Morning Report in Military Family Medicine Residencies

Military Medicine, Aug 2008 by Drifmeyer, Erin, Oh, Robert

ABSTRACT Morning report is a standard component of residency training; however, little is written about this conference in family medicine. We emailed a survey to all 17 military family medicine residency directors. Descriptive statistics were used to calculate means and SDs. Twelve of 17 programs responded. All conducted morning report and all agreed that the main purpose of morning report is education. Its educational value ranked highly (mean, 4.2; SD = 0.78; with 1 = minimal educational value and 5 = very important educational value). Programs reported morning report being held four to five times a week (66%) for 30 minutes (92%) and using preprepared cases (75%) half the time or more. Most (75%) reported having no written goals and objectives; 77% did not track educational outcomes. Although military residencies appear to regard morning report as an important educational venue, most do not have goals or objectives nor formally evaluate effectiveness.

INTRODUCTION

"Morning report" is a time-honored tradition in medicine. Despite its widespread inclusion in residency training programs, few studies evaluating the value of morning report or even systematic descriptions of this seminar exist in family medicine. One systematic review by Amin et al.1 examined the purposes, organization, instructional methods, and outcome of morning report; however, the majority of the studies reviewed were from internal medicine programs.

Amin's review1 found that the primary purpose of morning report is the education of residents. Other purposes of morning report include evaluation of residents, detection of adverse events, addressing administrative issues, and socialization.1 The organization, structure, participation, leadership, tone, record keeping, and follow-up of morning report varied greatly across internal medicine programs. Most programs had a similar frequency and duration of morning report, with most sessions consisting of a case-based presentation followed by a discussion. Variations included presentation of overnight admissions rather than preplanned cases. Individual programs have also adopted features to meet their specific needs. Evaluating costs of care, developing clinical decision making, and teaching evidence-based medicine have been identified as goals by various programs2-6 Only five studies examined educational outcomes of morning report.1 These studies examined methods to maintain interest and improve information retention. The implementation of specific interventions, such as presenting relevant literature articles, administering quizzes, and using radiological images resulted in reporting of positive changes.

Little is known about the perceived purpose, organization, tone, educational methods, and outcomes analysis of morning report in family medicine. This is a descriptive study of morning report in a sample of military family medicine residencies.

METHODS

Study Population

All military family medicine residency directors were asked to complete an online survey. Contact information was gathered from freely available World Wide Web-based resources found through the American Academy of Family Practice and Uniformed Services Academy of Family Physicians. This research was approved by the Institutional Review Board at Tripler Army Medical Center. Military residencies surveyed are located across the country, including geographically and socially diverse locations such as Hawaii, Texas, Georgia, Washington state, and the National Capital Area. Programs had between 5 and 10 residents per year group, with 6 being the most common class size.

Survey Instrument

Using input from three family medicine faculty members, we constructed an 18- item questionnaire focusing on organization, purposes, instructional methods, and outcomes. The survey included a multiple choice, 5-point Likert scale, and open-ended questions. It was administered to residents and staff at the researcher's residency to establish internal consistency and face validity.

Procedures

All military family medicine residency directors were emailed a letter describing the survey. If interested in completing the survey, they were asked to use a hyperlink which took them to the World Wide Web-based survey. Respondents were given the option of anonymity. Reminder emails were sent 2 and 4 weeks after the initial email.

Data Collection and Analysis

Results were tabulated by the World Wide Web-based survey site. We used descriptive statistics to calculate frequencies, means, and SDs.

RESULTS

Demographics

Twelve (71%) of 17 military programs completed the survey, all of which conducted a morning report. The sites included seven Army, three Navy, and two Air Force family medicine residencies.

Purpose of Morning Report

Table I summarizes the responses regarding the main purpose of morning report. Education and evaluation of residents were the top-reported purposes of morning report. Discussion of adverse events, administrative issues, and costs associated with care were rarely reported. However, a majority of programs reported discussing military-specific issues and evaluating quality of care half the time or more (Table II).