What does the morbidity and mortality conference look like at your residency program?

[propofology007]

My residency program currently does not have a morbidity and mortality conference. I was wondering how it's structured at various programs and if you all find it helpful.

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[pocafx]

Non existent

 

[Lidolover]

Renamed as QA/QI conference lol

 

[Volatile]

If there was an M&M case to discuss it was just included in our weekly morning conference. Only anesthesiology residents and attendings were present. Usually the person sitting the case presented it. I thought it was helpful; always constructive feedback not disciplinary. At my current gig we hold M&M conferences within our department and with our surgeons monthly, again laid back and educational.

 

[anbuitachi]

Chief resident presents a case and its discussed. It's happens once every few weeks. Entire department is there (resident, attending, crna, chair, etc)

 

[anbuitachi]

Non existent

Strong work

 

[Arch Guillotti]

Chief resident presents a case and its discussed. It's happens once every few weeks. Entire department is there (resident, attending, crna, chair, etc)

We always had the attending or resident involved present.

 

[anbuitachi]

We always had the attending or resident involved present.

were there a lot of grilling

 

[axeon123]

At my program, every two or three weeks, we would all present the cases we did, comment on anything interesting or anything we did wrong/complications. Then a few attendings would say that I did a terrible job, unacceptable, and my attendings on these cases would just sit back and say nothing. Learned eventually to just say didn't have any interesting cases. Another program we did 15-ish minutes presentation and went in depth on that particular topic. I thought that was helpful.

 

[coffeebythelake]

At my program, every two or three weeks, we would all present the cases we did, comment on anything interesting or anything we did wrong/complications. Then a few attendings would say that I did a terrible job, unacceptable, and my attendings on these cases would just sit back and say nothing. Learned eventually to just say didn't have any interesting cases. Another program we did 15-ish minutes presentation and went in depth on that particular topic. I thought that was helpful.

sounds like an awful culture in your 1st program

 

[Arch Guillotti]

were there a lot of grilling

Very nonjudgemental.

 

[IlDestriero]

Where I went to medical school and trained it was a bloodbath, merciless. Where I am now it’s more interesting case conference and group hug time. Both can be educational. If my old faculty saw us in action they’d be throwing chairs like Bobby Knight.

 

[ButterButter]

Ours is more of a group hug. Generally non-judgemental and pretty therapeutic. Always presented by the resident. Pre-COVID, it took place in one of our conference slots, usually in one of our big lecture halls (attendance between 50-100, faculty, anesthetists, etc.).

 

[victor le cube]

Complete, and utter BS, grasping for straws. I had to do one on a fib. The patient was a 19 y/o having transphenoidal pituitary surgery. The dumb nurse reported the patient had a fib by misreading the monitor several hours after I was done with the case, and the ekg showed normal sinus rhythm. I got to do a presentation about how to treat a fib with the story ending in my patient never had a fib. They also tried to get me to do a second one. As I was taking over a liver transplant from another resident the patient coded and died, literally while I was getting report. They tried to get me to do an m&m and I just said I have no idea what happened, I hadn’t even taken the case over yet. So many reasons I hate academic medicine with the hatred of a thousand water falls.

 

[nimbus]

Complete, and utter BS, grasping for straws. I had to do one on a fib. The patient was a 19 y/o having transphenoidal pituitary surgery. The dumb nurse reported the patient had a fib by misreading the monitor several hours after I was done with the case, and the ekg showed normal sinus rhythm. I got to do a presentation about how to treat a fib with the story ending in my patient never had a fib. They also tried to get me to do a second one. As I was taking over a liver transplant from another resident the patient coded and died, literally while I was getting report. They tried to get me to do an m&m and I just said I have no idea what happened, I hadn’t even taken the case over yet. So many reasons I hate academic medicine with the hatred of a thousand water falls.

