背景:最初设计为讨论不良患者事件的论坛,手术发病率和死亡率会议(M&M)已发展成为外科教育中不可或缺的工具,各级受训者将被教导批判性地检查决策。其他人扩大了M&M会议的子集的范围,以包括影响患者结果的其他因素,比如健康的社会决定因素,导致健康差距的隐性偏见和结构性政策。在这项研究中,我们在外科每周一次的M&M会议中进行了基于差异的讨论,并研究了对参与者对获得外科治疗的关键差异的理解和看法的影响.
方法:向外科M&M会议的与会者发送了一份匿名电子调查,包括教师,在实施干预措施之前,居民和医学生。调查询问了人们对获得手术护理的差异的存在和影响以及研究机构如何解决这些问题的看法。标准演示者幻灯片模板已更新为在“并发症原因”幻灯片中包含“差异因素”部分。一年多之后,向会议与会者发送了干预后调查,其中包括与最初调查相同的问题,以及与干预有关的新问题。对调查结果进行描述性统计,并对配对的岗前项目进行了比较。
结果:80名与会者完成了干预前调查,70人完成了干预后调查(22[27.5%];22[31.4%]出席者,24[30.0%];21[30.0%]居民,34名[42.5%];27名[38.6%]医学生)。社会经济学和语言在干预前和干预后都被认为是导致研究机构患者护理差异的最重要因素。受访者一致认为,获取方面的差异会显著影响外科护理,并且报告认为干预后差距正在得到解决的受访者数量有所增加。共有69%(n=48)的受访者认为,将关于获得外科护理方面的差异的讨论纳入M&M可以提高他们对这些差异所扮演角色的理解,66%(n=46)认为他们自己的想法或做法在患者差异方面发生了变化,84%(n=59)的人报告说,将这些关于差异的讨论纳入并购总体上是有帮助的。
结论:在每周的M&M会议中纳入差异讨论导致了研究机构的积极变化,在外科部门内促进更全面和具有社会意识的对话。调查受访者一致认为,在获得外科护理方面存在差异,干预改善了他们对研究机构如何解决差距的看法。受访者认为,整合差异讨论总体上是有帮助的,提高了他们对获得外科护理的差距的认识,并影响了他们解决自身实践差异的计划。
Originally designed as a forum to discuss adverse patient events, Surgery Morbidity & Mortality Conference (M&M) has evolved into an integral tool within surgical education where trainees at all levels are taught to critically examine decision-making. Others have expanded the scope of subsets of M&M conferences to include additional factors that influence patient outcomes, such as social determinants of health, implicit bias and structural policies that contribute to health disparities. In this study, we implemented a disparities-based discussion into our surgical department\'s weekly M&M conference and examined the effect(s) on participants\' understanding and perceptions of key disparities in access to surgical care.
An anonymous electronic survey was sent to attendees of the Department of Surgery\'s M&M conference including faculty, residents and medical students prior to implementation of the intervention. The survey queried perceptions of the presence and impact of disparities in access to surgical care and how these are addressed at the study institution. The standard presenter slide template was updated to include a \"Disparities Factors\" section within the \"Reasons for Complication\" slide. After over 1 year, a postintervention survey was sent to conference attendees that included the same questions as the initial survey, as well as new questions related to the intervention. Descriptive statistics were performed on survey results, and comparisons were made for paired pre-post items.
Eighty conference attendees completed the pre-intervention survey, and 70 completed the postintervention survey (22 [27.5%]; 22 [31.4%] attendings, 24 [30.0%]; 21 [30.0%] residents, 34 [42.5%]; 27 [38.6%] medical students respectively). Socioeconomics and language were most commonly identified both pre- and postintervention as the most important factors contributing to disparities in care experienced by patients at the study institution. Respondents agreed disparities in access significantly impact surgical care, and there was an increase in the number of respondents who reported feeling that disparities are being addressed postintervention. A total of 69% (n = 48) of respondents thought that integrating discussion of disparities in access to surgical care into M&M improved their understanding of the role these disparities play, 66% (n = 46) felt that their own thinking or practice changed regarding patient disparities, 84% (n = 59) reported integrating these discussions of disparities into M&M has been helpful overall.
The inclusion of a disparities discussion in weekly M&M conference has led to positive change at the study institution, fostering a more comprehensive and socially conscious dialogue within the Department of Surgery. Survey respondents agreed that disparities exist in access to surgical care, and that the intervention improved their perceptions of how the study institution addresses disparities. Respondents felt that the integration of a disparities discussion was overall helpful, improved their knowledge of disparities in access to surgical care, and impacted their plans to address disparities in their own practices.