The Utility of the Matrix Format for Surgical Morbidity and Mortality Conference

Abstract

With the limitations posed by increasing work hour restrictions, surgical residency programs are focusing more on maximizing the educational benefit of their conferences. The Morbidity and Mortality (M&M) conference serves as a forum to discuss adverse events and patient care improvement using evidence-based medicine. The matrix format (MF) is an enhancement to the traditional format (TF), focusing on the case selection process and a postconference newsletter reiterating the relevant literature review and discussion points. Our institution adopted the MF to evaluate both its short- and long-term educational values. Surveys were distributed to residents and faculty within the Department of General Surgery to assess their interest and satisfaction, perception of educational value, and efficiency with the MF compared with the TF. Responses were obtained from 22/22 (100%) residents for the TF and 11/23 (48%) for the MF. Faculty responses were 19/19 (100%) and 9/16 (56%), respectively. Reasons for an overall decreased response with the MF were not investigated further, as participation was strictly voluntary. Our results confirmed an overall approval of the MF by both residents and faculty. Faculty reported an improved efficiency of the conference ( P < 0.039), encompassing improved content and presentation quality. Residents reported an improved overall interest and satisfaction with the MF ( P < 0.001) as well as an improvement in the educational value ( P < 0.007). Residents spent less time preparing presentations and reported learning greater educational benefit to the conference when preparing their own presentations ( P < 0.001). In conclusion, the MF resulted in a greater overall satisfaction for residents and attending surgeons with an increased investment by the audience and overall improvement in perceived educational benefit.

The role of morbidity and mortality rounds in medical education: a scoping review

“…). The application of our selection criteria resulted in the inclusion of 67 studies, including eight surveys, four literature reviews, 33 case studies with no comparison or pre/post‐intervention evaluation, nine case studies with pre/post‐intervention evaluations, seven case studies with a comparison, one ethnography study, two qualitative observations and three opinion papers (Table ). Case studies took the form of descriptive programme reviews of an MMR model and related evaluations.…”

“…Objectives regarding medical knowledge were framed around the dissemination of clinical knowledge and the competencies of a medical expert . Less explicit aspects included competencies in professionalism and communication, such as collegiality, modelling communication and presenting skills, and demonstrating reflective practice and discussion of errors …”

“…There was significant heterogeneity in how programmes identified and selected cases for MMRs. Many papers described informal processes in which interesting ‘teaching’ cases were brought forward for presentation and were often selected and reviewed by residents in leadership roles or staff physicians . Other MMRs identified cases through formalised data collection of critical incidents, complications and mortality, using methods ranging from chart reviews to error reporting systems .…”

“…Common features among MMR programmes included a case presentation, a review of medical knowledge or literature, and a group discussion period . The level of planning and structure around these features vary within the literature, with more formalised models including predetermined agendas, standardised presentation formats, and assigned MMR facilitators …”

“…Few MMR programmes described incorporating comprehensive processes for developing and implementing improvement ideas . These often included devoting time to the summarising of lessons learned and brainstorming for improvements, and having clear processes in place for disseminating findings and recommendations to those involved in QI in leadership positions within the organisation . Factors associated with MMR‐initiated QI initiatives included participation of physician leaders and interprofessional staff, utilisation of structured system‐based case analysis, planning around change ideas, and assigning responsibility for follow‐up tasks .…”