An analysis of morning report: implications for internal medicine education.

OBJECTIVE

To compare the initial diagnosis of cases presented at morning report with the final morning report diagnosis reached at discharge from the Medicine service and the diagnosis as evaluated 6 months after discharge.

DESIGN

Prospective cohort study of morning report cases.

SETTING

A university internal medicine residency program.

MEASUREMENTS

Proportion of morning report cases in which the initial morning report diagnosis differed from the final morning report diagnosis at discharge or, in cases where a firm diagnosis was not reached at discharge, the proportion for which a diagnosis was established by 6 months after discharge.

MAIN RESULTS

In 24% of cases, a firm morning report diagnosis was not available at discharge. For 61% of these, a diagnosis could be established by 6-month follow-up: for 36% the diagnosis differed from the final morning report diagnosis; and for 25% it was the same. Among cases where a firm final diagnosis was reached during morning report, the initial morning report diagnosis differed for 17%.

CONCLUSIONS

Most patients discharged without a firm diagnosis have one established by 6 months later--often with surprising results. Postdischarge follow-up information could enhance the educational value of inpatient cases.