An Exploration of Psychiatry Residents’ Morbidity and Mortality Education Through a Structured Curriculum to Teach Self-Reflection, Accountability, and Systems-Based Learning

OBJECTIVE: This study describes a psychiatry residency curriculum integrating root cause analysis (RCA), reflective practice, and systems-based thinking within morbidity and mortality (M&M) conferences. METHODS: As part of post-graduate year 2 (PGY-2) didactics, 40 residents and recent graduates (n = 40) completed a 9-week RCA course culminating in a formal, resident-led M&M conference from 2018 to 2023. A one-time anonymous electronic survey was distributed to past participants in March 2024. The survey included 20 Likert scale items assessing knowledge, skills, and attitudes aligned with Accreditation Council for Graduate Medical Education (ACGME) competencies. RESULTS: Respondents (n = 29; 100%) agreed or strongly agreed with 13 of 20 survey items, particularly regarding understanding of systems issues and contributing factors in adverse events. Twenty-nine respondents (100%) reported the course fostered respect and psychological safety. Items receiving neutral or disagree responses primarily reflected self-assessments of ability to challenge judgments or discuss their mistakes. CONCLUSIONS: A structured curriculum combining reflective practice with objective RCA effectively enhanced psychiatry residents' knowledge, skills, and attitudes across multiple ACGME competencies. Although limited by single site-design, modest sample size, and recall bias, this model represents a scalable approach to teaching patient safety and systems-based practice in psychiatry training.