrointestinal system events (16.1%).
  
  
  CONCLUSIONS
  Surgery resident MMC reporting patterns and adverse event rates are generally stable over time. This study shows which adverse event cases are important for chief residents to report.
authors.affiliation: University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Department of Surgery, Pittsburgh, Pennsylvania 15213, USA. falconej@upmc.edu
authors.forename: John L
authors.initials: JL
authors.lastname: Falcone
authors.forename: Kenneth K W
authors.initials: KK
authors.lastname: Lee
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Billiar
authors.forename: Giselle G
authors.initials: GG
authors.lastname: Hamad
mesh_terms: D000068:Accreditation; D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D003162:Competency-Based Education / Q000458:organization & administration*; D003226:Congresses as Topic; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000592:standards* / Q000639:trends; D008297:Male; D009017:Morbidity / Q000639:trends; D009026:Mortality / Q000639:trends; D058996:Quality Improvement; D012189:Retrospective Studies; D012308:Risk Management / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality*; D014481:United States