A Resident Morbidity and Mortality Conference Curriculum to Teach Identification of Cognitive Biases, Errors, and Debiasing Strategies

Whitehead, Anne

doi:10.15766/mep_2374-8265.11190

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…A total of 179 full-text records were reviewed, and 59 studies met the inclusion criteria (Figure 1). After classification by type, there were 16 survey-based studies (27.1%), 34 intervention-based studies (57.6%), and 9 studies that were neither survey nor intervention based (15.3%) (eTables 1-3 in the Supplement, respectively). The mean MERSQI score for the included studies was 6.7 (range, 5.0-9.5) of a maximum possible 18, which implied that the studies were of average quality.…”

Section: Resultsmentioning

confidence: 99%

“…Studies highlighted that a nonpunitive, blame-free environment contributed positively to educational outcomes, participant engagement, and satisfaction . Methods of promoting a constructive environment included the following: establishing expectations at the start of each conference, having faculty present case examples, using nonjudgmental and objective language in slides and discussion, and creating discussion questions in advance of the MMC.…”

Section: Resultsmentioning

confidence: 99%

“…Multiple adjunct initiatives have been found to advance the broad objectives of MMCs . Whitehead et al described a structured MMC series in which residents systematically evaluated cognitive biases related to adverse outcomes.…”

Section: Resultsmentioning

confidence: 99%

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Defining a High-Quality and Effective Morbidity and Mortality Conference

Beaulieu-Jones,

Wilson,

Howard

et al. 2023

JAMA Surg

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ImportanceMorbidity and mortality conferences (MMCs) are thought to advance trainee education, quality improvement (QI), and faculty development. However, there is considerable variability with regard to their completion.ObjectiveTo compile and analyze the literature describing the format, design, and other attributes of MMCs that appear to best advance their stated objectives related to QI and practitioner education.Evidence ReviewFor this systematic review, a literature search with terms combining conference and QI or morbidity and mortality was performed in January 2022, using the PubMed, Embase, and ERIC (Education Resources Information Center) databases with no date restrictions. Included studies were published in English and described surgical or nonsurgical MMCs with explicit reference to quality or system improvement, education, professional development, or patient outcomes; these studies were classified by design as survey based, intervention based, or other methodologies. For survey-based studies, positively and negatively regarded attributes of conference design, format, and completion were extracted. For intervention-based studies, details of the intervention and their impact on stated MMC objectives were abstracted. Principal study findings were summarized for the other group. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Abstract screening, full-text review, and data extraction and analysis were completed between January 2022 and December 2022.FindingsA total of 59 studies met appropriateness for study inclusion. The mean MERSQI score for the included studies was 6.7 (range, 5.0-9.5) of a maximum possible 18, which implied that the studies were of average quality. The evidence suggested that preparation and postconference follow-up regarding QI initiatives are equally as important as both (1) succinctly presenting case details, opportunities for improvement, and educational topics and (2) creating a constructive space for accountability, engagement, and multistakeholder discussion.Conclusions and RelevanceThese findings suggest that the published literature on MMCs provides substantial insight into the optimal format, design, and related attributes of an effective MMC. This systematic review provides a road map for surgical departments to improve MMCs in order to align their format and design with their principal objectives related to practitioner and trainee education, error prevention, and QI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Defining a High-Quality and Effective Morbidity and Mortality Conference

Beaulieu-Jones,

Wilson,

Howard

et al. 2023

JAMA Surg

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“…23 M&M also provides trainees with the ability to identify cognitive errors and biases within both themselves and peers in a learning and constructive environment. 24 In addition, the M&M conference has also been shown to be potentially superior to the NSQIP (National Surgical Quality Improvement Program) database when identifying potential interventions, due to its ability to identify singular failures in an adverse event. 25 The purpose of this study was to elucidate the common practices related to conducting M&M conferences in anesthesiology, emergency medicine and general surgery residency programs, in addition to assessing how (or if) these conferences were affected by COVID-19.…”

Section: Discussionmentioning

confidence: 99%

A Survey-Based Assessment of the Practices Governing Morbidity and Mortality Conferences and the Effects of the COVID-19 Pandemic

