When it comes to surgical residency training, resident physicians and faculty agree that the most important and the most effective nonclinical education activity is the morbidity and mortality conference (M&M), according to a recent publication in JAMA Surgery.
For the study, “Faculty and Resident Perceptions of Learning Activities During Surgery Residency,” researchers surveyed faculty and residents from 15 general surgery residency programs. The physicians were asked to evaluate the effectiveness and the importance of 19 different nonclinical educational activities on a five-point scale, from “not important” or “not effective” to “extremely important” or “extremely effective.” Their answers were collected anonymously, and of the survey responses, 52.6% came from faculty, 27.5% came from junior residents and 19.9% came from senior residents.
“Nonclinical resident educational activities in general surgery residency, such as morbidity and mortality conference (M&M), are vital to the maturation of trainees into independent surgeons,” the authors wrote.
A vital aspect of training
Less than half—42%—of the activities were offered in all programs. The M&M conference—in which teams internally review adverse patient outcomes in order improve care—was one of them. In the most recent study, both faculty and residents rated the M&M as the most important and most effective nonclinical activity in surgical residency training.
The study’s authors posited that the importance of the M&M could be due to the emphasis leaders place on the activity, as well as that it was one of the most longstanding activities in the residency training programs involved in the study. The vast majority of clinical specialties conduct M&M conferences in some form during residency training, though specialties such as general surgery may hold them more frequently. Additionally, the authors noted, M&M conferences are an activity that provides for direct engagement between resident and faculty physicians.
After the M&M conference, the four nonclinical education activities rated most important by the survey respondents—both residents and faculty—were, in order:
- Technique or operative simulation.
- Attending teaching rounds.
- American Board of Surgery In-Training Examination (ABSITE) review sessions.
- Mentors and allies.
The five nonclinical education activities survey respondents ranked least important, from lowest to highest in mean value, were:
- Fundamentals of Endoscopic Surgery (FES) curriculum.
- Diversity and Inclusion curriculum.
- Fundamentals of Laparoscopic Surgery (FLS) curriculum.
- Wellness curriculum.
- Professionalism curriculum.
The other nonclinical education activities assessed in the research letter, from highest to lowest average rating in importance, were:
- Career planning curriculum.
- Clinical simulation.
- Financial planning curriculum.
- Cadaver anatomy laboratory.
- Grands rounds.
- Residents as teachers curriculum.
- Leadership curriculum.
- Risk management and medicolegal education.
- Journal clubs.
In addition to the M&M, the other activities that took place in all training programs included in the study were:
- Technique or operative simulation.
- Attending teaching rounds.
- ABSITE review sessions.
- Grand rounds.
- Wellness curriculum.
- FLS curriculum.
- FES curriculum.
Residents, faculty rated items differently
In some cases, such as with professionalism curriculum, there was a statistically significant gap between the ratings for residents and faculty on the importance of an activity. In that example, faculty rated professionalism curriculum as being more important than did residents.
The biggest differences in ratings by residents and faculty were for the importance of FLS and FES curricula, with senior residents, particularly, rating both as less important than either faculty or junior residents rated them. When it came to ratings of effectiveness, the largest difference was again in FLS and FES curricula, where senior residents rated both as less effective than did faculty.
Career planning and financial planning curricula were rated fairly important, but both fell at or near the bottom of average effectiveness rankings.
“Some activities, such as attending rounds and technique/operative simulation, had a high level of perceived importance yet exhibited the largest gaps in effectiveness,” the authors note. “Residents and faculty were largely aligned on the importance of activities, yet residents often rated the effectiveness of many activities lower than did faculty.”
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