Evolution of the Morbidity and Mortality Conference in Surgery: From Codman to Contemporary Practice

The morbidity and mortality (M&M) conference is a foundational tradition in surgery, serving as a forum for education, accountability, and patient safety for more than a century. Originally rooted in early efforts to track outcomes and improve hospital efficiency, M&M has evolved alongside major developments in surgical education, quality improvement, and patient safety science. This review traces the historical evolution of the M&M conference from Ernest Codman's end-result system to its institutionalization by the American College of Surgeons and formalization in graduate medical education. It examines the cultural shift from individual blame toward systems-based learning, highlights the influence of the patient safety movement, educational theory, and human factors science, and reviews contemporary approaches incorporating data analytics, multidisciplinary participation, and technology. Persistent challenges including variability in structure, underreporting, and medicolegal concerns along with future opportunities to strengthen M&M as a driver of continuous improvement are discussed. Despite ongoing evolution, the core purpose of honest reflection in service of safer and higher-quality surgical care in M&M remains unchanged.