1. Sounds like they were short of cases to review.

2. Signing out cases while the patient is dying makes us look bad.

 

[victor le cube]

1. Yes I agree, but has anyone ever seen a 19 year old with a fib? I just thought it was so ironic, they could have just said ‘please do a lecture on a fib’

2. Yes I totally agree, but because it was a military resident rotating in our program for a cardiac month they couldn’t ask him to do the m&m so it fell on me. He was telling me about how they just had to keep going up and up on pressors and then next thing I know the attendig is having the surgeon do chest compressions. I had not even signed in to the computer yet.

Residency was so much fun, wish I was back there

 

[dchz]

has anyone ever seen a 19 year old with a fib?

What you described was awful and LOL....

But yes 19 years old can have A fib, Ebsteins anomaly. (the A fib didn't cause it self)

They tried to get me to do an m&m and I just said I have no idea what happened, I hadn’t even taken the case over yet.

If i know anything about your program is that the resident you took over from didn't have any idea what happened either.

 

[woopedazz]

The least useful ones were always when trainees would try to teach a topic at the end of a case. Everyone would check out and the M&M would die on its arse. Boring; waste of time. 0 attending buy in.

Most useful M&Ms were always: trainee frames a polarizing scenario --> throw meat to the wolves --> let the attendings politely engage with one another for about 2 seconds --> battle lines become clear and there's a few minutes of really good debate --> the side losing the popular vote scrambles to find an irrelevant minutiae that could potentially undermine the strong position held by their opponents --> one attending identifies the exact hill they wish to die on and prepares to ruin the meeting for everyone --> presenter intervenes and redirects with newer, tastier meat --> rinse and repeat.

Learned a heap at these meetings.

 

[D P356]

As a med student I attended numerous gen Surg M&M conferences. A condescending blood bath would come up short in describing those rodeos.

 

[MirrorTodd]

Ours are standardized, educational in nature. Resident presents. Large majority are soft m/m's where no harm was done to the patient, but occasionally, we have a case go bad and those are livelier with more intense discussion between attendings but no grilling of resident. VERY rarely we have a cross m/m, with ob, or gen surg and those are invariably **** shows with services blaming each other for how the case went.

 

[IlDestriero]

VERY rarely we have a cross m/m, with ob, or gen surg and those are invariably **** shows with services blaming each other for how the case went.

Those are the only ones that get a little lively, but it’s usually because the opposing team tries to deflect 110% of the blame on us and/or makes ridiculous demands that are impossible and unrealistic. And of course they are then called out on it openly. Fortunately we rarely invite guests. Something like...
The massive transfusion protocol took too long to get the blood ready and we needed to give O- blood. He should have had a type and screen done in advance and blood in the room...
—Well, actually, we discussed that your team didn’t order one pre op and you said he didn’t need a T&S as the tumor was small and not vascular, bleeding shouldn’t have been an issue. And it wasn’t until you tore a hole in the IVC.
Or...
If the peds team orders blood tests in the OR they need to be drawn! It’s unacceptable that you can’t get all the tubes we needed while under anesthesia! This needs to be policy...
—Hold on there partner. This kid was Microscopic, medically complex, lived 50% of their lives in the NICU where they were stuck 1000 times, and we were doing an ear tube. We spent 30 minutes with 2 Attendings and 2 ultrasound machines to get 6 of the 14 vials of blood you ordered drawn. I’m not going to place a central line or an A line to get non urgent blood tests on a kid for an ear tube where we don’t even need an IV. And I called and spoke with your resident who said only 3 were critical to get, and we did them first. You don’t really believe that we should be placing central lines to get routine blood draws, do you?
Turns out they did, and we agreed to disagree.

 

[deleted697127]

I’m actually shocked to hear places don’t have m and m conferences. That is a sad reality of snowflake culture. I may be wrong but i thought this was an ACGME requirement. M and M is invaluable for exposure to rare events, what to do and not do, and for hearing the true experts in your program openly debate best practices. Additionally, it is critical to learning how to present, discuss, and defend handling of different cases. Decisions need to be picked apart even if it is uncomfortable. As a resident, rare cases should be reviewed in detail for personal improvement meaning the work and understanding of the situation needs to be mastered even if you did not have to present it. It is in your best interest to take the extra steps and present it.

