1. Development of Resident Led Outpatient Morning Report As An Educational Model to Improve Resident Lectures
Hobart Lee, MD
Academic Fellow
Clinical Lecturer
Brian Bluhm
Chief Resident
Tom O’Neil
Chief Resident
Department of Family Medicine
University of Michigan

2. Goals & Objectives Literature Review Methods Results
Discussion & Conclusions

3. Literature Review …
“The [residency] program must possess a well-organized and effective curriculum, both academic and clinical” (ACGME RRC)
Primary focus on education, fewer cases better, proceed in stepwise fashion (Gross 1999)
Unusual or rare diagnoses, management issues, remarkable imaging studies (Ramratnam 1997)
Evaluation of resident performance and quality of clinical care (Parrino 1986)

4. … Literature Review
2 teams competing against each other (Huffman 2010)
FM: 4-5x/week for 30 minutes, pre-prepared cases, < 50% outpatient
75% have no goals & objectives
77% did not track educational outcomes (Drifmeyer, 2008)

5. Methods
Initial survey using surveymonkey regarding resident lecture conferences (no interns surveyed)
Two 30 minute cases presented each month
25 minute case presentation + 5 minute “expert” debrief
Varied response format
Repeat survey in 9 months

6. Rank diagnosis after each section
Clinical reasoning
Rank diagnosis after each section
Diagnosis
History
Physical
Labs/Rad
Final
arrhythmia 1   5 4 
 aortic stenosis 2   1
MI  3   2
 orthostatic hypotension
 medication reaction
autonomic insufficiency 

7. Results

8. Case Diagnoses Ovarian mass Pediatric pneumonia Post-strep arthritis
Acute lymphoblastic leukemia
CVA
Diabetes myositis
Grave’s disease
Hypersensitivity pneumonitis
Myopericarditis
Molluscum contagiosum
Neck cellulitis
Ovarian mass
Pediatric pneumonia
Post-strep arthritis
Secondary adrenocortical insufficiency
Serum sickness
Syncope
Trigeminal Neuralgia

9. Pre-survey 13/20 residents Post-survey 8/20 residents
Survey Results
Pre-survey 13/20 residents
Post-survey 8/20 residents

10. Year of Training

11. Percent of conferences attended

12. Lecture types
16 different types of resident lectures ranked by educational content:
#1 Case presentation conference (presented by attending)
#2 Morbidity & mortality conference
#3 Grand rounds (outside speakers) …
#14 Professional skills
#15 Resident wellness
#16 Ethics

13. Specialty cases
Out of 22 specialties, residents requested lectures on:
#1 Pediatrics
#2 Infectious disease
#3 Dermatology
#4 Cardiology …
#20 Hematology-Oncology
#21 Dentistry
#22 Anesthesia

14. Results
How would you rate the overall educational quality of Wednesday morning lectures?
(Likert scale 1-7)
4.2 vs. 5.8, p= 0.003
To what extent do you agree/disagree that a outpatient "morning report" case presentation would be (has been) a valuable addition to the conference schedule? (Likert scale 1-7)
6.5 vs. 6.1, p= 0.3

15. Number of cases to present in 1 hour

16. Length of “expert teaching”

17. Differential Diagnosis Discussion
50% as one big group
0% as two groups competing against each other
50% small groups (3-5 people)

18. Residents’ Comments “Case based lectures are the best”
“I like everyone shouting out different things and getting the whole differential on the board including ‘zebras’ so we can hear all of the different ideas rather than only the most likely.”
“I would like to see more practical lectures on topics encountered clinically and I think that the case presentations were a good step in that direction.”

19. Limitations: Limited residents response in surveys Recall bias
Self perceived educational benefit does not always equal education

20. Conclusion:
Based on resident perceptions, outpatient morning report could provide a preferred alternative model for conveying outpatient specific medical knowledge and enhance real time problem solving.

21. Acknowledgements Stephanie Kay, MD (Chief resident 2009-2010)
Tammy Chang, MD (Chief resident )
Brian Bluhm, MD (Chief resident )
Tom O’Neil, MD (Chief resident )
Department of Family Medicine, University of Michigan

22. Questions?