A Comparison of Attending versus Resident Opinions Regarding Morbidity and Mortality Conference at a General Surgery Residency Program

Courtney Cripps, MD, Parswa Ansari, MD, Gary Giangola, MD, Robert Andrews, MD. Northshore LIJ Lenox Hill Hospital

Objective: To compare attending surgeon and resident perceptions of the weekly morbidity and mortality conference at an Accreditation Council for Graduate Medical Education (ACGME) accredited general surgery residency program.

Background: A hallmark of surgical education, morbidity and mortality conference was introduced following the publication of the Flexner report in 1910 and the creation of the American College of Surgeons in 1912. The conference facilitates discussion between faculty, residents, and ancillary staff. Discussion allows for the assessment of errors made and resultant complications while providing an opportunity for the suggestion of solutions. These conferences are a vital component of the peer review process exercised by most medical centers, and are a strict residency requirement mandated by the ACGME.

Methods: A confidential survey was presented at the weekly conference between October 29th and December 17th 2014. The questionnaire was attached in a randomized fashion to the weekly case summary. The survey contained 13 items, 10 of which were directly related to attitudes towards morbidity and mortality conference, and a 5-point Likert scale was employed to weigh the responses.

Results: A total of 40 respondents completed the survey (21 attendings, 13 residents and 6 others including students, physician assistants, pharmacists or nurses). A result was considered statistically significant at the p<0.05 level. All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC) except stripchart graphs, done using R version 3.2.0 (R Foundation for Statistical Computing, Vienna, Austria). There was a significant association between number of conferences attended and rank (p=0.0005). The level of agreement with the proposed statements was significantly higher for attendings than for residents when identifying the conference as a means to reflect and improve upon performance, to employ leadership skills that improve upon professional development, and in the confirmation that criticism provided by attendings is constructive (p=0.049, p=0.01, p=0.007).

Conclusions: Morbidity and mortality conference has been a mainstay of surgical education and remains a necessary element of training. With the changing climate of surgical residencies, it is suggested that the morbidity and mortality conference undergo modifications to ensure its present and future utility in producing competent and confident surgeons. Despite agreement between attending and resident surgeons in many benefits of morbidity and mortality conference, statistically significant differences exist in vital opinions and deserve reconciliation in order to create fluidity amongst the present and future leaders of this field.

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