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PURPOSE
PURPOSE
The purpose of the M&M Conference is to provide a safe venue for fellows to identify areas of improvement, and promote professionalism, ethical integrity and transparency in assessing and improving patient care. The M&M Conference also provides a forum to teach curriculum on quality improvement and medico legal issues to fellows and students and to foster a climate of openness and discussion about medical errors.
Preparation
Preparation
The M&M Case Preparation Guide and Worksheet should be used to create your presentation
The conference also promotes leadership, research, and scholarly activity and incorporates into a learning opportunity the six core ACGME competencies of:
Patient care
Medical knowledge
Practice-based learning and improvement
Interpersonal and communication skills
Professionalism
Systems-based practice
PARTICIPANTS
PARTICIPANTS
Faculty moderator
All fellows are expected to attend
All faculty are invited and expected to attend
Anyone involved in the case with direct knowledge of the system and events relevant to the discussion (this may include other physicians, nurses, pharmacists, therapists, lab personnel, and representatives of ancillary departments)
CASE SELECTION
CASE SELECTION
Cases should be selected from the entire practice population. Cases (inpatient and outpatient), should involve:
a poor or unintended outcome which might have been due to or worsened by error or system problems, or
"near-misses," where there was an error or misstep in care delivery that could have led to a poor patient outcome, or
an interesting and unique case that may provide new learning and inquiry
Resident Presenter should complete the M & M Conference Preparation Worksheet and review in advance with the Faculty Moderator.
Ground Rules
Ground Rules
Follow the format
No finger-pointing: focus on systems of care rather than individual errors
Confidentiality: avoid patient identifies (no names, dates, record numbers) and do not discuss casually outside the conference
Conference Format
Conference Format
PowerPoint Presentation limited to 30 minutes
Introduction and Overview by Faculty Moderator
Case Presentation by Fellow
Overview of the case
Review timeline of events
Describe how the patient care issue(s) caused potential or actual harm to the patient, family, or a healthcare professional
Identify any evidenced-based literature that is applicable
Identify the ACGME competency the patient care issue related to
Identify the nature of the patient care issue
Identify the "Take Home Points"
Recommend any clinical or system changes that should be considered to prevent this patient care issue from occurring in the future
Faculty moderator facilitates the discussion of the case and Take Home Points- 15 minutes
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