Recently I was in an M and M, which stands for Mortality and Morbidity, and I made some notes for myself.  Now, if you have never participated in an M & M meeting, you may be interested to know what it is.

An M & M is about reviewing poor outcomes in healthcare.  There are some specific criteria regarding what cases should be included in the list for an M & M.  I won't go over those today.  I would like to offer some important points, however, to those who might be new to this sort of thing.  Usually the chief or senior resident on a given surgical service will have the responsibility of presenting these to the group.  Because I was part of the inaugural class in my surgical residency, we began presenting these cases as interns, which is a very unusual circumstance.  So most of the time, you will have already been exposed to how to do these presentations.  Your program will have its own particular rules about M & Ms.  Stick to them.

That being said, I would like to offer some of my observations, based on a recent presentation I witnessed at our program.

• Know the sequence of events.  Write them down.  Major events should be memorized, especially when they affect the eventual outcome.
• Know the case better than the attending.
• This is possible!  Read, re-read and map and re-map the data that make up the case.  
• Know how the data relate to the outcome(s).  
• If you are contradicted by the attending in the meeting, don't fight them.
• Review the expected complications for your procedure/hospital course/co-morbidities.
• Be able to compare your complication with other complications
• Somehow learn how to present without saying "uh," or "um" & the like
• Do you need to practice in front of a mirror or video camera?  DO SO!
• If the attending has to tell you that it was an avoidable morbidity or mortality during the meeting, you just made an intern mistake.  Hide your face in shame!!
• Meet with the attending before the meeting and go over the M and M in detail.  Make sure the intent and conclusions are congruent with the attending's viewpoint.
• Avoid casual vocabulary:
• GOOD: "...cautery sufficient to ensure hemostasis..."
• LESS GOOD: "...cauterized the heck out of it..."
• DO NOT CONTRADICT THE ATTENDING

M and M's are a very valuable supplement to medical education.  When a resident prepares well, it shows professional judgement and everyone benefits from such a presentation.  When a resident is poorly prepared, it makes everyone uncomfortable.  Be professional, be responsible.