Integrating Morbidity and Mortality Core Competencies and Quality Improvement in Otolaryngology

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Abstract

Importance

To date, an otolaryngology-specific morbidity and mortality (M&M) conference has never been reported or evaluated.

Objective

To propose a novel otolaryngology-specific M&M format and to assess its success using a validated assessment tool.

Design, Setting, and Participants

Preintervention and postintervention cohort study spanning 14 months (September 2014 to November 2015), with 32 faculty, residents, and medical students attending the department of otolaryngology M&M conference, conducted at the the San Antonio Uniformed Services Health Education Consortium.

Interventions

A novel quality assurance conference was implemented in the department of otolaryngology at the San Antonio Uniformed Services Health Education Consortium. This conference incorporates patient safety reports, otolaryngology-specific quality metrics, and individual case presentations. The revised format integrates the Accreditation Council for Graduate Medical Education (ACGME) core competencies and Quality Improvement and Patient Safety (QI/PS) system. This format was evaluated by faculty, residents, and medical students every other month for 14 months to assess changes in attitudes regarding the M&M conference as well as changes in presentation quality.

Results

Overall, 13 faculty, 12 residents, and 7 medical students completed 232 evaluations. Summary statistics of both resident and faculty attitudes about the success of the M&M format seem to improve over the 14 months between the prequestionnaires and postquestionnaires. General attitudes for both residents and faculty significantly improved from the pretest to posttest (odds ratio, 0.32 per month; 95% CI, 0.29-0.35). In the pretest period, “established presentation format” was considered the most necessary improvement, whereas in the posttest period this changed to “incorporate more QI.” For resident presentations evaluated using the situation, background, assessment, and review/recommendations (SBAR) tool, all evaluations, from all participants, improved over time.

Conclusions and Relevance

The M&M conference is an essential component of all otolaryngology residency programs and provides a unique opportunity to successfully incorporate the ACGME core competencies and regularly implement QI/PS.

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