Background: Morning report (MR) is an integral part of residency training, with literature demonstrating the importance residents place on MR for the transfer of knowledge. However, little data exists into whether MRs cover core curricula, with data suggesting MRs often focus on uncommon diagnoses instead of common illnesses. This study aimed to compare morning report learning objectives (MRLOs) from resident-selected cases with the composition of American Board of Internal Medicine (ABIM) certification examination blueprint objectives.
Methods: MR slideshow presentations from the 2020-21 academic year were reviewed from one internal medicine (IM) residency at a single institution, the University of Chicago. MR cases are resident-selected and presented with a pre-determined faculty discussant; cases are often selected with the discussant’s specialty in mind. MRLOs were defined as the presentation’s “teaching points” from the title and final slides. MRLOs were abstracted and matched to the ABIM blueprint, which contains both IM content categories (e.g., hematology) and cross content categories (e.g., ethics). MRLOs were coded by one reviewer; a 10% sample was examined by a second reviewer for consistency. Pearson’s chi-square test of proportions was used to compare MRLOs to ABIM blueprint categories, assessing whether the proportion of presented material matched ABIM proportions. Additionally, we defined uncommon diagnoses as those not present in the ABIM blueprint, tabulated their frequencies, and used chi-square to compare incidence throughout the academic year.
Results: In 2020-21, 181 MR cases were presented, with 12 MRs (7%) by PGY-1, 79 (43%) by PGY-2, and 90 (50%) by PGY-3/4 residents. We divided the year into three periods, referred to as tertiles; 75 MRs (41%) were delivered in tertile 1 (July-October), 59 (33%) in tertile 2 (November-February), and 47 (26%) in tertile 3 (March-June). The mean number of MRLOs was 4.29 (SD = 2.09). Most faculty discussants (n = 106, 59%) were from IM subspecialties, 66 (36%) were from general IM or hospital medicine, and 5 (3%) were from non-IM specialties.There were significant differences between the proportions of MRLO IM content categories and the ABIM breakdown (X2 = 28.3, p < .05) (Table 1). While some categories were similar in observed versus expected representation (e.g., hematology with 7% observed versus 6% expected), other categories had more discrepancy (e.g., infectious disease with 17% observed versus 9% expected). Similarly, 113 of 181 MRs contained cross content categories, with significant differences noted between observed and expected material (X2 = 23.1, p < .05) (Table 1). Uncommon diagnoses were observed in 34 of 181 MRs, with tertile 3 containing 11.3% (n = 17) uncommon diagnoses compared to 3.38% (n = 9) in tertile 1 and 3.96% (n = 8) in tertile 2 (X2 = 13.0, p = .001) (Table 2).
Conclusions: In reviewing resident-led MR content from a single academic medical center IM residency, significant differences exist between the observed breakdown of MRLOs versus the expected breakdown from ABIM. Given MR cases are resident-selected, often based on their assigned faculty discussant’s specialty, adjustments can be made to lead residents to consider cases that include core ABIM content that may otherwise be missed. Further, we observe an increasing representation of uncommon diagnoses in the final third of the year. Further research into determining factors behind case selection can elucidate how better to utilize MR as a valuable educational tool for residents.
