Daniel B Heppe1,2, Albertine S Beard3,4, Paul B Cornia5,6, Tyler J Albert5,6, Azadeh Lankarani-Fard7,8, Joel M Bradley9,10, Michelle M Guidry11,12, Brian Kwan13,14, Anand Jagannath13,14, Matthew Tuck15,16, Kathlyn E Fletcher17,18, Elizabeth S Gromisch19,20,21, Craig G Gunderson22,23. 1. Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA. Daniel.Heppe@Cuanschutz.edu. 2. VA Eastern Colorado Health Care System, Aurora, CO, USA. Daniel.Heppe@Cuanschutz.edu. 3. Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA. 4. Minneapolis VA Health Care System, Minneapolis, MN, USA. 5. University of Washington School of Medicine, Seattle, WA, USA. 6. VA Puget Sound Health Care System, Seattle, WA, USA. 7. David Geffen School of Medicine, Los Angeles, CA, USA. 8. VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. 9. Geisel School of Medicine, Hanover, NH, USA. 10. White River Junction VA Medical Center, Hartford, VT, USA. 11. Tulane University School of Medicine, New Orleans, LA, USA. 12. Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA. 13. University of California San Diego School of Medicine, San Diego, CA, USA. 14. VA San Diego Healthcare System, San Diego, CA, USA. 15. George Washington University School of Medicine, Washington, DC, USA. 16. Washington DC VA Medical Center, Washington, DC, USA. 17. Medical College of Wisconsin, Wauwatosa, WI, USA. 18. Milwaukee VA Medical Center, Milwaukee, WI, USA. 19. Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health of New England, Hartford, CT, USA. 20. Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA. 21. Departments of Rehabilitative Medicine and Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, Hamden, CT, USA. 22. Yale University School of Medicine, New Haven, CT, USA. 23. VA Connecticut Healthcare System, West Haven, CT, USA.
Abstract
BACKGROUND: There are more than five hundred internal medicine residency programs in the USA, involving 27,000 residents. Morning report is a central educational activity in resident education, but no recent studies describe its format or content. OBJECTIVE: To describe the format and content of internal medicine morning reports. DESIGN AND PARTICIPANTS: Prospective observational study of morning reports occurring between September 1, 2018, and April 30, 2019, in ten different VA academic medical centers in the USA. MAIN MEASURES: Report format, number and type of learner, number and background of attending, frequency of learner participation, and the type of media used. Content areas including quality and safety, high-value care, social determinants of health, evidence-based medicine, ethics, and bedside teaching. For case-based reports, the duration of different aspects of the case was recorded, the ultimate diagnosis when known, and if the case was scripted or unscripted. RESULTS: A total of 225 morning reports were observed. Reports were predominantly case-based, moderated by a chief resident, utilized digital presentation slides, and involved a range of learners including medicine residents, medical students, and non-physician learners. The most common attending physician present was a hospitalist. Reports typically involved a single case, which the chief resident reviewed prior to report and prepared a teaching presentation using digital presentation slides. One-half of cases were categorized as either rare or life-threatening. The most common category of diagnosis was medication side effects. Quality and safety, high-value care, social determinants of health, and evidence-based medicine were commonly discussed. Medical ethics was rarely addressed. CONCLUSIONS: Although a wide range of formats and content were described, internal medicine morning report most commonly involves a single case that is prepared ahead of time by the chief resident, uses digital presentation slides, and emphasizes history, differential diagnosis, didactics, and rare or life-threatening diseases.
BACKGROUND: There are more than five hundred internal medicine residency programs in the USA, involving 27,000 residents. Morning report is a central educational activity in resident education, but no recent studies describe its format or content. OBJECTIVE: To describe the format and content of internal medicine morning reports. DESIGN AND PARTICIPANTS: Prospective observational study of morning reports occurring between September 1, 2018, and April 30, 2019, in ten different VA academic medical centers in the USA. MAIN MEASURES: Report format, number and type of learner, number and background of attending, frequency of learner participation, and the type of media used. Content areas including quality and safety, high-value care, social determinants of health, evidence-based medicine, ethics, and bedside teaching. For case-based reports, the duration of different aspects of the case was recorded, the ultimate diagnosis when known, and if the case was scripted or unscripted. RESULTS: A total of 225 morning reports were observed. Reports were predominantly case-based, moderated by a chief resident, utilized digital presentation slides, and involved a range of learners including medicine residents, medical students, and non-physician learners. The most common attending physician present was a hospitalist. Reports typically involved a single case, which the chief resident reviewed prior to report and prepared a teaching presentation using digital presentation slides. One-half of cases were categorized as either rare or life-threatening. The most common category of diagnosis was medication side effects. Quality and safety, high-value care, social determinants of health, and evidence-based medicine were commonly discussed. Medical ethics was rarely addressed. CONCLUSIONS: Although a wide range of formats and content were described, internal medicine morning report most commonly involves a single case that is prepared ahead of time by the chief resident, uses digital presentation slides, and emphasizes history, differential diagnosis, didactics, and rare or life-threatening diseases.
Entities:
Keywords:
education; internal medicine residency; morning report
Authors: Tyler J Albert; Jeff Redinger; Helene Starks; Joel Bradley; Craig G Gunderson; Dan Heppe; Kyle Kent; Michael Krug; Brian Kwan; James Laudate; Amanda Pensiero; Gina Raymond; Emily Sladek; Joseph R Sweigart; Paul B Cornia Journal: J Gen Intern Med Date: 2021-01-14 Impact factor: 5.128
Authors: Tyler J Albert; Joel Bradley; Helene Starks; Jeff Redinger; Cherinne Arundel; Albertine Beard; Laura Caputo; Jonathan Chun; Craig G Gunderson; Dan Heppe; Anand Jagannath; Kyle Kent; Michael Krug; James Laudate; Vignesh Palaniappan; Amanda Pensiero; Zaven Sargsyan; Emily Sladek; Matthew Tuck; Paul B Cornia Journal: J Gen Intern Med Date: 2021-06-25 Impact factor: 6.473