A two-tiered quality management program : Morbidity and mortality conference data applied to resident education

The ACGME mandates a competency-based resident education curriculum. The Joint Commission (TJC) requires a quality improvement (QI) program in all hospitals with residency training programs. Our QI program, based on M&M conference data, provided the operational framework for peer review and resolution of adverse events. However, the conference focused on only three of the six ACGME core competencies (patient care, medical knowledge, practice-based learning and improvement) but not specifically on interpersonal and communication skills, professionalism or systems-based practice. To address this issue, we devised a two-tiered QI process that meets the reporting mandate of TJC and addresses all six ACGME core competencies. Adverse events are reported and discussed in the Department of Surgery's divisional M&M conferences. If an issue involving the ACGME core competencies is identified that requires nonconference discussion, ie, communication, professionalism or systems-based practice, the case is referred to the Department of Surgery Subcommittee for Quality Improvement (SCQI). A report is then returned to the divisional M&M for discussion and possible incorporation into the Resident Core Curriculum. Resident and attending surgeon surveys demonstrated the new format to be effective in addressing all six ACGME competencies.