title: Systems-based content in medical morbidity and mortality conferences: a decade of change.
abstract: BACKGROUND
  Following the Accreditation Council for Graduate Medical Education recommendations in 1999 to foster education in the systems-based practice (SBP) competency by examining adverse clinical events, institutions have modified the morbidity and mortality conference (MMC) to increase SBP-related discussion. We sought to examine the extent to which SBP-related content has increased in our department's MMCs compared with MMCs 10 years prior.
  
  
  METHODS
  We qualitatively analyzed audio recordings of our MMCs during 2 academic years, 1999-2000 (n  =  30) and 2010-2011 (n  =  30). We categorized comments and questions from moderators and faculty as SBP or non-SBP and characterized conferences by whether adverse events were presented and which systems issues were discussed.
  
  
  RESULTS
  Compared with MMCs in 1999-2000, present-day MMCs included a greater average percentage of SBP comments stated (69% versus 12%; P ≤ .001) and questions asked (13% versus 1%; P  =  .001) by the moderator, SBP comments stated (44% versus 4%; P ≤ .001) and questions asked (19% versus 1%; P ≤ .001) by faculty, and were more likely to present adverse events (87% versus 13%; P < .001). Interrater reliability for the distinction between SBP and non-SBP content was good (κ  =  0.647). Most common categories of systems issues discussed in 2010-2011 were critical laboratory value processing and reporting, institutional policies, and hospital-based factors.
  
  
  CONCLUSIONS
  Over the past decade, our MMC has transformed to include more discussion of SBP-related content and adverse events. The MMC can be used to educate residents in SBP and can also serve as a cornerstone for departmental quality and safety initiatives.
authors.forename: Jed D
authors.initials: JD
authors.lastname: Gonzalo
authors.forename: Julius J
authors.initials: JJ
authors.lastname: Yang
authors.forename: Grace C
authors.initials: GC
authors.lastname: Huang