The State of Morning Report in the Current Healthcare Landscape: a National Survey of Internal Medicine Program Directors

Abstract

Background Case-based Morning Report (MR) has long been the predominant educational conference in Internal Medicine (IM) residency programs. The last comprehensive survey of IM MR was in 1986. Much has changed in the healthcare landscape since 1986 that may impact MR. Objective We sought to determine the current state of MR across all US IM programs. Design In 2018, US IM program directors (PDs) were surveyed about the dynamics of MR at their institutions, perceived pressures, and realized changes. Key Results The response rate was 70.2% (275/392). MR remains highly prevalent (97.5% of programs), although held less frequently (mean 3.9 days/week, SD 1.2), for less time (mean 49.4 min, SD 12.3), and often later in the day compared to 1986. MR attendees have changed, with more diversity of learners but less presence of educational leaders. PD presence at MR is associated with increased resident attendance (high attendance: 78% vs 61%, p=0.0062) and punctuality (strongly agree/agree: 59% vs 43%, p=0.0161). The most cited goal for MR is utilizing cases to practice clinical reasoning. Nearly 40% of PDs feel pressure to move or cancel MR; of those, 61.2% have done so, most commonly changing the timing (48.5%), reducing the length (18.4%), and reducing the number of sessions per week (11.7%). Compared to community-based and to community-based, university-affiliated programs, university-based programs have 2.9 times greater odds (95% CI: 1.3, 6.9; p = 0.0081) and 2.5 times greater odds (95% CI 1.5, 4.4; p =0.0007), respectively, of holding MR after 9 AM, and 1.8 times greater odds (95% CI: 0.8, 4.2; p = 0.1367) and 2.0 times greater odds (95% CI: 1.2, 3.5; p = 0.0117), respectively, of reporting pressure to cancel or move MR compared to their counterparts. Conclusions While MR ubiquity reflects its continued perceived value, PDs have modified MR to accommodate changes in the healthcare environment. This includes reduced frequency, shorter length, and moving conferences later in the day. Additional studies are needed to understand how these changes impact learning. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07010-1.

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

“…A recent national survey of internal medicine program directors reported that the most common goals of morning report were to develop clinical reasoning and resident knowledge acquisition 5 . Our results suggest that scripted and unscripted formats have complementary strengths.…”

A Multicenter Observational Study Comparing Virtual with In-Person Morning Reports during the COVID-19 Pandemic

“…This may in turn alter approaches to case-based presentations to reflect the learning priorities and teaching methods preferred by residents 7,15 . Our results indicate an important change in the number of slides used to present content in the virtual setting, which may affect case sequencing and opportunities for clinical reasoning and problem solving valued by program leaders in this setting 22 …”

“…7,15 Our results indicate an important change in the number of slides used to present content in the virtual setting, which may affect case sequencing and opportunities for clinical reasoning and problem solving valued by program leaders in this setting. 22 Morning report extends beyond clinical teaching, prioritizing connections between faculty and learners, and is a forum for dialog about experiences in specific clinical settings. Although care delivery pressures have decreased its frequency and duration, 22 morning report continues to be a cornerstone of academic internal medicine, prioritizing exchanges between trainees and faculty.…”

“…Morning report extends beyond clinical teaching, prioritizing connections between faculty and learners, and is a forum for dialog about experiences in specific clinical settings. Although care delivery pressures have decreased its frequency and duration, 22 morning report continues to be a cornerstone of academic internal medicine, prioritizing exchanges between trainees and faculty. Virtual formats may attenuate social connection, 7 and with it, learner and faculty engagement.…”

Responsibilities of Internal Medicine Chief Residents in the Modern Era: A National Survey

“…Educational and administrative duties remain core features of the position ( 4 ). CRs continue to facilitate conferences such as Morning Report and are increasingly involved in other educational activities such as simulation teaching ( 5 ). Similarly, administrative duties such as resident scheduling and food delivery remain common.…”