What internal medicine attendings talk about at morning report: a multicenter study

Authors

Jeffrey W. Redinger, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA. Jeffrey.Redinger@va.gov.
Daniel B. Heppe, VA Eastern Colorado Health Care System, Aurora, CO, USA.
Tyler J. Albert, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA.
Paul B. Cornia, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA.
Kirsha S. Gordon, VA Connecticut Health Care System, West Haven, CT, USA.
Cherinne Arundel, Washington, DC VA Medical Center, Washington, DC, USA.
Joel M. Bradley, White River Junction VA Medical Center, White River Junction, VT, USA.
Laura M. Caputo, Durham VA Health Care System, Durham, NC, USA.
Jonathan W. Chun, VA Palo Alto Health Care System, Palo Alto, CA, USA.
Jessica E. Cyr, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Erik T. Ehlers, Omaha VA Medical Center, Omaha, NE, USA.
Michelle M. Guidry, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA.
Anand D. Jagannath, VA Portland Health Care System, Portland, OR, USA.
Brian K. Kwan, San Diego VA Medical Center, San Diego, CA, USA.
James D. Laudate, White River Junction VA Medical Center, White River Junction, VT, USA.
Christine A. Mitchell, Omaha VA Medical Center, Omaha, NE, USA.
Andrea C. Smeraglio, VA Portland Health Care System, Portland, OR, USA.
Joseph R. Sweigart, Lexington VA Health Care System, Lexington, KY, USA.
Matthew G. Tuck, Washington, DC VA Medical Center, Washington, DC, USA.
Craig G. Gunderson, VA Connecticut Health Care System, West Haven, CT, USA.

Document Type

Journal Article

Publication Date

2-2-2023

Journal

BMC medical education

Volume

23

Issue

1

DOI

10.1186/s12909-023-04057-y

Keywords

Graduate medical education; Internal medicine residency; Medical education; Morning report

Abstract

BACKGROUND: Morning report is a core educational activity in internal medicine resident education. Attending physicians regularly participate in morning report and influence the learning environment, though no previous study has described the contribution of attending physicians to this conference. This study aims to describe attending comments at internal medicine morning reports. METHODS: We conducted a prospective, observational study of morning reports conducted at 13 internal medicine residency programs between September 1, 2020, and March 30, 2021. Each attending comment was described including its duration, whether the comment was teaching or non-teaching, teaching topic, and field of practice of the commenter. We also recorded morning report-related variables including number of learners, report format, program director participation, and whether report was scripted (facilitator has advance knowledge of the case). A regression model was developed to describe variables associated with the number of attending comments per report. RESULTS: There were 2,344 attending comments during 250 conferences. The median number of attendings present was 3 (IQR, 2-5). The number of comments per report ranged across different sites from 3.9 to 16.8 with a mean of 9.4 comments/report (SD, 7.4). 66% of comments were shorter than one minute in duration and 73% were categorized as teaching by observers. The most common subjects of teaching comments were differential diagnosis, management, and testing. Report duration, number of general internists, unscripted reports, and in-person format were associated with significantly increased number of attending comments. CONCLUSIONS: Attending comments in morning report were generally brief, focused on clinical teaching, and covered a wide range of topics. There were substantial differences between programs in terms of the number of comments and their duration which likely affects the local learning environment. Morning report stakeholders that are interested in increasing attending involvement in morning report should consider employing in-person and unscripted reports. Additional studies are needed to explore best practice models of attending participation in morning report.

Department

Medicine

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