Tewfik¹,

Srinivasan²,

Rodriguez-Correa³

et al. 2022

AMEP

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Background: Morbidity and mortality (M&M) conferences are essential components for resident education and provide a valuable tool to improve patient safety and quality of care. M&M conferences help identify important gaps in safety and reduce avoidable events in future patient care. Active methods to improve the utilization of M&M conferences have been shown to enhance their educational value for residents, faculty and multidisciplinary teams in healthcare institutions. Objective: The purpose of this study was to use a survey-based methodology to assess how morbidity and mortality conferences are conducted in residency programs, including characteristics such as frequency, involvement of personnel and the effects of COVID-19. Methods: From February to October 2021, a validated 19 question survey was electronically distributed to residency program directors in anesthesiology, emergency medicine and general surgery, after a search for email addresses in the ACGME database. The survey was created and hosted on Google Forms. Results: A total of 125 of 713 program directors (17.5%) responded to the survey. Eighty-three percent of respondent programs reported mandatory participation for residents, with residents providing most of the presentations. Case presentations utilized various formats including SBAR, adverse event analysis and root cause analysis as the most common modalities. Though most programs reported no change in frequency of M&M conferences due to COVID-19, most respondents reported a shift to a virtual or hybrid platform. Conclusion: M&M conferences are an important educational and quality improvement modality, and many residency directors changed practice to incorporate virtual platforms due to the COVID-19 pandemic to maintain uninterrupted educational sessions. Nonetheless, significant variation still exists in how these conferences are conducted between different institutions.

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“…As the healthcare community continues to address musculoskeletal health disparities, it is important to assess the association between patient-specific SDoH characteristics, such as food insecurity, housing instability, challenges with affording medication, lack of reliable transportation, educational attainment, and employment status, and a patient's ability to cope with and manage symptoms, disease, and injury. When doing so, it is also vital that healthcare professionals remain cognizant of and resistant to the cognitive biases that may be introduced with the assessment of patient-specific SDoH characteristics [36]. Nonetheless, such insight can allow for the development of more targeted initiatives and interventions that may lead to better clinical care and outcomes for patients.…”

Section: Introductionmentioning

confidence: 99%

Are Detailed, Patient-level Social Determinant of Health Factors Associated With Physical Function and Mental Health Among Patients With Orthopaedic Conditions

Bernstein

Lans

Karhade

et al. 2022

Clin Orthop Relat Res

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BackgroundIt is well documented that routinely collected patient sociodemographic characteristics (such as race and insurance type) and geography-based social determinants of health (SDoH) measures (for example, the Area Deprivation Index) are associated with health disparities, including symptom severity at presentation. However, the association of patient-level SDoH factors (such as housing status) on musculoskeletal health disparities is not as well documented. Such insight might help with the development of more-targeted interventions to help address health disparities in orthopaedic surgery.Questions/purposes(1) What percentage of patients presenting for new patient visits in an orthopaedic surgery clinic who were unemployed but seeking work reported transportation issues that could limit their ability to attend a medical appointment or acquire medications, reported trouble paying for medications, and/or had no current housing? (2) Accounting for traditional sociodemographic factors and patient-level SDoH measures, what factors are associated with poorer patient-reported outcome physical health scores at presentation? (3) Accounting for traditional sociodemographic factor patient-level SDoH measures, what factors are associated with poorer patient-reported outcome mental health scores at presentation?MethodsNew patient encounters at one Level 1 trauma center clinic visit from March 2018 to December 2020 were identified. Included patients had to meet two criteria: they had completed the Patient-Reported Outcome Measure Information System (PROMIS) Global-10 at their new orthopaedic surgery clinic encounter as part of routine clinical care, and they had visited their primary care physician and completed a series of specific SDoH questions. The SDoH questionnaire was developed in our institution to improve data that drive interventions to address health disparities as part of our accountable care organization work. Over the study period, the SDoH questionnaire was only distributed at primary care provider visits. The SDoH questions focused on transportation, housing, employment, and ability to pay for medications. Because we do not have a way to determine how many patients had both primary care provider office visits and new orthopaedic surgery clinic visits over the study period, we were unable to determine how many patients could have been included; however, 9057 patients were evaluated in this cross-sectional study. The mean age was 61 ± 15 years, and most patients self-reported being of White race (83% [7561 of 9057]). Approximately half the patient sample had commercial insurance (46% [4167 of 9057]). To get a better sense of how this study cohort compared with the overall patient population seen at the participating center during the time in question, we reviewed all new patient clinic encounters (n = 135,223). The demographic information between the full patient sample and our study subgroup appeared similar. Using our study cohort, two multivariable linear regression models were created to determi...

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A Resident Morbidity and Mortality Conference Curriculum to Teach Identification of Cognitive Biases, Errors, and Debiasing Strategies

Cited by 5 publications

References 17 publications

Defining a High-Quality and Effective Morbidity and Mortality Conference

Defining a High-Quality and Effective Morbidity and Mortality Conference

A Survey-Based Assessment of the Practices Governing Morbidity and Mortality Conferences and the Effects of the COVID-19 Pandemic

Are Detailed, Patient-level Social Determinant of Health Factors Associated With Physical Function and Mental Health Among Patients With Orthopaedic Conditions

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