If you think M and M is bad, i would encourage you to sit in on real life peer review board. Cases are reviewed anonymously (at least as anonymous as possible). Decisions are often roasted without representation by the specialty being questioned. I will never forget sitting in on a conference reviewing an ED docs competence for sending home a healthy 19 year old who presented with near syncope at a gas station. Normal vitals in the ED. Later turned out to have a PE. OB/Gyn and Psych were ready to have this guys head on a stick. “It is unacceptable to miss a life threatening diagnosis in a young healthy patient.” As a resident i spoke out and reviewed the criteria for workup of PE. This patient had 0 criteria suggesting further workup was necessary. The review was being done by physicians. I can only imagine what it’s like to have non-physicians attacking in a court room.

If something rare and significant happens in the OR, I strongly believe it is in everyone’s best interest to have the case discussed in open forum.

 

[anbuitachi]

I’m actually shocked to hear places don’t have m and m conferences. That is a sad reality of snowflake culture. I may be wrong but i thought this was an ACGME requirement. M and M is invaluable for exposure to rare events, what to do and not do, and for hearing the true experts in your program openly debate best practices. Additionally, it is critical to learning how to present, discuss, and defend handling of different cases. Decisions need to be picked apart even if it is uncomfortable. As a resident, rare cases should be reviewed in detail for personal improvement meaning the work and understanding of the situation needs to be mastered even if you did not have to present it. It is in your best interest to take the extra steps and present it.

If you think M and M is bad, i would encourage you to sit in on real life peer review board. Cases are reviewed anonymously (at least as anonymous as possible). Decisions are often roasted without representation by the specialty being questioned. I will never forget sitting in on a conference reviewing an ED docs competence for sending home a healthy 19 year old who presented with near syncope at a gas station. Normal vitals in the ED. Later turned out to have a PE. OB/Gyn and Psych were ready to have this guys head on a stick. “It is unacceptable to miss a life threatening diagnosis in a young healthy patient.” As a resident i spoke out and reviewed the criteria for workup of PE. This patient had 0 criteria suggesting further workup was necessary. The review was being done by physicians. I can only imagine what it’s like to have non-physicians attacking in a court room.

If something rare and significant happens in the OR, I strongly believe it is in everyone’s best interest to have the case discussed in open forum.

thats ridiculous to have OB and psych there judging the ED physicians decision like that.

 

[sigrhoillusion]

At my institution we have a pretty involved process for reporting.

Every day there's an anesthesiologist in charge of adverse outcomes. Not saying these things happen every day, but there's always someone there to notify. This includes but not limited to deaths, codes, re-intubations, corneal abrasions, position injuries. Obviously some of these things are not apparent right away, and occasionally our M&M committee will get a case to review from our surgical colleagues. We also have a post-op and intra-op QI section which needs to be filled out in our anesthesia EMR (EPIC). Patient's records can't be closed unless something is clicked in these sections (usually "no outcomes"). The head of M&M committee can then pull data from EPIC to see any negative outcomes and we meet quarterly to discuss the cases.
Prior to these quarterly sessions each member is assigned a case or two to review. We have a form that is filled out by the attending of record, in which they describe what happened, and then the reviewer from the committee will look over the record to see if what they said meshes with the record, or if there are any issues with the events/documentation/interventions/etc. This form is supposed to be filled out by the attending of record within a few days of the event after they talk to the attending who is in charge of outcomes that day. This is in hopes of keeping the events fresh in their mind and to make sure the record is correct. The problems come when we get cases from surgeons a month later, and the attending can't remember things in detail.

Along with this quarterly meeting. we usually have an M&M conference once a month with 1-3 cases discussed by a resident and is supervised by the head of the M&M committee. Some of the cases that we discussed at the quarterly meeting are discussed, while some are presented prior to the quarterly meeting. We have everyone present at the meetings, but the attending and who they are supervising don't actively present the case and their names are never mentioned. However, the meetings never become hostile, and the people who did the case more often or not will "own up to it" and never feel threatened about admitting they were responsible for the case, and what they were thinking.