Design: A quality improvement initiative over one academic year. Gynecologic surgical cases presented at M&M conference were reviewed by presenting residents and the Inclusion, Diversity and Equity (IDE) committee to determine if implicit or cognitive biases and/or SDOH impacted the clinical outcome. Case presentations incorporated discussion of these factors.

Setting: OB/GYN residency program at a tertiary care hospital serving a diverse patient population.

Patients or Participants: Gynecologic surgical cases were submitted for consideration at M&M conference if they met criteria from a predetermined list. Each month, one case was reviewed.

Interventions: Institutional IRB exemption granted. Two lectures and one journal club oriented residents and faculty to interplay of implicit and cognitive bias in surgical complications. Residents were provided with reference articles and lists of types of cognitive biases. M&M presentations were prepared with addition of slides addressing whether bias or SDOH contributed to the surgical complication. Inclusion of strategies to de-bias within discussion was encouraged. IDE committee members provided feedback and mentorship to residents prior to presentations.

Measurements and Main Results: Nine types of cognitive biases were identified, impacting 70% of gynecologic surgical complications: anchoring, conformity, framing, confirmation, ascertainment, omission, playing the odds, law of the instrument, premature closure. 40% of cases identified implicit bias and 40% identified SDOH as factors in the adverse patient outcome.

Conclusion: Implicit bias, cognitive biases and social determinants of health are major factors that impact patient outcomes in gynecologic surgical care. Incorporating routine discussions of these factors into M&M conference is imperative to providing equitable and safe surgical care to our patients.