‘Golden hour’ of education: The best way to learn
As physicians, we have every opportunity to stay on the cutting edge of treatment and diagnosis in the area of oncology.
It is especially critical because of the tremendous amount of new information to which we have access almost every day.
In the field of genetics and genomics, it can be overpowering and mind-boggling.
There are educational opportunities through ASCO, Society of Surgical Oncology, NCI, American College of Surgeons, ASH and other organizations. And, of course, in this day and age, all of these society meetings and several others are right at our fingertips — accessible from our offices via our computers or handheld devices.
Learning from mistakes
OK, so I haven't told you anything new. So what's the point of this commentary?
In my career, one of the most educational conferences has been surgical morbidity and mortality (M&M).
Today, surgical M&M is a hybrid between virtual and in person, but there is nothing like having everyone in a room together. I realize those days are probably gone, but it's easier to look into the eyes of a surgical resident physically rather than on a screen when posing a question — especially if you're trying to make a proactive point.
The goals of specialty M&M conferences are learning from our mistakes, recognizing the problems, and being aware of the risks of one's own procedures and actions.
Of course, throughout our careers — whether in medical, surgical or radiation oncology — we make mistakes. However, the safe physician in any specialty will recognize that mistake and correct it — or learn how to correct it. Failure to recognize a mistake or error is more serious.
At M&M conferences, data are collected continuously, complications are classified and results are analyzed. The goal is to be proactive and establish a learning environment.
Surgical M&M conferences are not peer review. So, in essence, M&M conferences can be considered clinical review meetings that allow departments or specialties to review the quality of care being provided to their patients.
Cornerstones of quality improvement
The concept of these conferences is to review adverse events and preventable errors with an opportunity to learn from them and adjust.
As described by Slater and colleagues, M&M conferences are cornerstones of quality improvement programs and provide timely opportunities for education within the urgent context of clinical care.
Slater and colleagues reviewed the M&M conference literature and focused on five themes: educational value, error analysis, case selection and representation, attendance and dissemination of information.
Error analysis is critical, and a way to improve this analysis is to focus discussion on causative factors.
The classic question asked to the surgeon at the end of a discussion on causative factors is: “If you had to do this over again, what would you do differently."
If there had been an obvious error that could've been prevented, the answer you don't want to hear is: “I would do things the same way." That answer would be a major concern.
M&M conferences play a very important role in educating all trainees and, at the same time, improving patient safety. They lead to improving a trainee’s knowledge, skills and patient care practices.
The surgical M&M conference has been referred to as the “golden hour of surgical education.” Hence, the importance of this conference — whether in the department of surgery or department of medicine — cannot be overstated.
Also, all academic departments are required by the Accreditation Council for Graduate Medical Education to have a weekly M&M conference to discuss all complications and deaths.
Despite all of the information available to us in the field of medicine — especially in oncology — I believe the surgical M&M conference is one of the most valuable learning experiences from which a physician in any specialty can learn.
The most effective M&M conferences are multidisciplinary, just like the care we provide to patients with cancer.
The surgeon, anesthesiologist, radiologist, interventional radiologist, infectious disease specialist, oncologist and cardiologist — along with others — can play an important educational role in any M&M conference.
It truly is the golden hour of education — and not just surgical.
Stay safe.
Interested in more on this topic? Browse free activities on Healio CME
References:
- Gordon, LA. Gordon's Guide to the Surgical Morbidity and Mortality Conference. Hanley & Belfus Inc. St. Louis, Mo. 1994.
- Mitchell EL, et al. Acad Med. 2013;doi:10.1097/ACM.0b013e31828f87fe.
- Slater N, et al. Can J Surg. 2020;doi:10.1503/cjs.009219.
For more information:
Nicholas J. Petrelli, MD, FACS, is Bank of America endowed medical director of ChristianaCare’s Helen F. Graham Cancer Center & Research Institute and associate director of translational research at Wistar Cancer Institute. He also serves as Associate Medical Editor for Surgical Oncology for HemOnc Today. He can be reached at npetrelli@christianacare.org.
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