morning report

[ckent]

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How do you guys like your morning report? I like learning about new stuff in morning report, but mine could definitely be improved. They keep presenting new patients that were admitted by the night float the previous night and having us generate a differential. That's not as useful as presenting an older patient who has already gone through the appropriate w/u because then, at least there is some satisfaction at the end of the presentation and guess work in that you know who was right, and what was plausible. I feel like a lot of the differential that people at my school shout out isn't even all that plausible but it's put on the differential anyways (like TB and syphillis for everything), but maybe that's just because the patients that are being presented don't present with textbook symptoms. That's another reason that I think that it'd be nice to have definitive answers at the end. They always ask the admitting team to give us follow up, but they rarely do. Does anybody else have the same problem with morning report? I think that's going to be one of the things that I look at carefully when I interview.

 

[sanfilippo]

YEs, I have encountered differences in morning report structure as well. During my M3 medicine rotation at a university hospital, the case(s) presented at morning report were selected for didactic purposes (not cases that presented overnight to the team on call). It was preceded by 1-3 MSKAP-like questions related to the specialty involved (oncology case, ID case). The resident would present the case briefly. THe audience would ask questions to elicit further information and then generate a d/dx. AN attending in that specialty would be present to ask questions as well. Then the dx would be revealed and the attending would discuss the dx and management and see how that correlates with what actually happened while the patient was in house. Then a journal article is given at the end for other residents to read.

At a community hospital where I did my sub-i, morning report is where the team on call has to be ready to present any of the patients that were admitted as chosen by the presiding IM attending. A D/Dx is discussed as well as abnl labs, radiology findings, etc. Then mgt is discussed. More pragmatic that didactic and not that great for neophyte residents.

I agree that the structure and content of a place's morning report, grand rounds, noon conferences, MandM, etc. may become more influential in selecting an IM program than I had originally thought. I definitely want to know how much time attendings spend actually TEACHING.

-S.

 

[SHOX]

At Christiana Care (a community academic program, formerly the Medical Center of Delaware) where I did residency, we initially used to just present cases from the night/day before.

We then switched to splitting morning report to half cases from the night before (2-3 interesting cases) which was good in that we developed differentials and focused on workup/management issues. The other half of morning report was a prepared interesting case (which everyone had to do a couple of times a year). Many of the cases presented were awesome, stuff you may never see again except on your board exams; people did a really good job putting together a handout of pearls for each case which was put together in a book format and handed out to everyone toward the end of the year. People brought xrays, pictures, CT/MRIs, Echos, specialists and on rare occasion the patient. Our MR is run by the chief res. and there are always one or 2 academic faculty members to help stimulate discussion.

We also have a teaching resident and a medical librarian who attend MR to help do literature searches on clinical questions that come up in MR. The teachin resident then presnts his/her findings the next day based on the literature and pulled the relevant articles (that's EBM for you!). Overall it was a great experience.

SH