A Comparative Study of Scripted versus Unscripted Morning Reports: Results from a Prospective Multicenter Study

Anand D. Jagannath, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
Brian Kwan, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
Daniel B. Heppe, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
Albertine S. Beard, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
Paul B. Cornia, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
Tyler Albert, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
Azadeh Lankarani-Fard, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
Joel M. Bradley, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
Michelle M. Guidry, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
Matthew Tuck, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
Kathlyn E. Fletcher, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
Craig G. Gunderson, From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.

Document Type

Journal Article

Publication Date

7-1-2022

Journal

Southern medical journal

Volume

115

Issue

7

DOI

10.14423/SMJ.0000000000001411

Abstract

OBJECTIVES: Morning report is one of the central activities of internal medicine residency education. The two most common morning report formats are scripted reports, which use preselected cases with prepared didactics, and unscripted reports in which a case is discussed without preparation. No previous study has compared these two formats. METHODS: We conducted a prospective observational study of morning report conducted at 10 academic medical centers across the United States. RESULTS: A total of 198 case-based morning reports were observed. Of these, 169 (85%) were scripted and 29 (15%) were unscripted. Scripted reports were more likely to present a case with a known final diagnosis (89% vs 76%, 0.04), use electronic slides (76% vs 52%, 0.01), involve more than 15 slides (55% vs 3%, < 0.001), and reference the medical literature (61% vs 34%, 0.02), including professional guidelines (32% vs 10%, 0.02) and original research (25% vs 0%, 0.001). Scripted reports also consumed more time in prepared didactics (8.0 vs 0 minutes, < 0.001). Unscripted reports consumed more time in case history (10.0 vs 7.0 minutes, < 0.001), physical examination (3.0 vs 2.0 minutes, 0.06), and differential diagnosis (10.0 vs 7.0 minutes, 0.01). CONCLUSIONS: Most contemporary morning reports are scripted. Compared with traditional unscripted reports, scripted reports are more likely to involve a case with a known diagnosis, use extensive electronic presentation slides, and consume more time in didactics, while unscripted reports consume more time in the early diagnostic process, including history, physical examination, and differential diagnosis. Residency programs interested in emphasizing these aspects of medical education should encourage unscripted morning reports.

Department

Medicine

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