Morning Report Guidelines

In our ongoing attempt to perfect morning report we have addressed some of the recent feedback regarding the lack of residents’ opportunity to participate in the discussion. Below are our goals and format, slightly altered from the prior version. Please read it carefully. Please note that we still focus on the presenter giving an excellent presentation and leading the way; however, in this version there are places to stop and open up for more discussion.

 
The Goal:

To provide an interactive forum for house staff to develop skills in presentation, diagnostic evaluation, and patient treatment, and to increase the knowledge and understanding of pediatric inpatient cases.


The Format:

o   Run by the chief resident along with a faculty member.

o   Residents select the cases and are expected to know all the details of the patient and patient’s care. This should ensure a successful presentation. 

o   Presentations should include the chief complaint, HPI, past history and physical exam, and the beginnings of a discussion of the most likely diagnoses based on that patient’s presentation, and discussion about how the differential diagnosis guided the selection of laboratory tests and any other diagnostic testing.

o   Presentations should be as concise as possible, focusing on the details pertinent to the case; faculty and other residents should not interrupt until the presentation is complete.

o   As a general rule, the presenting resident will be “in charge” of the presentation, allowing for questions at appropriate intervals (after the HPI, for example) – others should hold their questions until the presenter asks for others’ feedback. If you have come in late, please refrain from asking questions that might have already been discussed, as it makes it hard for the presenter to maintain their focus.

o   The presenter may give the top diagnosis or two being considered – but at this point everyone else will be expected to participate in a lively discussion, of further differential diagnosis and management. PL2s and 3s should share knowledge with PL1s. PL1s should feel free to ask questions and offer responses.

o   Faculty are encouraged to contribute to the discussion at the appropriate times, but are asked to refrain from interrupting the presentation or from redirecting the discussion away from the main area of focus

o   At the end of morning report, the faculty preceptor and/or chief resident will give brief constructive feedback to the presenting resident(s), privately (5 minutes or less)

 

The Case Selection Process:

o   Three cases are required to be prepared for morning report daily.

o   By 5pm each weekday, the floor senior, the heme/onc senior, and the residents from the PICU will have contacted the chiefs to offer cases for the following day (text message is fine).  Ideally, the floor team will offer 2-3 cases, the heme/onc team will offer 1 case (if possible), and PICU 1-2 cases, but the seniors of all three areas should try to work together to coordinate at least 3 cases each day.  Then, by 6pm (sign out time), the chiefs will have contacted the appropriate people to let them know who is expected to present the following day. 

o   If an extremely interesting admission comes in overnight, one or more of the cases previously selected may be bumped, but the resident or intern who has prepared a case to present may save that case to be presented later in the week. If a bumped resident would like to present the case later in the week, they should speak with the Chiefs directly to let them know and coordinate a day. It is important to remember that the cases that are presented do not have to be cases that were admitted the night before, nor do they have to be presented by the admitting resident.

o   For each weekend shift, the intern who is on the ward must select one case to potentially present on Monday morning.  This case and the resident's name will be recorded on a piece of paper to be kept on the bulletin board on the 11N core, PONC and in the PICU.  On Sunday, the chiefs will touch base with the PICU, Heme/onc and floor teams to find out what cases are available.  By 6pm on Sunday, the people presenting will be contacted directly, even if they are at home.  If an interesting case emerges overnight on Sunday, the resident will text the chiefs and prepare the case, potentially bumping one of the other cases, as during the week.

o   As always, if you are unsure which cases might be interesting to present at morning report, please feel free to speak with the Chiefs or any of the faculty members.

 

Attendance:

The days listed below are when you should attend morning report:

o   Ward Senior: daily (unless in clinic)

o   Night Senior: post-call (unless is the rare case in clinic)

o   Ward Intern: daily

o   Night Intern: never

o   Heme/Onc Senior: daily

o   Heme/Onc Intern: daily

o   PICU: daily (unless on call that day)

o   NICU: for NICU morning report (approximately once weekly)

o   Newborn: never

o   Newborn Nights: never

o   ER*: never

o   ED: never

o   Backup: never

o   AmbR: daily if doing Research, never if doing Ambulatory

o   Electives:

§  Adol: daily

§  A&I/Pulm: Tuesdays, Fridays

§  Cardio: Mondays, Fridays

§  Community: daily (unless otherwise indicated in your schedule)

§  Development: daily (unless otherwise indicated in your schedule)

§  Endo: Mondays, Tuesdays, Thursdays

§  Genetics: daily

§  GI: daily

§  ID: Mondays, Tuesdays, Fridays

§  Nephro: Tuesdays, Thursdays, Fridays

§  Neuro: daily

§  Rads: daily

§  Rheum: Thursdays, Fridays

§  Derm/Ophtho/Peds Surg/Anesth/Procedures/everyone else: daily (unless you have received prior approval to miss)