The Morning Report

A short story by Mary Coleman, winner of the 48-Hour Short Story Competition of the 2021 Create the Summer Series, an online arts festival celebrating and inspiring creativity in Niagara, organized by Create Niagara.

Morning report goes virtual: learner experiences in a virtual, case-based diagnostic reasoning conference

Objectives Participation in case-based diagnostic reasoning (DR) conferences has previously been limited to those who can attend in-person. Technological advances have enabled these conferences to migrate to virtual platforms, creating an opportunity to improve access and promote learner participation. We describe the design and evaluation of virtual morning report (VMR), a novel case-based DR conference that aimed to expand access to these conferences, leverage a virtual platform to create new opportunities for learner participation, and improve learner confidence in performing DR. Methods VMR took place on a videoconferencing platform. Participants included health professions students, post-graduate trainees, and practitioners. In designing VMR, we adapted concepts from the experience-based model of learning to design opportunities for learner participation. Teaching strategies were informed by information-processing and situativity theories. We evaluated learner experiences in VMR using a survey with open and closed-ended questions. Survey items focused on accessing case-based teaching conferences outside of VMR, participant perceptions of the educational value of VMR, and VMR’s impact on participants’ confidence in performing DR. We used thematic analysis to manually code open-ended responses and identify themes. Results 203 participants (30.2%) completed the survey. 141 respondents (69.5%) reported they did not otherwise have access to a DR conference. The majority of participants reported increased confidence performing DR. Respondents highlighted that VMR supplemented their education, created a supportive learning environment, and offered a sense of community. Conclusions VMR can expand access to DR education, create new opportunities for learner participation, and improve learner confidence in performing DR.

Morning report for all: a qualitative study of disseminating case conferences via podcasting

Background Despite its long-established importance, diagnostic reasoning (DR) education has suffered uneven implementation in medical education. The Clinical Problem Solvers (CPSolvers) podcast has emerged as a novel strategy to help teach DR through case conferences with expert diagnosticians and trainees. CPSolvers has 25,000 listeners in 147 countries. The aim of this study was to evaluate the podcast by eliciting the developers’ goals of the podcast, then determining to what extent they aligned with the listeners’ actual usage habits, features they valued, and perceptions of the podcast. Methods We conducted semi-structured interviews with 3 developers and 8 listeners from April–May 2020, followed by qualitative thematic analysis. Results Three major developer goals with sub-goals resulted: To teach diagnostic reasoning in a case-based format by (1a) teaching schemas, (1b) modeling expert diagnostic reasoning, (1c) teaching clinical knowledge, and (1d) teaching diagnostic reasoning terminology. To change the culture of medicine by (2a) promoting diversity, (2b) modeling humility and promoting psychological safety, and (2c) creating a fun, casual way to learn. To democratize the teaching of diagnostic reasoning by leveraging technology. Listeners’ usage habits, valued features, and perceptions overall strongly aligned with all these aspects, except for (1c) clinical knowledge, and (1d) diagnostic reasoning terminology. Listeners identified (1a) schemas, and (2c) promotion of psychological safety as the most valuable features of the podcast. Conclusion CPSolvers has been perceived as a highly effective and novel way to disseminate DR education in the form of case conferences, serving as an alternative to traditional in-person case conferences suspended during COVID-19. CPSolvers combines many known benefits of in-person case conferences with a compassionate and entertaining teaching style, plus advantages of the podcasting medium — democratizing morning report for listeners around the world.

Morning Report Goes Virtual: Learner Experiences in a Virtual, Case-Based Diagnostic Reasoning Conference

Background: Participation in case-based diagnostic reasoning (DR) conferences has previously been limited to those who can attend in-person. Technological advances have enabled these conferences to migrate to virtual platforms, creating an opportunity to improve access and learner participation. We describe the design and evaluation of virtual morning report (VMR), a novel case-based DR conference.Methods: VMR took place on a videoconferencing platform. Participants included health professions students, post-graduate trainees, and practitioners. In designing VMR, we adapted concepts from experience-based learning theory to design opportunities for learner participation. Teaching strategies were informed by information-processing and situativity theories. We evaluated learner experiences in VMR using a survey with open and closed-ended questions. Survey items focused on accessing case-based teaching conferences outside of VMR, participant perceptions of the educational value of VMR, and VMR’s impact on participants’ confidence in performing DR. We used qualitative content analysis to manually code open-ended responses and identify themes. Results: 203 participants (30.2%) completed the survey. 141 respondents (69.5%) did not otherwise have access to a DR conference. The majority of participants reported increased confidence performing DR. Respondents highlighted that VMR supplemented their education, created a supportive learning environment, and offered a sense of community.Conclusions: VMR can expand access to DR education, create new opportunities for learner participation, and improve learner confidence in performing DR.

Improving Information Adequacy of Clinical Morning Reports: Development of a Structured Model in the Obstetrics and Gynecology Department

Background: This study was aimed to improve the information adequacy of clinical Morning Reports by developing a structured reporting model. Methods: This study was a qualitative research conducted in three phases at the Obstetrics and Gynecology Department of three educational hospitals in northeastern Iran. After investigating the current status of MR sessions, the content of 120 reports were included extracted. The items were assigned subject groups for primary structuring while their validation getting confirmation using a two-round Delphi technique involving 10 specialists. Then, the structured model of clinical MRs was developed in two formats: structured paper-based form (SPF) and structured electronic format (SEF). The final evaluation was conducted comparing three practices of SPF, SEF, and conventional formats.Results: All studied MR samples were found unstructured in content. From 120 collected samples, 58 items were extracted and categorized into four categories. During the first Delphi round, all existing information were preserved with varying weights. but the participating experts also suggested six additional items to be included. In the second round, 11 items with the lowest scores were removed. Results of the comparative evaluation showed that the SPF format scored highest on the preference of use, ease of archiving and retrieval, application in future research, and ease of reporting. The SEF format scored highest on the clear understanding of patient status and readability.Conclusion: Using a standardized structured morning report based on the preference of local experts improves the quality of morning reports in various matters including efficiency, adequacy, and ease.

Training in neurology

ObjectiveTo describe cases presented by junior neurology residents, and to evaluate resident diagnostic patterns to help address individual and systemic educational needs.MethodsFor 6 academic years, details of all morning report cases assessed and presented by junior neurology residents were logged, including the resident's independent initial diagnostic impression. Cases were later revisited at subsequent morning reports to “close the loop” on a final diagnosis. We conducted retrospective review to quantify case demographics and to determine resident diagnostic accuracy based on pre-specified localization pathways.ResultsDemographic analysis included 1,472 cases; of these, 1,301 qualified for accuracy analysis due to diagnostic uncertainty at time of morning report. Non-neurologic etiologies represented 26.0% of cases. Central nervous system etiologies were the majority (86.0%) of neurologic cases. The most frequent diagnoses were ischemic stroke and seizure. Overall resident diagnostic accuracy was 64.0%. Accuracy was similar between central and peripheral etiologies. Of 1,301 cases, 15.3% were overcalled as neurologic, while neurologic disease was rarely mistaken as non-neurologic (5.1%). Most diagnostic errors (49.1%) occurred when determining if a case was neurologic. Where in the localization pathway errors occurred varied between etiologies.ConclusionOverall diagnostic accuracy for neurology junior residents in our cohort was similar to prior work conducted in smaller samples. Analysis of errors, particularly at the critical “neurologic or non-neurologic” decision-point, warrants further investigation. “Close the loop” methodology is simple to employ and can guide educational and quality initiatives to improve neurology resident clinical acumen.