Prepare the Slides: Confession in Surgical Education

Abstract

The Morbidity and Mortality (M&M) conference is one of surgery’s most enduring rituals—a gathering where physicians publicly confront the errors and complications inherent to their work. Yet while its purpose is to examine the causes and consequences of harm, M&M often neglects the moral and emotional wounds carried by trainees. This essay draws on the Catholic sacrament of Confession to frame M&M as a contemporary ritual that has retained the form of self-examination but lost its means of moral restoration. In Confession, repentance moves through reflection, confession, contrition, and absolution—a process designed not only to acknowledge wrongdoing but to restore the penitent to right relationship with self and community. The M&M parallels this structure but omits the final steps of contrition and absolution, leaving residents without a path to forgiveness or reintegration. The result is the cultivation of technically skilled yet spiritually fractured surgeons, burdened by guilt or numbed by repetition. This essay proposes that M&M can become a space of moral as well as technical formation. By naming the emotional toll of complications, inviting contrition without shame, and offering explicit absolution when appropriate, educators can help restore meaning and hope to surgical training. Done well, M&M becomes not only a forum for improving outcomes but a liturgy of professional renewal—one that acknowledges failure, fosters accountability, and restores the humanity of those who bear the weight of healing others.