Morbidity and Mortality Conferences: A Powerful Learning Tool to Improve Patient Care

Morbidity and Mortality (M and M) conferences have been around for a long time, though they have had different emphasis in different specialties. Some specialties have focused more on the individual physician and the procedures and judgments of that physician while others have focused more on diseases and diagnostic dilemmas. The conference has served the dual purposes of education and quality improvement, with the common theme of learning from our mistakes.

There is probably not a more potentially powerful learning activity that occurs in medical education than the presentation of an M and M case because everyone knows this was a real patient and real case, and not something dreamt up by a Board examiner or a teacher trying to illustrate a point. And the presenters are often our friends, colleagues or students who have to get up in front of the group, admit fallibility, and seek understanding and forgiveness. I have watched departmental chairs devolve into tears as they admitted their mistakes that led to a patient’s death, and most residents are shaken after presenting a case gone bad. I find myself struggling to balance the need to provide support  for individuals with my frustration about errors that we did not prevent and systems that did not catch the errors.

In the June issue of Academic Medicine there are three articles that provide some guidance about our M and M review process and our communications during transitions in care. Michael Stillman, MD provides a “Teaching and Learning Moment” that demonstrates how an M and M presentation can improve communications and bring closure with a family after a difficult event. Mitchell and colleagues describe how to standardize the M and M process in Surgery to better identify problems, learning issues and recommendations. Their study demonstrated improved learning and satisfaction with a standardized process. We do not know if this translated into safer, better care, but as we continue to focus efforts on joining our clinical and educational missions at medical schools, we should strive to understand how improved learning will improve patient care. The third article, by Kessler and colleagues, focuses on the education of medical students and discusses improving the communications that occurs between physicians during the consultation process. They suggest a standardized approach to improve communications.

Both Mitchell and Kessler’s articles have in common the recommendation for more standardization and improved communications. Standardization provides a structure or scaffolding for our communications. It allows us to reduce our dependency upon human memory, which can become clouded by emotion, fatigue or distractions, and frees us to make best use of our individual creativity and problem solving abilities.

The next time you attend an M and M conference or engage a consultant in a patient care discussion, consider trying out these new ideas and share your experience with me here on the blog so that we can continue to learn from each other and improve the care of our patients.

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2 Comments

  1. Kemi Tomobi
    June 6, 2013 at 8:42 PM

    It is true, that M and M is a great learning experience.  But I thought residents and attendings conducted M and M conferences.  Have medical students (or other health professions students) also been afforded the opportunity to present at M and M conferences? If so, awesome! I would love to hear more about those experiences.

    I definitely agree that M and M affords provides opportunities for providers to develop a common professional language, which definitely helps in communicating with patients.

    I look forward to further reading the issue you mention below.

    • David Sklar
      June 12, 2013 at 3:41 PM

      Unfortunately medical students are often not included in the M and M conference, though this may vary by department, and fourth year students who are doing a subinternship are more likely to be included than third year students. As we continue to include patient safety and quality improvement discussions in the M and M conference it will be increasingly important to expose the students to these discussions. However, it is also important that faculty and residents feel safe and comfortable discussing errors, and the presence of students or anyone who is not a regular member of the team may inhibit these difficult conversations.