How to Improve the Quality of Morning Report; Department of Internal Medicine, An action research

Abstract

Background: Morning reports (MRs) are commonly used as an efficient technique in Medical Education. This study was intended to assess the developmental process following Iranian definable standards in the Internal Medicine Department, Imam Reza General Hospital, Mashhad, Iran. <br/>Methods: Following an initial one-month assessment through direct observation of morning reports held in Imam Reza Hospital Internal Medicine Department, workshops were run for 6 weeks aiming at rectifying the flaws and reforming the trends practiced contrary to current standards. Checklists were filled by the attending researcher, subsequent to which feedback was given regarding possible flaws and/or challenges to the attending physicians. Reforms as well as alterations were urged to improve the status quo, which were eventually accepted and implemented by the Head of Department. Reassessment was conducted six weeks afterwards, using checklists having been prepared in advance. An equal number of MR Sessions (n=25) was evaluated prior to and following the Reform Scheme. <br/>Results: Significant differences can be seen in the level of participation by nephrologists, infectious disease specialists and clinical pharmacologists after the scheme (P<0.001). Better arrangements were made between the coordinator and the resident in charge prior to the MR session, mainly via short text messages (44%). This encompassed the case selection, number of cases to be presented and the chief objective behind these presentations. Of the total of 65 patients presented, 50 (77%) were complicated ones whereas common disorders only reported in 6% of the cases. Presentations became growingly shorter in case of the first cases (P=0.022) while second and third ones took as much time as prior to the Reformation Scheme. There could be seen no considerable improvement in the accuracy of the final diagnoses yet punctuality was reported to have improved significantly as morning reports routinely and regularly commenced at 8 a.m. following alterations(P=0.025). A significant rise in the number of cases presented and discussed in every meeting (p=0.006). <br/>Conclusions: Training and feedback seem to have improved the quality of morning reports in different respects, especially when augmented by applying national as well as international standards used in this and other studies.