How Surgical Leadership Shapes Morbidity And Mortality Meetings: A Qualitative Study From Learners' Perspectives.

OBJECTIVE: To explore how surgical learners - medical students on clinical rotation and residents - perceive morbidity and mortality meetings (M&Ms) as educational experiences and how these meetings shape perceived learning about surgical complications and errors. DESIGN: Qualitative study using convenience sampling and a constructivist grounded theory approach. SETTING: Three surgical teaching hospitals in Switzerland. PARTICIPANTS: Thirty-two learners (15 residents and 17 final-year medical students) who attended M&Ms between January and July 2023. RESULTS: We developed five themes that together resembled a dramatic play: (1) M&Ms as a suboptimal learning theater, (2) learners as a silent audience, (3) hidden learning processes behind the scenes of surgical education, (4) the surgical team as supporting cast, and (5) chief surgeon as director. Learners reported barriers including limited preparation, unclear expectations, hierarchical structures, and time constraints. Confrontational interactions such as peer hostility discouraged participation, whereas supportive discussions facilitated reflection and normalization of complications and errors. Senior leadership was perceived as central in shaping both the tone and educational value of M&Ms. CONCLUSIONS: In this qualitative study, surgical learners reflected on structure, preparation, team dynamics, and senior surgical leadership as important factors shaping the educational value of M&Ms. These findings suggest that clearer learning goals, better preparation, protected opportunities to participate, psychological safety, and constructive leadership may help learners engage with, reflect on, and learn from surgical complications and errors.