August 6, 2020

A focus on systems instead of individuals makes quality conferences more relevant to resident physicians and faculty

Three U-M Family Medicine faculty have published a new article in Family Medicine reporting on improvements to quality conferences.

Morbidity and mortality (MM) conferences are a standard part of most family medicine residency programs. During these conferences, patient cases are reviewed with a focus on what went wrong.  Residents and faculty discuss medical errors and what personal actions could change outcomes for the better in future cases.

Christina Chiang, M.D.
Christina Chiang, M.D., lead author

“It’s easier to recount what happens and say, ‘that is bad,’” said Christina W. Chiang, M.D., clinical assistant professor of family medicine. “The harder part is, as such, what should we do to prevent this?”

To shift the focus away from individual resident actions, the Family Medicine Department restructured MM conferences to create a Quality Conference (QC) focused on patterns of errors across multiple cases with common system level solutions.  Themes of QC focused on system level factors such as communication, supervision and medications. 

“The idea was not to do away with the MM conference entirely,” Chiang said. “We felt we needed to reframe the process and refocus.”

Chiang, along with Jenna B. Greenberg, M.D., clinical assistant professor, and Caroline R. Richardson, M.D., the Dr. Max and Buena Lichter research professor of family medicine and associate chair for research programs, have published a new evaluation report in the July-August 2020 issue of Family Medicine.

In a six-month program evaluation comparing traditional MM to CQ, residents and faculty rated CQ as more relevant to their work than MM. The study, however, did not find a statistically significant difference between MM and CQ in how likely clinicians were to change their clinical practices.

“Increased relevance overall means that the work that we have our residents do is more personally meaningful, applicable and impactful -- and hopefully more rewarding and purposeful -- but also a better use of faculty time, who can now better relate, connect with, and contribute to what is being presented,” Chiang said.

“Physicians are not perfect. Most of the things that happen that are not supposed to happen is because of a hole in the safety net.  The quality conference helps shift the presenter and the audiences’ mindset to being more proactive,” Chiang said. “It’s not just one person who made a mistake. If there’s an error, there’s a crack in the system. It is more impactful to look at the system and how the stars aligned to let this error happen.

Chiang, who went through the residency program herself before joining the faculty, said the curriculum continues to adapt to the needs of resident doctors and faculty.  “This was one of the ways that we decided to drive quality in our residency program. It’s highlighted the fact that we’re all part of the medical system,” she said

Article Citation: Chiang CW, Greenberg JB, Richardson CR. Focus on Systems to Improve Morbidity and Mortality Conference Relevance. Family Medicine. 2020;52(7):528-532. doi:10.22454/fammed.2020.940516.


Download the full-text article Focus on Systems to Improve Morbidity and Mortality Conference Relevance