Participate in M & M meetings

At the early registrar level it is expected that a prevocational doctor will have acquired the skills, knowledge and behaviours to competently participate in morbidity and mortality meetings.

This task describes a number of activities, as below, where proficiency should be achievable by the end of PGY3.  The doctor is encouraged to download the key clinical task guidelines and seek the support of his/her supervisor for feedback on performance.

  • Recognises quality, safety and education aspects
  • Presents case honestly
  • Participates in discussion
  • Notes learning achieved
  • Makes key points explicit
  • Incorporates into practice
  • PGY 1
  • PGY 2
  • PGY 3

  • Collaboration and teamwork

    • Understand both personal and collective responsibility within the team to ensure the safety of patients
    • Maintain accurate records and follow-up on investigation results
  • Health advocacy
    • Consider, and allow for, the impact of social, economic and political factors, as well as culture, ethnicity, sexuality, disability and spirituality, on patient illness and health

  • Judgement and clinical decision making

    • Following any error in clinical reasoning, reflect on own clinical reasoning process and learn from mistake
  • Leadership and management
    • Work well with others to gain respect and trust
    • Identify hazards within the clinical environment; ensure they are reported and then acted upon
    • Participate and demonstrate leadership in patient safety and quality improvement activities
  • Professionalism
    • Demonstrate flexibility and ability to adapt to change
    • Able to learn from mistakes (own and others)
    • Identify specific strategies for improving performance based on feedback

  • Scholarship and teaching

    • Attend unit or morbidity/mortality meetings. Identify any personal knowledge, skills or behaviour changes required
    • Participate in research, quality improvement and clinical audit activities where possible
      • Participate in research
      • Undertake literature searches relevant to the clinical care of patients, including use of PubMed, Medline and Cochrane reviews
      • Apply critical appraisal skills when reading medical literature
      • Compare outcomes of published research studies relating to clinical care within the unit
    • Reflect on and learn from own observations of clinical practice

  • Technical expertise

  • Communication
    • Explain clinical reasoning to current health team using concise language and a structured approach
  • Health advocacy
    • Identify key issues on which to advocate for the patient to ensure their immediate clinical care and requirements are achieved

  • Judgement and clinical decision making

    • Able to succinctly present the patient scenario and discuss management plan
    • Has awareness and acknowledges errors or omissions in own decision making
  • Leadership and management
    • Document and report adverse events in accordance with local incident reporting systems
  • Medical expertise
    • Work within unit-based protocols with regard to pre-operative assessment and care, operative procedures and post-operative care:
      • apply medical knowledge to clinical practice
      • implement and evaluate a management plan relevant to the patient following discussion with a senior clinician
      • identify when patient transfer is required, and manage risks prior to and during patient transfer
      • recognise indications for, and risks of, fluid and electrolyte therapy and blood products
      • provide appropriate aftercare and arrange follow up for common procedures 
      • safely manage anti-coagulant therapy and manage diabetes
      • recognise acute cardiac events and use relevant resuscitation/drug protocols
      • initiate resuscitation of the unwell patient. Recognise indicators for sepsis and implement clinically relevant plan
      • maintain a clinically relevant patient management plan of fluid, electrolyte and blood product use
      • recognise and manage fluid and electrolyte imbalances in a patient
      • effectively use semi-automatic and automatic defibrillators
      • provide appropriate aftercare and arrange follow up for more complex procedures
      • recognise when patients are ready for discharge and arrange referral to relevant members of the healthcare team to promote planning for safe discharge
    • Safely prescribe use of antimicrobials and be aware of the influence of the pharmaceutical industry. Clearly understand proper surgical prophylaxis and distinguish this from therapeutic use of antibiotics for bacterial infections
  • Professionalism
    • Show insight on what needs to be improved

  • Scholarship and teaching

    • Contribute to unit morbidity/mortality meetings

  • Technical expertise

  • Collaboration and teamwork

    • Identify issues that impede teamwork and suggest actions; after discussion with Unit Head, assist with implementation
  • Communication
    • Set an appropriate tone for any communication with patients and their families, peers and colleagues
    • Contribute to analysis of complex cases and imperfect outcomes, and identify any changes needed to care processes or systems

  • Judgement and clinical decision making

    • Retrieve, comprehend and apply results of systematic reviews, clinical prediction rules, decision analysis and clinical practice guidelines
  • Leadership and management
    • Participate in systemic quality process of evaluation and improvement, such as patient safety initiatives or proposed clinical service changes
  • Medical expertise
    • Present complex cases effectively to senior medical staff and other health professionals
    • Audit own and team performance in relation to patient progress and outcome

  • Scholarship and teaching

    • Identify areas of improvement in teaching/ learning activities and work with Unit Head/ Director of Surgery to implement change
    • Chair/facilitate morbidity/mortality meetings, and identify desirable changes to processes and systems of care

  • Technical expertise