title: Surgery and Medicine Residents' Perspectives of Morbidity and Mortality Conference: An Interdisciplinary Approach to Improve ACGME Core Competency Compliance.
abstract: OBJECTIVE
  Morbidity and mortality conferences (MMCs) are often used to fulfill the Accreditation Council for Graduate Medical Education practice-based learning and improvement (PBLI) competency, but there is variation among institutions and disciplines in their approach to MMCs. The objective of this study is to examine the trainees' perspective and experience with MMCs and adverse patient event (APE) reporting across disciplines to help guide the future implementation of an institution-wide, workflow-embedded, quality improvement (QI) program for PBLI.
  
  
  METHODS
  Between April 1, 2013, and May 8, 2013, surgical and medical residents were given a confidential survey about APE reporting practices and experience with and attitudes toward MMCs and other QI/patient safety initiatives. Descriptive statistics and univariate analyses using the chi-square test for independence were calculated for all variables. Logistic regression and ordered logistic regression were used for nominal and ordinal categorical dependent variables, respectively, to calculate odds of reporting APEs. Qualitative content analysis was used to code free-text responses.
  
  
  METHODS
  A large, multihospital, tertiary academic training program in the Pacific Northwest.
  
  
  METHODS
  Residents in all years of training from the Accreditation Council for Graduate Medical Education-accredited programs in surgery and internal medicine.
  
  
  RESULTS
  Survey response rate was 46.2% (126/273). Although most respondents agreed or strongly agreed that knowledge of and involvement in QI/patient safety activities was important to their training (88.1%) and future career (91.3%), only 10.3% regularly or frequently reported APEs to the institution's established electronic incident reporting system. Senior-level residents in both surgery and medicine were more likely to report APEs than more junior-level residents were (odds ratio = 4.8, 95% CI: 3.1-7.5). Surgery residents had a 4.9 (95% CI: 2.3-10.5) times higher odds than medicine residents had to have reported an APE to their MMC or service, and a 2.5 (95% CI: 1.0-6.2) times higher odds to have ever reported an APE through any mechanism. The most commonly cited reason for not reporting APEs was "finding the reporting process cumbersome." Overall, 87% of respondents agreed or strongly agreed that MMCs were valuable, educational, and contributed to improving patient outcomes, but many cited opportunities for improvement.
  
  
  CONCLUSIONS
  Although the perceived value of MMCs is high among both surgical and medicine trainees, there is significant variability across disciplines and level of training in APE reporting and experience with MMCs. This study presents a multidisciplinary resident perspective on optimizing APE reporting, MMCs, and PBLI compliance.
authors.affiliation: Department of Surgery, University of Washington Medical Center, Seattle, Washington; Harborview Injury Prevention and Research Center, Seattle, Washington. Electronic address: flynnobr@uw.edu.
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Flynn-O'Brien
authors.affiliation: Department of Surgery, University of Washington Medical Center, Seattle, Washington; Harborview Injury Prevention and Research Center, Seattle, Washington; Division of Trauma and Burn Surgery, Harborview Medical Center, Seattle, Washington.
authors.forename: Samuel P
authors.initials: SP
authors.lastname: Mandell
authors.affiliation: Department of Surgery, University of Washington Medical Center, Seattle, Washington; Division of Trauma and Burn Surgery, Harborview Medical Center, Seattle, Washington.
authors.forename: Erik Van
authors.initials: EV
authors.lastname: Eaton
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington; Department of Medicine, Harborview Medical Center, Seattle, Washington.
authors.forename: Anneliese M
authors.initials: AM
authors.lastname: Schleyer
authors.affiliation: Department of Surgery, University of Washington Medical Center, Seattle, Washington; Division of Trauma and Burn Surgery, Harborview Medical Center, Seattle, Washington.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: McIntyre
mesh_terms: D000068:Accreditation; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003226:Congresses as Topic; D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D009017:Morbidity; D009026:Mortality
keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; competency-based education; graduate medical education; morbidity; mortality; patient safety; quality improvement