Morbidity and Mortality

Morbidity and Mortality Conference
University of Hawaii Department of OB/GYN

Since Hippocrates, professors of medicine have made liberal use of two techniques:

The most effective learning technique is to make a mistake, then be required to answer for it later, preferably in a forum that generates a lot of stress.

The second most effective learning technique is to watch some other miserable soul answer for his mistake and thank the stars above you didn’t do that.

Adapted from the Witherspoon series by John A. Kona


M&M conferences began around 1917 as a system to investigate the reasons and responsibility for adverse outcomes. The Accreditation Council for Graduate Medical Education mandated M&M conferences in 1983 and many physicians view these conferences as the most important they attended during their training.

The primary function of M&M is education. An effective M&M provides the forum to discuss, evaluate, develop and disseminate effective strategies for improved patient care. M&M conference is the best place to teach and cultivate the culture of medicine, to stress the value of knowledge, skill and alertness in caring for patients. Errors, mistakes, and bad outcomes contain valuable lessons for all physicians. These weekly reminders of what can happen when we lose our intensity or ignore the fundamentals are good for physicians at all levels.

The atmosphere of M&M is a dynamic one that fosters a cooperative esprit de corps within the department. M&M conferences are to be free flowing exchanges, the intention is not to place blame or find fault, rather to seek better understanding of the events and to focus on the goal of improved patient care. The review of cases should be a straightforward, unvarnished explanation of what happened. Often the analysis helps everyone to understand that in medicine there are outcomes that are unavoidable. Outcomes due to a lapse in knowledge or implementation and outcomes due to systematic or protocol problems can be decreased through an effective M&M conference.

The discussions during M&M should focus on best patient care practices and contain concise “Clinical Pearls” rather than being a lecture or didactic session. Anecdotes and opinion, even “expert opinion” should be identified as such and play a limited role in the discussion. The conference is not intended to be a risk management, quality assurance, or peer review process and thus the meetings are not to be recorded.


M&M is a closed meeting. Attendance at this conference is limited to students, residents and faculty, and all who are not providing emergency care are expected to arrange their schedules in order to attend.

All complications from the previous week (Tuesday to Tuesday) are forward to the moderator by the resident running the service, no later than Wednesday. These will be collated and forwarded to the Chair, the Division Chiefs, and the Attendings of the Week (OB, Gyn, MFM and Queens) two days prior to the conference. These individuals will confirm the accuracy and completeness of the lists and are free to designate cases that they feel should be given a priority for presentation. Monthly Obstetrics and Gynecology statistics are included in the first M&M of every month. Cases with unanticipated or unfortunate outcomes from all sub-specialties as well as from the outpatient clinic should be included on the case lists.The start of the conference alternates each week between Obstetrics and Gynecology. All deaths and a few of the most educational cases are prepared for presentation by the residents, however the resident running the service must be prepared to discuss any patients on their list. The selected cases are presented in a stepwise fashion to simulate the chronology of the case as it unfolded to the OB/GYN team. The faculty on service is to review the presentations with the residents to keep them complete bt concise and to help with anticipated questions from the audience or moderator. Residents in the audience should listen actively and expect to be asked management questions along the way, appropriate for their level of training and expertise.

A short discussion led by the resident running the service will begin each M&M conference. The literature relevant to the case is summarized, information regarding controversial and unanwered questions will be provided and the important clinical pearls are to be reviewed. A short discussion led by the Chief on service follows each presentation. The disease process, diagnostic workup, and evaluation of tests and procedures are important topics for discussion. The literature relevant to the case is summarized and the clinical pearls are provided. The Chair or moderator’s role is to make sure the discussion stays on track, the emphasis stays on education and the learning environment stays safe. However, if laziness, ignorance, or complacency, is revealed during the discussion, the Chair or moderator is allowed to (and should) make that clear.


Gawande, A. When Doctors Make Mistakes. The New Yorker. 74(41):40–52, 1999.
Gross, C. P., G. B. Donnelly, et al. (1999). “Resident expectations of morning report: a multi-institutional study.” Arch

Intern Med 159(16): 1910-4.
Harbison, S. P. and G. Regehr (1999). “Faculty and resident opinions regarding the role of morbidity and mortality

conference.” Am J Surg 177(2): 136-9.
Kinzie, J. D., R. A. Maricle, et al. (1992). “Improving quality assurance through psychiatric mortality and morbidity

conferences in a university hospital.” Hosp Community Psychiatry 43(5): 470-4.
Kohn L.M. , J. M. Corrigan, and M.S. Donaldson, Editors; Committee on Quality of Health Care in America, Institute

of Medicine. To Err Is Human: Building a Safer Health System. National Academies Press 2000
Kona JA “The Purpose of the “Witherspoon” Series”.Nov 2003<>

Latham, S. R. (2001). “System and responsibility: three readings of the IOM report on medical error.” Am J Law Med 27(2-3): 163-79.

Murayama, K. M., A. M. Derossis, et al. (2002). “A critical evaluation of the morbidity and mortality conference.” Am J Surg 183(3): 246-50.

Orlander, J. D., T. W. Barber, et al. (2002). “The morbidity and mortality conference: the delicate nature of learning from error.” Acad Med 77(10): 1001-6.

Thompson, J. S. and M. A. Prior (1992). “Quality assurance and morbidity and mortality conference.” J Surg Res 52(2): 97-100.

Aeby, T. (2011). “The Role of Morbidity and Mortality (M&M) Conferences in Medical Education.” Hawaii Med J. 2011 Feb;70(2):39-40