VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA.
Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
BMC Med Educ. 2023 Feb 2;23(1):84. doi: 10.1186/s12909-023-04057-y.
Morning report is a core educational activity in internal medicine resident education. Attending physicians regularly participate in morning report and influence the learning environment, though no previous study has described the contribution of attending physicians to this conference. This study aims to describe attending comments at internal medicine morning reports.
We conducted a prospective, observational study of morning reports conducted at 13 internal medicine residency programs between September 1, 2020, and March 30, 2021. Each attending comment was described including its duration, whether the comment was teaching or non-teaching, teaching topic, and field of practice of the commenter. We also recorded morning report-related variables including number of learners, report format, program director participation, and whether report was scripted (facilitator has advance knowledge of the case). A regression model was developed to describe variables associated with the number of attending comments per report.
There were 2,344 attending comments during 250 conferences. The median number of attendings present was 3 (IQR, 2-5). The number of comments per report ranged across different sites from 3.9 to 16.8 with a mean of 9.4 comments/report (SD, 7.4). 66% of comments were shorter than one minute in duration and 73% were categorized as teaching by observers. The most common subjects of teaching comments were differential diagnosis, management, and testing. Report duration, number of general internists, unscripted reports, and in-person format were associated with significantly increased number of attending comments.
Attending comments in morning report were generally brief, focused on clinical teaching, and covered a wide range of topics. There were substantial differences between programs in terms of the number of comments and their duration which likely affects the local learning environment. Morning report stakeholders that are interested in increasing attending involvement in morning report should consider employing in-person and unscripted reports. Additional studies are needed to explore best practice models of attending participation in morning report.
晨交班是内科住院医师教育的核心教学活动。主治医生定期参加晨交班，并影响学习环境，但以前没有研究描述主治医生对该会议的贡献。本研究旨在描述内科晨交班中主治医生的发言。
我们对 2020 年 9 月 1 日至 2021 年 3 月 30 日期间 13 个内科住院医师培训计划进行了前瞻性、观察性研究。描述了每位主治医生的发言，包括发言时长、发言是否具有教学意义、教学主题以及发言者的执业领域。我们还记录了与晨交班相关的变量，包括学习者人数、报告形式、主任参与情况以及报告是否有脚本（主持人事先了解病例）。我们建立了一个回归模型，以描述与每个报告中主治医生发言数量相关的变量。
在 250 次会议期间，共有 2344 条主治医生的发言。中位数的主治医生出席人数为 3 人（IQR，2-5）。报告中每条发言的数量因地点而异，范围从 3.9 到 16.8，平均每条报告有 9.4 条发言（SD，7.4）。66%的发言时长不到一分钟，73%的发言被观察者归类为教学。教学发言最常见的主题是鉴别诊断、管理和检验。报告时长、普通内科医生人数、无脚本报告和现场报告形式与主治医生发言数量的显著增加相关。
晨交班中的主治医生发言通常简短，重点是临床教学，涵盖了广泛的主题。不同计划在发言数量和时长方面存在很大差异，这可能会影响当地的学习环境。有兴趣增加主治医生在晨交班中参与度的晨交班利益相关者应考虑采用现场和无脚本报告。需要进一步研究以探索主治医生参与晨交班的最佳实践模式。
