The Morning Report

The morning report held every morning before 9.00 AM in our department of psychiatry is usually a pleasant and informative gathering of residents, faculty and medical students. To my opinion the important purpose of the morning report is mostly education but since recent also evaluating residents, discussing calamities and social interaction. The morning report is the social event for both residents and faculty. It’s also the only time during the day most of the physicians are present in one room and daily tasks or changes in the daily schedule can be tackled.

Morning report is scheduled every morning of a working day. The residents suggested that we should increase the educational purpose of our morning report. After some searching I found a review on the morning report. My purpose is not to increase knowledge as such but to improve their problem-solving and data-gathering skills without loosing the social interaction. From the literature an appealing suggestion is the four phase morning report to improve the educational purpose. These four phases consist of the discussion of an assigned question from the previous day. The report of the search result for the question from the day before should be done by using a standardized format. It emphasizes the precise question, brief answers, the scientific quality of the evidence found and the relevance to the management of the patient. Very evidence based much like the PICO model.

The next phase consists of the report of the new admissions from the previous 24 hours. In this example it’s done by the chief resident who poses questions about the admitted patients. In our morning report the resident on call the previous 24 hours presents the patients admitted during non office hours and the resident during office hours present the other admitted patients.

The third phase is the discussion of two or three patients in a collegial professional ambiance. The fourth phase is devoted to formulating new questions from the discussed patients or any other subject of interest appearing during the previous discussions.

This format is developed in Internal medicine and is scheduled for an hour while we’ve got 30 minutes at the most. I think it’s also applicable to psychiatry but I’m not sure. Another topic is it’s educational effectiveness. Reports are mostly anecdotal and not very evidence based

Research is needed to document the educational and clinical effectiveness of morning report and to assess the relative merits of various ways of conducting morning report such that evidence and tradition can go hand in hand.

Any suggestions or links for a educational format of the morning report in psychiatry are welcome in the comments, thanks.
Reilly B, & Lemon M (1997). Evidence-based morning report: a popular new format in a large teaching hospital. The American journal of medicine, 103 (5), 419-26 PMID: 9375711
Amin Z, Guajardo J, Wisniewski W, Bordage G, Tekian A, & Niederman LG (2000). Morning report: focus and methods over the past three decades. Academic medicine : journal of the Association of American Medical Colleges, 75 (10 Suppl) PMID: 11031158