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Teaching M&M rounds skills: enhancing and assessing patient safety competencies using the Ottawa M&M model
  1. Shawn E Mondoux,
  2. Jason R Frank,
  3. Edmund S H Kwok,
  4. A Adam Cwinn,
  5. A Curtis Lee,
  6. Lisa A Calder
  1. Department of Emergency Medicine, University of Ottawa, Ontario, Ontario, Canada
  1. Correspondence to Dr Lisa A Calder, Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Ave, F662, Ottawa, ON, Canada K1Y 4E9; lcalder{at}


Background Postgraduate medical education bodies and national patient safety institutes recommend that trainees develop patient safety competencies such as those for Morbidity and Mortality (M&M) rounds, yet there exists no model for their educational delivery.

Objective We studied the effect of a single educational intervention on emergency medicine residents’ aptitudes in selecting and analysing M&M rounds cases.

Methods In this before-and-after study, participants attended an 1 h educational session based on the previously described Ottawa Morbidity and Mortality Model (OM3). Residents were asked to submit a case suitable for M&M rounds both preintervention and postintervention. A novel M&M rounds case critique tool was developed based on OM3 and used to assign a numerical score to each submitted case. Our primary outcome was an increase in mean scores between phases using the case critique tool. An a priori score increase of 1 was defined as educationally significant. Data were analysed using a paired Student's t test.

Results A total of 19 residents were recruited for our pre-intervention and 15 residents for the post-intervention analysis. Mean M&M rounds case critique scores increased from 5.53 to 8.67 (p<0.01) between phases. Residents reported higher comfort with structured case selection and analysis, with an increase in five-point Likert scale means of 2.32 and 3.69 (p<0.01).

Conclusions We found that residents were more effective at M&M rounds case selection and analysis after our focused 1 h educational intervention. Training programmes should consider an M&M rounds training model to ensure future physicians have these skills for 21st-century practice.


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  • Contributors SEM established the study concept and design, collected data, conducted the analysis and interpretation of data (including visual formatting) and drafted the manuscript. JRF contributed to study design, critical appraisal and revision of the manuscript as well as co-supervised the study. ESHK provided the team with critical revision of the manuscript. AAC led the group in administrative and material support for the research project. ACL provided insight on the statistical methodologies and conducted the statistical analysis for this manuscript. LAC contributed significantly to study design, conducted many iterations of critical appraisal and manuscript revision, co-supervised the study and provided administrative support.

  • Competing interests None declared.

  • Ethics approval The Ottawa Hospital Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.