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An Analysis of Morning Report: Implications for Internal Medicine Education
- Neil S. Wenger, MD, MPH; and
- Robert B. Shpiner, MD
- From the University of California, Los Angeles. Requests for Reprints: Neil S. Wenger, MD, UCLA Department of Medicine, Division of General Internal Medicine and Health Services Research, Center for the Health Sciences, B-564 Factor Building, Los Angeles, CA 90024-1736. Acknowledgments: The authors thank Neil Parker, MD, Roy T. Young, MD, and Stella Schloss, BSN, for assistance and advice; Thoa Nguyen and Kathy Oka for technical assistance; and Martin F. Shapiro, MD, PhD, for advice on the manuscript.
Abstract
Objective: To compare the initial diagnosis of cases presented at morning report with the final morning report diagnosis reached at discharge from the Medicine service and the diagnosis as evaluated 6 months after discharge.
Design: Prospective cohort study of morning report cases.
Setting: A university internal medicine residency program.
Measurements: Proportion of morning report cases in which the initial morning report diagnosis differed from the final morning report diagnosis at discharge or, in cases where a firm diagnosis was not reached at discharge, the proportion for which a diagnosis was established by 6 months after discharge.
Main Results: In 24% of cases, a firm morning report diagnosis was not available at discharge. For 61% of these, a diagnosis could be established by 6-month follow-up: for 36% the diagnosis differed from the final morning report diagnosis; and for 25% it was the same. Among cases where a firm final diagnosis was reached during morning report, the initial morning report diagnosis differed for 17%.
Conclusions: Most patients discharged without a firm diagnosis have one established by 6 months lateroften with surprising results. Postdischarge follow-up information could enhance the educational value of inpatient cases.
- Copyright 2004 by the American College of Physicians
