Introduction: The role of mortality and morbidity conferences (M&MC) in surgical departments is to provide education and improve patient care. However, evidence in the literature that M&MCs reduce preventable deaths is sparse. Therefore, this study aimed to assess the impact of routine M&MC on the preventable death rate over four years. Methodology: This study used a quantitative research methodology. In this retrospective audit of the M&MC data, we collected all mortality data from the date the database started, July 2016, to December 2019, for the surgery department. The department adopted and adapted the criteria and definitions of preventability based on WHO guidelines for trauma quality improvement programs. We used the Pearson correlation statistic to evaluate the correlation between the time (years) since the start of routine M&MC and the preventable death rate. We secured ethical approval. Results: There were 4660 registered admissions from July 2016 to December 2019. Of these, 267 deaths were recorded, resulting in a crude mortality rate of 6%. Overall, the department considered 23% (61/267) of the deaths as preventable. A strong linear correlation (R2 = 0.982, p = 0.009) between the preventable death rate and time(years) since the commencement of routine M&MC was found. Trauma was the leading cause of preventable deaths (27.0%, 17/61). Conclusion: Our findings suggest that routine M&MCs have the desired effect of reducing preventable death rates. Further studies are required to investigate this observed effect.
Background: The apprenticeship model of surgical training is the gold standard worldwide. However, increasing evidence shows that its traditional method of teaching surgical procedures covers cognitive skills inadequately. Therefore, the traditional teaching method for surgical procedures may be liable for producing surgeons who are not fully proficient in cognitive decision-making. This study designed a digital teaching method for surgical procedure cognitive skills and compared it to the traditional teaching method. Methods: This was a quantitative experimental study conducted in two phases. Participants were novice medical officers and general surgery residents at the Universities of Botswana and Pretoria. Ethical approval was obtained. The digital teaching method was designed using the ADDIE model and compared to the traditional teaching method. ADDIE is an iterative instructional design model composed of five stages: Analysis, Design, Development, Implementation and Evaluation. A crossover-repeated-measures study design was used to determine the difference in knowledge gain and retention between the two teaching methods. A satisfaction level survey was also conducted. Results: The digital teaching method for surgical procedure cognitive skills was designed and hosted on Moodle. Twenty-nine participants completed the study. The paired sample t-test showed that the mean differenced score for the digital teaching method (M = 3.59, SD = 1.48) was significantly greater than that of the traditional teaching method (M = 1.93, SD = 1.28), t (28) = -10.950, p < 0.001. Likewise, the mean differenced retention score for the digital teaching method (M = 2.96, SD = 1.480) was significantly higher than that of the traditional teaching method (M = 1.48, SD = 1.087). Seventy-two percent preferred the digital teaching method over the traditional one. Conclusion: Students taught surgical procedure cognitive skills using the digital teaching method had better knowledge gain and retention than those taught using the traditional teaching method. Participants rated the digital teaching method highly compared to the traditional method. We recommend the adoption of the digital teaching method for teaching surgical procedure cognitive skills to produce surgeons competent in decision-making. The assumption is that this would lead to improved surgical outcomes.
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