The morning report

Experience of morning reports in the emergency department

Morning report in the emergency medicine departments is an emerging teaching modality in the medicine curriculum. Our institution, Hotel-Dieu de France hospital, a multidisciplinary tertiary care university hospital affiliated to the Saint Joseph University of Medical Sciences, is the only hospital in Middle East to hold morning reports in the emergency department (ED). We evaluate the usefulness of the morning report as a pedagogic tool as it assesses the content, quality of the discussions, professionalism, leadership, participation and duration of the morning report. The particularity of this paper is that it takes into consideration the interns' input often under-recognised in the studies. An anonymous questionnaire was diffused to the residents and interns that rotated in the ED during the previous year. It consisted of seven multiple-choice questions to evaluate the quality of the presentations, targeted discussions, ethics and professionalism, evidence-based medicine, clinical reasoning, relation of cases to discussions and implication of the ED physician. Overall, of the 63 patients who answered the survey, 65.1% were satisfied by the content. The majority considered the quality of the discussions acceptable and the leadership and participation satisfactory, professionalism was judged poor. Both residents and interns were satisfied of the teaching point of the morning reports. The only fail back observed was professionalism and pathophysiological discussions that require to be added to the sessions, whereas clinical management, teaching points, leadership and time management were completely satisfactory.

Tailoring Morning Reports to an Internal Medicine Residency in Qatar

BACKGROUND

Morning report, a case-based conference that allows learners and teachers to interact and discuss patient care, is a standard educational feature of internal residency programs, as well as some other specialties.

OBJECTIVE

Our intervention was aimed at enhancing the format for morning report in our internal medicine residency program in Doha, Qatar.

INTERVENTION

In July 2011, we performed a needs assessment of the 115 residents in our internal medicine residency program, using a questionnaire. Resident input was analyzed and prioritized using the percentage of residents who agreed with a given recommendation for improving morning report. We translated the input into interventions that enhanced the format and content, and improved environmental factors surrounding morning report. We resurveyed residents using the questionnaire that was used for the needs assessment.

RESULTS

Key changes to the format for morning report included improving organization, adding variety to the content, enhancing case selection and the quality of presentations, and introducing patient safety and quality improvement topics into discussions. This led to a morning report format that is resident-driven, and resident-led, and that produces resident-focused learning and quality improvement activities.

CONCLUSIONS

Our revised morning report format is a dynamic tool, and we will continue to tailor and modify it on an ongoing basis in response to participant feedback. We recommend a process of assessing and reassessing morning report for other programs that want to enhance resident interest and participation in clinical and safety-focused discussions.

A bitter pill: attempting change in a pediatric morning report

OBJECTIVE

To assess and address participants' dissatisfaction with departmental morning report (MR).

METHODS

Three consecutive MR sessions were observed, and those data, in combination with findings from the literature, were used to guide creation of a quantitative survey. The survey was administered to all faculty and housestaff. Survey items addressed the educational focus, leadership, and format of MR and the value of specific educational conferences. Subsequently, 2 interventions were developed to increase participants' level of satisfaction with MR. The interventions' effect was measured 1 year later using a second survey.

RESULTS

Eighty-two percent of housestaff and 43% of faculty responded to the first survey. Our findings are contrary to those in the literature. For example, respondents rated the presence of all faculty at MR as desirable, and both subspecialty and general pediatric contributions were considered important. Housestaff assigned greater educational value to all teaching conferences than did faculty. Similarly, housestaff believed more strongly than faculty that MR leadership should be changed. A follow-up survey demonstrated a decrease in mean perceived value of MR after our interventions.

CONCLUSIONS

Despite aggressive research, we failed to identify the source of participants' dissatisfaction. Although our interventions were based on research data and reflected participants' perceptions and concerns related to MR, they were not supported by the faculty. This demonstrates the inherent difficulties in changing an "institution" such as MR. Thus, examination of MR goals and satisfaction by individual training programs should be conducted within the confines of the conference's preexisting structure, without attempt to apply literature-driven expectations.

Gender differences in the ability to identify a mentor at morning report: a multi-institutional survey

BACKGROUND

Prior studies have shown that mentors are very important for career development of physicians, and that many female physicians have not had a mentor during their training. However, little is known about the availability of mentors for residents.

PURPOSE

To identify resident and program characteristics that were associated with the ability to identify a potential mentor at resident morning report.

METHOD

We performed a cross-sectional survey of 356 internal medicine residents at a convenience sample of 13 residency programs. The instrument included questions about demographic characteristics, subspecialty fellowship plans, and ability to identify a potential mentor at morning report during the previous 6 months.

RESULTS

Seventy-three percent were able to identify a potential mentor at morning report within the previous 6 months (63% of women vs. 79% of men). Among residents planning on entering general internal medicine, women were less likely than men to be able to identify a potential mentor (55% vs. 77%). The likelihood of identifying a mentor varied between the different programs, with a range from 27% to 89%.

CONCLUSION

Many residents could identify a potential mentor at morning report, although there was a wide variability between programs. Female residents who were going into general internal medicine were less likely than their male colleagues to find a potential mentor. Medical educators should ensure that all residents have exposure to potential generalist mentors.