Measuring What Matters at Morbidity and Mortality Conferences: A Scoping Review of Effectiveness Measures

Abstract

Objective: Efforts to study morbidity and mortality conferences (M&MC) are hampered by the lack of rigorous instruments to assess the effectiveness of the conferences for the purpose of quality improvement and medical education. This might limit further advancement of the practice. The aim of this scoping review was to determine commonly used effectiveness measures of M&MC in the literature.Method: A scoping review was performed of quantitative, qualitative, and mixed methods studies of M&MC, using databases from PubMed, Emcare, Embase, Web of Science, and the Cochrane library. Studies were included if an outcome was described after a general evaluation or an intervention to M&MC. Study quality was assessed with the Quality Assessment Tool for Studies with Diverse Designs.Results: A total of 43 articles were included in the review. The majority used a quantitative (n = 23) or mixed (n = 17) design, with surveys as the most frequent method used for data collection (n = 29). The overall Quality Assessment Tool for Studies with Diverse Designs scores were modest (64%). Outcome measures used to evaluate the effectiveness of M&MC were clustered in the following categories: "participant experiences," "characteristics of the meeting," "medical knowledge," "actions for improvement," and "clinical outcomes."Conclusions: This review found a wide variety of effectiveness measures for M&MC. Rather than using isolated measures, approaches that combine multiple effectiveness measures could offer a more comprehensive assessment of M&MC. Although there was a preference for quantitative metrics, this fails to seize the opportunity of qualitative methods to yield insights into sociological purposes of M&MC, such as building professional identities and safety culture.

The Morbidity and Mortality Conference: A Century-Old Practice with Ongoing Potential for Future Improvement

“…Our group recently published a scoping review of the literature that portrayed a large heterogeneity in outcomes measures used to evaluate M&M effectiveness; with the most commonly used categories relating to "conference characteristics," "participant experiences," "medical knowledge or competencies," "actions for improvement", and "clinical outcomes." 6 Most studies appeared to use quantitative approaches, mostly surveys. In contrast to surveys pointing out the extent of agreement with predetermined topics, qualitative approaches using interviews or observations may help to develop a deeper understanding of a phenomenon of interest, such as M&M practice and the many complex mechanisms that influence it (e.g., local culture and context).…”

“…It seems most sensible to first clearly determine the objectives of M&M practice and then select a combination of suited outcome metrics, both quantitative and qualitative. 6 Greater use of qualitative methods in M&M research could, for example, be deployed to help appreciate the many sociological benefits of the conference and help to understand all factors that make discussing complicated cases at M&M such a delicate matter. The sociologist Charles Bosk famously describes M&M as "putting on the hair shirt of professional responsibility" in his landmark study on surgical training.…”

“…While it remains difficult to establish a single evidencebased design for successful M&M, the literature still provides a rich source of information on various local experiences. Drawing on various studies on M&M practice from our group 6,16,19,36,37 as well as others, 1,5,38,39 some practical guidance on how to organize M&M is outlined in ►Table 1.…”

“…a Suggestions are based on various publications. 1,5,6,16,19,[36][37][38][39] Specific references are added only when deemed useful for readers interested in more detailed descriptions.…”

“…4 In addition to their evident educational purpose, these meetings also have come to serve a function for quality and safety improvement. [5][6][7] As such, modern M&M directs participants' attention not only outward, toward "evidence" as a source of knowledge, but also inward, toward opportunities for "systems improvement." 7 However, there is no definitive evidence that the conferences are actually effective for achieving the educational and improvement objectives.…”