From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
South Med J. 2022 Jul;115(7):400-403. doi: 10.14423/SMJ.0000000000001411.
Morning report is one of the central activities of internal medicine residency education. The two most common morning report formats are scripted reports, which use preselected cases with prepared didactics, and unscripted reports in which a case is discussed without preparation. No previous study has compared these two formats.
We conducted a prospective observational study of morning report conducted at 10 academic medical centers across the United States.
A total of 198 case-based morning reports were observed. Of these, 169 (85%) were scripted and 29 (15%) were unscripted. Scripted reports were more likely to present a case with a known final diagnosis (89% vs 76%, 0.04), use electronic slides (76% vs 52%, 0.01), involve more than 15 slides (55% vs 3%, < 0.001), and reference the medical literature (61% vs 34%, 0.02), including professional guidelines (32% vs 10%, 0.02) and original research (25% vs 0%, 0.001). Scripted reports also consumed more time in prepared didactics (8.0 vs 0 minutes, < 0.001). Unscripted reports consumed more time in case history (10.0 vs 7.0 minutes, < 0.001), physical examination (3.0 vs 2.0 minutes, 0.06), and differential diagnosis (10.0 vs 7.0 minutes, 0.01).
Most contemporary morning reports are scripted. Compared with traditional unscripted reports, scripted reports are more likely to involve a case with a known diagnosis, use extensive electronic presentation slides, and consume more time in didactics, while unscripted reports consume more time in the early diagnostic process, including history, physical examination, and differential diagnosis. Residency programs interested in emphasizing these aspects of medical education should encourage unscripted morning reports.
晨交班是内科住院医师培训的核心活动之一。两种最常见的晨交班形式是脚本报告，使用预先选择的病例和准备好的教学内容；以及无脚本报告，其中病例在没有准备的情况下进行讨论。以前没有研究比较过这两种形式。
我们在美国 10 个学术医疗中心进行了一项前瞻性观察性研究，以比较这两种晨交班形式。
共观察了 198 次基于病例的晨交班。其中，169 次（85%）为脚本报告，29 次（15%）为无脚本报告。脚本报告更有可能呈现一个已知最终诊断的病例（89%比 76%，0.04），使用电子幻灯片（76%比 52%，0.01），涉及超过 15 张幻灯片（55%比 3%，<0.001），并参考医学文献（61%比 34%，0.02），包括专业指南（32%比 10%，0.02）和原始研究（25%比 0%，0.001）。脚本报告在准备教学内容方面也花费了更多时间（8.0 分钟比 0 分钟，<0.001）。无脚本报告在病史（10.0 分钟比 7.0 分钟，<0.001）、体检（3.0 分钟比 2.0 分钟，0.06）和鉴别诊断（10.0 分钟比 7.0 分钟，0.01）方面花费了更多时间。
大多数当代晨交班是脚本报告。与传统的无脚本报告相比，脚本报告更有可能涉及一个已知诊断的病例，使用广泛的电子演示幻灯片，并在教学内容方面花费更多时间，而无脚本报告则在早期诊断过程中花费更多时间，包括病史、体检和鉴别诊断。对强调医学教育这些方面感兴趣的住院医师培训项目应该鼓励进行无脚本的晨交班。
