Internal Medicine Residents’ Perceptions of Morning Report: a Multicenter Survey

Abstract

BACKGROUND: Residents rate morning report (MR) as an essential educational activity. Little contemporary evidence exists to guide medical educators on the optimal content or most effective delivery strategies, particularly in the era of resident duty-hour limitations and shifts towards learnercentric pedagogy in graduate medical education. OBJECTIVE: Assess resident views about MR content and teaching strategies. DESIGN: Anonymous, online survey. PARTICIPANTS: Internal medicine residents from 10 VAaffiliated residency programs. MAIN MEASURES:The 20-item survey included questions on demographics; frequency and reason for attending; opinions on who should attend, who should teach, and how to prioritize the teaching; and respondents' comfort level with participating in MR. The survey included a combination of Likert-style and multiple-choice questions with the option for multiple responses. KEY RESULTS: A total of 497 residents (46%) completed the survey, with a balanced sample of R1s (33%), R2s (35%), and R3s (31%). Self-reported MR attendance was high (31% always attend; 39% attend > 50% of the time), with clinical duties being the primary barrier to attendance (85%). Most respondents felt that medical students (89%), R1 (96%), and R2/R3s (96%) should attend MR; there was less consensus regarding including attendings (61%) or fellows (34%). Top-rated educational topics included demonstration of clinical reasoning (82%), evidence-based medicine (77%), and disease pathophysiology (53%). Respondents valued time spent on diagnostic work-up (94%), management (93%), and differential building (90%). Overall, 82% endorsed feeling comfortable speaking; fewer R1s reported comfort (76%) compared with R2s (87%) or R3s (83%, p = 0.018). Most (81%) endorsed that MR was an inclusive learning environment (81%), with no differences by level of training. CONCLUSIONS: MR remains a highly regarded, wellattended educational conference. Residents value highquality cases that emphasize clinical reasoning, diagnosis, and management. A supportive, engaging learning environment with expert input and concise, evidencebased teaching is desired.

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“…Literature reports have suggested that learners in the medical field have been satisfied with online learning, 3,4 and the findings of the current study support this. Most survey respondents stated that they would recommend this rotation to someone else and would participate again if given the chance.…”

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“…Our results have relevance for medical educators in several ways. First, our observations of attending participation in morning report align with resident expectations: in a 2021 survey of internal medicine residents, Albert et al found that residents preferred practical clinical teaching at morning report and that the top three teaching domains desired by residents were differential diagnosis, diagnostic work-up, and management [ 13 ]. These were found to be the three most prevalent categories of attending teaching comments in our study.…”

“…Two recent surveys have helped delineate resident and program director expectations. A 2021 survey of residents at ten internal medicine programs concluded that the duration and content of attending commentary influences residents’ perceptions of morning report quality but found that only 61% of residents desired faculty attendance [ 13 ]. Similarly, a 2022 survey of internal medicine program directors found contrasting opinions on how often attending physicians should make comments during morning report, with some praising frequent teaching by faculty and others striving to maximize resident-driven education with less faculty commentary [ 14 ].…”

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“…In their study, Heppe et al investigated the format and content of internal medicine morning reports in the US and found that the morning report predominantly consists of case-based presentations [ 12 ]. However, they argue that learning outcomes could be improved by implementing principles from adult learning theory, e.g., co-learning [ 8 ].…”