APM Perspectives The Association of Professors of Medicine (APM) is the national organization of departments of internal medicine at the US medical schools and numerous affiliated teaching hospitals as represented by chairs and appointed leaders. As the official sponsor of The American Journal of Medicine, the association invites authors to publish commentaries on issues concerning academic internal medicine. For the latest information about departments of internal medicine, please visit APM’s website at www.im.org/APM. A Systems Approach to Morbidity and Mortality Conference Jason H. Szostek, MD, a Mark L. Wieland, MD, MPH, a Laura L. Loertscher, MD, MPH, b Darlene R. Nelson, MD, a Christopher M. Wittich, MD, PharmD, c Furman S. McDonald, MD, MPH, c Joseph C. Kolars, MD, c,d Darcy A. Reed, MD, MPH c a From the Department of Medicine, Mayo Clinic, Rochester, Minn; b Department of Medicine, Providence St Vincent Medical Center, Portland, Ore; c Internal Medicine Residency Program, Mayo Clinic, Rochester, Minn; d Department of Medicine, University of Michigan, Ann Arbor, Mich. Pressure from within and outside the medical profes- sion has pushed patient safety and recognition of med- ical errors to the forefront of health care priorities in the United States. The Institute of Medicine has recognized that it is essential for physicians at all levels of the educational continuum to participate in the examination of systems issues that contribute to medical error. 1,2 The morbidity and mortality conference within res- idency programs has been identified as an important platform to explore, disseminate, and address these systems issues that contribute to error in real-time. 3-5 However, there is little literature examining a formal assessment of error at morbidity and mortality confer- ences with a systems focus. 3,4 The morbidity and mortality conference is nearly ubiquitous among internal medicine residency pro- grams, but most lack explicit methods or formats. 6,7 Furthermore, although educators agree that morbidity and mortality conferences should examine medical er- ror and adverse events, most conferences do not ad- dress either of these elements regularly. 6-8 For resident physicians, the morbidity and mortality conference format has the potential to address all 6 of the core competencies mandated by the Accreditation Council for Graduate Medical Education. 9 However, the conference’s capacity to formally assess health care systems issues as they contribute to medical error po- sitions is a potential hallmark for the systems-based practice competency. Therefore, we report our experi- ence with a structured “systems audit” as a component of a weekly internal medicine residency morbidity and mortality conference. The objectives of this study were to determine whether implementation of the systems audit increased residents’ awareness of systems issues in health care and to examine the educational value of the systems audit relative to other educational experi- ences. Institutional improvements in patient care result- ing from systems audits also were identified. MATERIALS AND METHODS Design, Setting, and Participants We conducted a cross-sectional study of all 144 first-, second-, and third-year categorical internal medicine residents at Mayo Clinic Rochester in 2007 to deter- mine whether the systems audit increased residents’ Funding: This work was supported by the Mayo Clinic Internal Medicine Residency Office of Educational Innovations as part of the Accreditation Council for Graduate Medical Education Educational Innovations Project. Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript. Authorship: All authors had full access to the data and take responsibility for data integrity. Statistical analyses were conducted by Dr Reed. Reprint requests should be addressed to Jason H. Szostek, MD, Instructor in Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905. E-mail address: szostek.jason@mayo.edu APM Perspectives 0002-9343/$ -see front matter © 2010 The Association of Professors of Medicine. All rights reserved. doi:10.1016/j.amjmed.2010.03.010