Outpatient morning
report
 ALIREZA
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RAJAEI MD
ASSOCIATE PROFESSOR
INTERNIST , RHEUMATOLOGIST
LOGHMAN HOSPITAL
MEDICAL FACULTY EDO
SHAHID BEHSHTI MEDICAL SICENCE
UNIVERSITY
1.Definition
2.Purposes
3.Format
4.Conclusion
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Discussion about patients coming
to clinic
(1 day or more)
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1.Monitoring patient care
2.Reviewing management decisions
3.Reviewing outcomes
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Current purposes of
morning report
1.Case-oriented teaching session
2.Sharpen medical decision-making skills
3.Self-directed learning
4.Timely feedback/review management skills
5.Role-modeling
6.Socialization
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Ambulatory Morning Report
Can It Prepare Residents for the American Board of
Internal Medicine Examination?
We assessed the ability of a novel ambulatory morning report format to
expose internal medicine residents to the breadth of topics covered by the
American Board of Internal Medicine (ABIM) exam. Cases were
selected by the Ambulatory Assistant Chief Residents and recorded in a
logbook to limit duplication. We conducted a retrospective review of 406
cases discussed from July 1998 to July 2000 and cataloged each
according to the primary content area. The percentage of cases in each
area accurately reflected that covered by the ABIM exam, with little
redundancy or over-selection of esoteric diseases. Our data suggest that a
general medicine clinic is capable of exposing house staff to the wide
breadth of internal medicine topics previously thought to be unique to
subspecialty clinics.
Ambulatory Morning Report:
An Underutilized Educational Modality
The survey results from those residents exposed to
both teaching formats over 2 years revealed a high
degree of satisfaction with the ambulatory
morning report format. When comparing the longterm educational value, 94% of the residents
found the morning report format more effective
than the lecture-based preclinic conference. In
addition, many desirable characteristics of the
morning report also were defined.
Bethesda , Meryland, USA
Of the 583 Morning Reports
conferences during
the study period, 331 (57%)
focused on inpatient
cases and 252 (43%) focused
on outpatient cases
*.Size
*.Place
*.Time
*.Frequency
*.Number of cases
*.Protocol for presentation
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Attends, residents
Interns, student
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70% before
9:15 AM
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½-1 days/week
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Ambulatory Morning Report:
An Underutilized Educational Modality
Forty-three of 44 interns completed both pre- and
postambulatory block testing. The mean score on
these tests improved from 67% to 81%. Although
this overall improvement achieved statistical
significance, test question subgroup analysis
clearly indicated that the improved knowledge in
test items relating to our preclinic conference
topics contributed negligibly to the overall
statistical improvement
1-2 cases
Selected by chief
resident or
attend
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Determinants of Case
Selection at Morning Report
OBJECTIVE: To determine why residents present certain cases and not others at morning
report (MR) in an institution that permits residents the free choice of cases.
DESIGN/PARTICIPANTS: Prospective survey of 10 second- and third-year residents assigned
to the medical service.
SETTING: A 241-bed teaching hospital with 55 categorical internal medicine residents.
MEASUREMENTS AND MAIN RESULTS: Over a 4-week period, there were 194 admissions
to the medical service on 18 call days preceding MR. Of these admissions, 30 (15%) were
presented at MR. Cases were more likely to be presented if they were considered unusual or
rare in presentation or incidence ( p= .001), involved significant management issues ( p=
.001), or were associated with remarkable imaging studies or other visual material ( p=
.006). Residents were more likely to present cases in which they disagreed with attending
physicians on management plans ( p= .005). Overall, residents rated few admissions as
having notable physical examination findings (29/194) or ethical or cost issues (6/194). Of
the seven most common admitting diagnoses, representing 44% of admissions, residents did
not present cases involving four of these diagnoses.
CONCLUSIONS: Residents presented cases at MR that they felt were unique or rare in
presentation or incidence for purposes of discussing management issues. Complete resident
freedom in choosing MR cases may narrow the scope of MR and exclude common diagnoses
and other issues of import such as medical ethics or economics
Brief history, physical exam,
lab. tests, approach
during 5-10 min.
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*.Chief resident
*.Senior attend
*.head of dep.
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In morning report
process
rather than
content
should be taught
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Diagnosis process
1.History taking
2.Physical examination
3.Differential diagnosis
4.Paraclinic selection
5.Differential diagnosis adjustment
6.Diagnostic procedure
7.
Diagnosis
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Use of the “Educational Prescription”:
( Richardson & Smith)
1.Question
2.Search
3.Answer
4.Critical appraisal
5.Use(apply)
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Evidence
based
morning
report
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THE END
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