title: Morbidity and Mortality Conference in Emergency Medicine Residencies and the Culture of Safety.
abstract: BACKGROUND
  Morbidity and mortality conferences (M+M) are a traditional part of residency training and mandated by the Accreditation Counsel of Graduate Medical Education. This study's objective was to determine the goals, structure, and the prevalence of practices that foster strong safety cultures in the M+Ms of U.S. emergency medicine (EM) residency programs.
  
  
  METHODS
  The authors conducted a national survey of U.S. EM residency program directors. The survey instrument evaluated five domains of M+M (Organization and Infrastructure; Case Finding; Case Selection; Presentation; and Follow up) based on the validated Agency for Healthcare Research & Quality Safety Culture survey.
  
  
  RESULTS
  There was an 80% (151/188) response rate. The primary objectives of M+M were discussing adverse outcomes (53/151, 35%), identifying systems errors (47/151, 31%) and identifying cognitive errors (26/151, 17%). Fifty-six percent (84/151) of institutions have anonymous case submission, with 10% (15/151) maintaining complete anonymity during the presentation and 21% (31/151) maintaining partial anonymity. Forty-seven percent (71/151) of programs report a formal process to follow up on systems issues identified at M+M. Forty-four percent (67/151) of programs report regular debriefing with residents who have had their cases presented.
  
  
  CONCLUSIONS
  The structure and goals of M+Ms in EM residencies vary widely. Many programs lack features of M+M that promote a non-punitive response to error, such as anonymity. Other programs lack features that support strong safety cultures, such as following up on systems issues or reporting back to residents on improvements. Further research is warranted to determine if M+M structure is related to patient safety culture in residency programs.
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts ; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Aaronson
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts ; Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wittels
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts ; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts ; Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Nadel
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts ; Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Schuur
mesh_terms: D003226:Congresses as Topic / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate / Q000379:methods* / Q000458:organization & administration; D004635:Emergency Medicine / Q000193:education* / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000458:organization & administration; D015279:Organizational Culture; D012449:Safety; D011795:Surveys and Questionnaires; D014481:United States