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{ "pk": 12977, "title": "The Impact of Anonymity in Emergency Medicine Morbidity and Mortality Conferences: Findings from a National Survey of Resident Physicians", "subtitle": null, "abstract": "Introduction: \nAlthough the Accreditation Council for Graduate Medical Education mandates structured case review and discussion as a part of residency training, there remains little guidance on how best to structure these conferences to cultivate a culture of safety, promote learning, and ensure that system-based improvements can be made. We hypothesized that anonymous case discussion was associated with a more effective, and less punitive, morbidity and mortality (M&M) conference. Secondarily, we were interested in determining whether this core structural element was correlated with the culture of safety at an institution.\nMethods:\n We conducted a national survey at 33 emergency medicine residency programs evaluating residents’ perceptions of M&M and the culture of safety at their institutions. Data was analyzed using descriptive statistics and bivariate analyses. We summarized Likert scores using mean and 95% confidence intervals. We also performed content analysis of the free-text comments and report on the themes identified.\nResults:\n There were 1248 residents at the 33 programs surveyed. Of the 1002 who replied (80.3% response rate), 231 respondents reported anonymous case presentations and 744 reported non-anonymous case presentations. Residents at programs with anonymous case presentations were more likely to report that M&M was non-punitive. There were no other significant differences between anonymous and non-anonymous case presentations on any of the culture of safety domains measured. When these comments were systematically analyzed and coded, we found that the comments related to anonymity were both positive and negative. Among the themes identified were anonymity’s impact on punitive response to error, the ability to learn from cases, and professional responsibility.\nConclusion:\n Anonymous M&Ms are associated with a perception of a less-punitive M&M and with better ratings in several conference-specific outcomes; however, there appears to be no association between the other Agency for Healthcare Research and Quality culture of safety scores and anonymity in M&M.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Education, Graduate Medical" }, { "word": "Organizational Culture" }, { "word": "safety" }, { "word": "Qualitative Research" }, { "word": "Medical errors" } ], "section": "Original Research", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/6rv1z6xd", "frozenauthors": [ { "first_name": "Emily", "middle_name": "", "last_name": "Aaronson", "name_suffix": "", "institution": "Massachusetts General Hospital\nHarvard Medical School", "department": "None" }, { "first_name": "Kathleen", "middle_name": "", "last_name": "Wittels", "name_suffix": "", "institution": "Harvard Medical School, Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts", "department": "None" }, { "first_name": "Richard", "middle_name": "", "last_name": "Dwyer", "name_suffix": "", "institution": "Harvard Medical School, Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts", "department": "None" }, { "first_name": "Eric", "middle_name": "", "last_name": "Nadel", "name_suffix": "", "institution": "Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts\n\nHarvard Medical School, Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts", "department": "None" }, { "first_name": "Fiona", "middle_name": "", "last_name": "Gallahue", "name_suffix": "", "institution": "University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington", "department": "None" }, { "first_name": "Olesya", "middle_name": "", "last_name": "Baker", "name_suffix": "", "institution": "Center for Clinical Investigation, Brigham and Women’s Hospital, Boston, Massachusetts", "department": "None" }, { "first_name": "Christopher", "middle_name": "", "last_name": "Fee", "name_suffix": "", "institution": "University of California San Francisco School of Medicine, Department of Emergency Medicine, San Francisco, California", "department": "None" }, { "first_name": "Robert", "middle_name": "", "last_name": "Tubbs", "name_suffix": "", "institution": "Warren Alpert Medical School at Brown University, Department of Emergency Medicine, Providence, Rhode Island", "department": "None" }, { "first_name": "Jeremiah", "middle_name": "", "last_name": "Schuur", "name_suffix": "", "institution": "Harvard Medical School, Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts", "department": "None" } ], "date_submitted": "2019-07-15T22:11:45+03:00", "date_accepted": "2019-07-15T22:11:45+03:00", "date_published": "2019-12-19T23:37:23+03:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/12977/galley/6802/download/" } ] }