Blog | Monday, October 13, 2014

Morbidity and Mortality Conference: a clinical problem solving opportunity


For over 5 years, at our Huntsville campus, we have inserted M&M into our Grand Rounds schedule. We started our series for the Family Medicine senior residents. Once the Internal Medicine program started and had senior residents we expanded the number of M&M slots so that we now have 12 Family Medicine weeks and 8 Internal Medicine weeks.

We believe our format is a bit different. The resident presents the information in chunks (one slide at a time). The moderator then challenges the remaining residents to speculate on what is wrong with the patient, what further information they would want, what orders are appropriate at that time.

Over the hour, the story unfolds, laying out the decision making and what errors may have occurred.

We introduce this series every year with several cautions. The retrospectoscope always trumps our other scopes. We all make mistakes, and the purpose of our conference is not to skewer those who made mistakes, but rather to learn how to avoid such mistakes.

At dinner last night with some third year medical students, they strongly endorsed this conference as having special value to them. They want to understand thought processes, and the conference, as we run it, focuses on decision making opportunities.

Melding a clinical problem solving approach with M&M seems to make the conference more educational and not punitive. We stress often that during the “Fog of War” one cannot easily make such decisions unless one has prepared carefully though vehicles like our M&M.

The students last night loved the mystery solving as the story unfolds. They feel like participants rather than observers. Methinks the conference is achieving its goals.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.