Context Morbidity and mortality conferences in residency programs are intended
to discuss adverse events and errors with a goal to improve patient care.
Little is known about whether residency training programs are accomplishing
Objective To determine the frequency at which morbidity and mortality conference
case presentations include adverse events and errors and whether the errors
are discussed and attributed to a particular cause.
Design, Setting, and Participants Prospective survey conducted by trained physician observers from July
2000 through April 2001 on 332 morbidity and mortality conference case presentations
and discussions in internal medicine (n = 100) and surgery (n = 232) at 4
US academic hospitals.
Main Outcome Measures Frequencies of presentation of adverse events and errors, discussion
of errors, and attribution of errors.
Results In internal medicine morbidity and mortality conferences, case presentations
and discussions were 3 times longer than in surgery conferences (34.1 minutes
vs 11.7 minutes; P = .001), more time was spent listening
to invited speakers (43.1% vs 0%; P<.001), and
less time was spent in audience discussion (15.2% vs 36.6%; P<.001). Fewer internal medicine case presentations included adverse
events (37 [37%] vs 166 surgery case presentations [72%]; P<.001) or errors causing an adverse event (18 [18%] vs 98 [42%],
respectively; P = .001). When an error caused an
adverse event, the error was discussed as an error less often in internal
medicine (10 errors [48%] vs 85 errors in surgery [77%]; P = .02). Errors were attributed to a particular cause less often in
medicine than in surgery conferences (8 [38%] of 21 medicine errors vs 88
[79%] of 112 surgery errors; P<.001). In discussions
of cases with errors, conference leaders in both internal medicine and surgery
infrequently used explicit language to signal that an error was being discussed
and infrequently acknowledged having made an error.
Conclusions Our findings call into question whether adverse events and errors are
routinely discussed in internal medicine training programs. Although adverse
events and errors were discussed frequently in surgery cases, teachers in
both surgery and internal medicine missed opportunities to model recognition
of error and to use explicit language in error discussion by acknowledging
their personal experiences with error.