Original article
Putting the Heat Back Into Radiology Morbidity and Mortality Conferences

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Morbidity and mortality (M&M) conferences run the gamut from heated adversarial affairs seen in traditional surgery departments, to more passive versions often seen in radiology departments. If done well, not only can M&M conferences have great utility as a resident training tool, but they also can be a vehicle for quality improvement and allow a first impression for how a complication might be perceived in court. The legislature and courts have deemed candid peer review so essential that such proceedings have been provided with a qualified privilege. To maximize the benefit of M&M conferences, an emphasis on accountability and robust debate, preconference preparation, broader faculty attendance, and an understanding of the ground rules are necessary. M&M conferences also should be solution oriented, and practice quality improvements and teaching modules should regularly be generated from such conferences. An example of a potential revised M&M conference is outlined.

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Putting Accountability Back Into the System

In surgical M&M conferences, typically a member of the team who cared for the patient and was at least partially responsible for the complication presents the case at the conference. In radiology and other specialties, frequently the case is presented by a more impartial, more distanced presenter. To some extent, this is a product of varying specialty culture. Surgeons have long had a culture of assuming responsibility for their actions, a form of bravado that carries from the operating room

An Understanding of the Ground Rules

The value of M&M conferences is severely limited if individuals are unwilling to stand by their actions or to criticize the actions of their colleagues. A set of shared guidelines that emphasize the need for candid discussion, debate, and constructive criticism, and that remind the attendees of the purpose of M&M conferences, specifically resident learning and systemic improvements, rather than a forum for blame or derision, may prove useful. Although it may be difficult for individual

Preparation

Many M&M conferences fall short of their goals because of a lack of participation. The primary reason for this is lack of preparedness. Topics at M&M conferences are frequently not shared ahead of time with the attendees. At some conferences, there is no single moderator, and the conference is conducted informally as a “who has a complication to share” event. A better system would be the identification and selection of topics before the conference through a single moderator and the circulation

Broader Faculty Attendance

At most M&M conferences, attendance by residents is mandatory. However, participation by attending physicians can vary widely.3 To some extent, useful peer review requires an adversarial battle of equals. Residents may be loath to challenge their attending physicians in any meaningful way. Thus, if one attending physician bears responsibility for an error or complication, it

The Morbidity and Mortality Matrix Concept

One well-publicized variation on the surgical M&M conference format is the “M&M matrix” adopted by Cedars Sinai Medical Center in Los Angeles [5, 14]. This format involves focus on a specific complication at each M&M conference, with all surgical residents on the patient care team assigned associated topics for presentation. “The case is presented as a story of surgical complication; surgical principles involved are discussed and recommendations are made” [14]. The moderator then formulates a

Taking a Page from the Legal Profession

Although rarely used as such, the M&M conference, if done in a more adversarial format, can provide physicians with insight as to how a complication or error, and arguments as to whether the standard of care was met, might be perceived by onlookers. A robust debate with colleagues about whether one's actions met or deviated from the standard of care is a good proxy for the “battle of experts” such matters tend to be exposed to in court. Lawyers sometimes use “shadow juries,” a group of randomly

The Role of Interdisciplinary Morbidity and Mortality Conferences

Some authors have suggested that M&M conferences can best accomplish the ACGME's core competencies if they are multidisciplinary in nature [16]. Gore [5] suggested that increased participation by radiologists and others in surgical M&M conferences “may help in augmenting the educational value of the conference, especially in regard to discussion of clinical management and alternative nonsurgical treatments.” Kravet et al [15] suggested that including “members of the greater healthcare

Improvements and Implementation

It is not enough to simply identify errors and complications at an M&M conference. At each M&M meeting, one or more potential improvements should be identified, which could eliminate future similar morbidities and mortalities. The moderator should be responsible for delegating to one or more persons, including information technologists, residents, or other faculty members, as appropriate, to assess the feasibility of implementing such a proposed change and, where possible, to implement such

How It Might Work

A revised M&M conference format might work as follows. Attending radiologists on a regular basis will identify errors and complications and communicate these to a person designated as the M&M moderator. The communication will outline the issue and specify whether the radiologist's action resulted in a morbidity or a mortality, was a “near miss,” or is something that may likely result in litigation. The moderator will organize complications by topics and subspecialties, and once an adequate

Conclusions

The radiology M&M conference has the potential to be the most valuable hour of residency training, as it is so deemed in many surgical programs. It can provide the basis for ongoing quality initiatives directly affecting patient safety. It can also offer attending radiologists an opportunity to see how their actions might be viewed by a potential judge or jury. The legislature and courts have paved the way for candid peer review by providing a qualified privilege, and in opinions have suggested

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