Outpatient morning report  ALIREZA RAJAEI MD  ASSOCIATE PROFESSOR  INTERNIST, RHEUMATOLOGIST  LOGHMAN HOSPITAL  MEDICAL FACULTY EDO  SHAHID BEHSHTI MEDICAL SICENCE UNIVERSITY

1.Definition 2.Purposes 3.Format 4.Conclusion A.R.RAJAEI

Discussion about patients coming to clinic (1 day or more) A.R.RAJAEI

1.Monitoring patient care 2.Reviewing management decisions 3.Reviewing outcomes A.R.RAJAEI

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 A.R.RAJAEI

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 Can It Prepare Residents for the American Board of Internal Medicine Examination?

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 long- term 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.

Of the 583 Morning Reports conferences during the study period, 331 (57%) focused on inpatient cases and 252 (43%) focused on outpatient cases Bethesda, Meryland, USA

*.Size *.Place *.Time *.Frequency *.Number of cases *.Protocol for presentation A.R.RAJAEI

Attends, residents Interns, student A.R.RAJAEI

70% before 9:15 AM A.R.RAJAEI

½ -1 days/week A.R.RAJAEI

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 A.R.RAJAEI

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 Determinants of Case Selection at Morning Report

Brief history, physical exam, lab. tests, approach during 5-10 min. A.R.RAJAEI

*.Chief resident *.Senior attend *.head of dep. A.R. RAJAEI

In morning report process rather than content should be taught A.R.RAJAEI

Diagnosis process 1.History taking 2.Physical examination 3.Differential diagnosis 4.Paraclinic selection 5.Differential diagnosis adjustment 6.Diagnostic procedure 7. Diagnosis A.R.RAJAEI

Use of the “Educational Prescription”: ( Richardson & Smith) 1.Question 2.Search 3.Answer 4.Critical appraisal 5.Use(apply) A.R.RAJAEI

Evidence based morning report

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THE END A.R.RAJAEI