The M+M Matrix is a concept that redefines and reconfigures the traditional surgical morbidity and mortality conference. This seminal surgical conference is the logical place to begin such Flexnerian and Halstedian change.
The M+M Matrix is a mechanism for reconfiguring the traditional surgical morbidity and mortality (M&M) conference, which, as currently conducted in many training programs, has failed in its educational mission. The great lessons voiced at most M&M conferences are dismissed at the exit door. It is as if a culture developed that failed to invent a written language and is restricted to the oral transmission of complication-reducing surgical principles. The reasons for the failure of the traditional M&M conference include the lack of continuity, the lack of educational accountability, and its lack of logic. It is an educational Roach Motel©: Great surgical ideas check in, but they don’t check out!
The M+M Matrix implemented at Cedars- Sinai addresses these weaknesses through a process that involves a discussion of each surgical complication. That discussion is outlined and codified into a matrix—a framework on which residents and staff can build an approach to managing that complication as their education and careers progress.
The moderator of the forum serves as the chief and driving force behind this changing educational approach. The moderator’s task is to supervise a one-week educational effort aimed at conference preparation. This individual formulates the weekly matrix outlines and works with the residents to arrive at unifying surgical principles.
The Matrix uses the inherent dynamic of a well-moderated, well-coordinated, and well-attended M&M conference. Using a weekly, monthly, and yearly cycle of e-mail, written examinations, and referenced discussions, the Matrix program codifies and sustains the great lessons of the traditional M&M conference while [Vol. 89, No. 6, Bulletin of the American College of Surgeons; 18] purging it of the unfortunate legacy of shame and blame. It does so by changing the focus from rooting out problems to decreasing surgical complications and encouraging participants to recognize them earlier and to treat them more effectively. [7]
Using their well-documented views on medical education, it is likely that both Flexner and Halsted would focus on the surgical morbidity and mortality conference as the place to begin change in surgical education.