A Novel Standardized Morbidity and Mortality Process to Promote Discourse, Improve Education, and Facilitate Practice Change: The M-PROVE Model

Abstract

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.

Editorial Commentaries

“…The present study 1 adds to a considerable literature underscoring that a lack of standardization for organizing, conducting, and reflecting on M&M may lead to missed opportunities for meaningful discussion and quality improvement. 2,3 By orienting not only the structure, but also the processes surrounding M&M on quality improvement, the M-PROVE (Morbidity and Mortality Process Redesign to Optimize Value and Education) model shows promise in restructuring M&M to improve data capture, increase quality of education, and foster a more collaborative, systems-based approach to responsibility for adverse outcomes.…”

Editorial Commentaries

“…Perhaps the greatest strength of M-PROVE is that it, as the authors state, "facilitates the ability to holistically study and improve our practice." 1 Bosk's seminal work, Forgive and Remember, reminds us that while surgical skill development and clinical judgment are essential components to residency, at the crux of surgical training is moral education. 3 More importantly, this should continue as we become lifelong learners in surgical practice.…”