Introduction:The morbidity and mortality conference is essential to medical education and quality improvement. Ideally, the conference is inclusive, judgment-free, and focused on practice improvement. In reality, it may not meet these goals. We reimagined the process by standardizing presentations and creating an oversight committee to improve the perceived value of the conference and identify opportunities for improvement. This study evaluates the subjective impact of the redesigned process at our institution and provides a blueprint for our reproducible model.Methods:We created a faculty and resident committee to review all submitted cases, implemented a standardized presentation template and moderating structure, and tracked quality improvement measures from proposed improvement initiatives. Attitudes toward the conference, including perceived quality/relevance, identification of potential systems changes, inclusiveness, and educational value, were assessed among faculty and trainees using pre- and postintervention Likert-style surveys.Results:Of 45 eligible department members, 41 (91%) completed the preintervention and 36 (80%) completed the postintervention survey. We found a statistically significant improvement in all questions between pre- and postintervention surveys except on the question about the conference environment being nonthreatening, which also improved but was not statistically significant. The overall average answer improved on the postintervention survey compared to the preintervention survey (3.36 vs 4.20, P < .001). These trends were similar regardless of attendee role and gender.Conclusions:Redesigning and standardizing the morbidity and mortality conference with greater attention to education, inclusion, systems change, and quality improvement improves the attitudes of conference attendees and increases the perceived value of the conference.

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METHODS: FPMRS clinical practice logs were obtained from the American Board of Urology from 2013-21. We grouped encounters into FPMRS diagnostic groups and calculated the proportion of clinic visits to corresponding procedures. We performed multilevel logistic regression to evaluate variability between surgeons while accounting for surgeon gender, age, certification status, year and patient age.RESULTS: 370 FPMRS urologists submitted 383,424 clinic and 323,929 procedural encounters, of which 49% constituted FPMRSrelated diagnoses. Of these urinary incontinence (UI, 30%), overactive bladder (OAB; 26%), and urinary tract infections (14%) were most common. Diagnoses with the highest proportion of procedural visits (%) included pelvic organ prolapse (POP; 30%), UI (39%), and fistulas (50%), while interstitial cystitis (0%), neurogenic bladder (0%), and benign prostatic hyperplasia (4%) had the fewest associated procedures (Figure 1). Multilevel regression found that 15% of variance (intraclass correlation, ICC) in the proportion of FPMRS clinic visits to procedures was explained by clustering at the physician level and that increasing surgeon age was associated with a deceased proportion of clinic visits (Odds Ratio (OR): 0.99p[0.01).When evaluating diagnostic sub-groups, results were similar, with clustering under physicians explaining 14-19% of variance in clinic vs. procedural proportion depending on the diagnostic group. Increasing patient age was associated with increased clinic visits (fewer procedures) for OAB (OR[1.00 p<0.001), UI (OR[1.00 p<0.001), and POP (OR[1.01 p<0.001). Female physicians had 20% increased odds of having a clinic visit per procedure compared to male counterparts for UI (OR[1.25 p<0.001) and POP (OR[1.23 p[0.01).CONCLUSIONS: A large portion of FPMRS-urologists practice is non-operative and not sub-specialty related. Efforts that increase access to FPMRS-trained urologists may benefit from methods to triage non-operative management to physician extenders and focus practices on FPMRS care.