While it is one of the typical trappings of medical education, we have also striven to make our Quality Review Conference (or Morbidity and Mortality Conference - M&M) align with our efforts to optimize resident learning. QRC or M&M occurs monthly at both Tulane and Ochsner, and we have restructured it to serve as a quality-improvement tool. During this conference, a senior resident (one not involved with the case in question, to help ensure objectivity) serves as the lead investigator, reviewing the case with all of the principal actors involved (primary MD or outside hospital, attending MD, residents, nursing staff, family, etc.) to ensure that all relevant information is available. Read More
He or she presents the summary of these findings for the patient under discussion, outlining that patient's presentation, workup, and outcome. A discussion, with participation by the various faculty and residents who were involved, follows.
This is structured to address the systems-based practice core competency as outlined by the ACGME – we discuss aspects of a particular patient's treatment that worked, those that didn't, the cost of delays or malfunctions in care, and ways in which we can learn from experience and improve the system in which problems occurred. Because we use a systems-based approach, M&M is not an exercise in finger-pointing or criticism of individuals, but rather an effort to find aspects of our medical system upon which we can make a positive impact for the benefit of our patients. Subspecialists and other specialties involved in a given case are in attendance, teaching supporting data for diagnosis and workup, as well as helping to pinpoint exactly what could have been done better in a particular situation. And after each M&M conference, we leave with an area for possible improvement identified, as well as initial ideas on how to structure our system in a way that can get us to that goal. In other words, each month's conference serves as a potential Quality Improvement project waiting to happen; since a QI project is a requirement for all of our residents to complete at some point during their residency, this can be an easy launch point for getting started.