Morning Report 

Morning report is one of your opportunities to teach your colleagues and interact with expert faculty. Many of these cases form the foundation of Potpourri cases and several turn into published case reports. To ensure adequate teaching in diagnostic and clinical decision-making as well as a standardized educational environment, the chief residents have developed this guideline. Further, to streamline teaching, the chief resident may contact the presenting resident the day before their morning report to get basic information on the patient (chief complaint and diagnosis). This will allow the chief resident to tailor the didactic portion of morning report to make it relevant to the particular case.  

Site Specific Details: 

PHHS:  

Mondays to Thursdays, 9 am to 10 am. No MR on Recruitment Fridays

Attendance required for: 

  • R2s and R3s on wards 
  • R1s, R2, and R3s on Parkland consult services 
  • Residents on elective who choose to come to Parkland for morning report 

Pre-Long Call resident presents the case.

 

CUH:  

Mondays to Thursdays, 9 am to 10 am 

Thursday will be in-take confernece

Pre-Long Call resident presents the case.

  • Attendance is expected for: 
  • Wards residents and interns 
  • CUH consult services (nephrology, cardiology, ID*, pulmonary) 
  • GI/Liver* 
  • Interns on elective and residents on elective who choose to come to CUH for morning report 

If your service or attending is not allowing you to go to morning report, please let the chief resident know.  

 *Exceptions: 

ID resident during ID didactics morning (Tuesday, Wednesday, Thursdays) 

Liver resident if they prefer to attend liver MDR 

If you know that you will need to miss, please let the chief resident know. 

 

VA: 

Mondays to Thursdays, 8 am to 9 am 

Attendance is required for: 

  • R2 and R3s on wards 
  • PRIME clinic interns and residents. VA Rheum interns and residents 

The case is presented by the pre-call resident. A brief intake report detailing admissions from the previous call day is done by the post-call resident. 

Thursday mornings are occasionally QI morning reports. Check the resident calendar for clarification. QI MR is also mandatory. 

Attendance is required and tracked. Failure to show up or provide an acceptable reason for absence in advance will result in addition of 1 half-day of jeopardy.  

Post-Call Resident 

At the VA, the post-call resident provides a one-liner of the patients admitted over the call cycle. These can be brief with patient demographic, short pertinent history, presenting chief complaint, presumed diagnosis and overnight management. If a case may be a morning report case, you can state you admitted a patient who will be a morning report case and withhold the information. On occasion, the faculty discussant or chief resident may have questions about management, these are mostly for exploring decision- making for the group.  

 

 

Tips on Creating a Great Morning Report 

During the R1-R2 transition, it can be intimidating to think of how to present morning report-style cases. The following guideline can ease this process and provide you material to think about while preparing your first cases.  

Case Types: 

  • In general, cases with a known diagnosis are preferred. In these cases, the group works through the patient presentation, from history and physical, to labs and imaging, stopping to create and refine the differential along the way. At some point, the group will decide on the diagnosis and the resident will provide the clinical course and final diagnosis.  
  • Unknown diagnoses where you are seeking input from your colleagues can also create an interesting and entertaining report, however these require a deep knowledge of the patient’s history. If you are presenting this style, it would be most helpful if you are utilizing the facilitator’s specific expertise. 
  • Management dilemmas – these are cases where major management decisions had to be made in the middle of the night that had potential to impact the clinical course. These presentations lend themselves to exciting discussions where everyone can learn

Finding a Case 

During intern year and throughout your residency, you should be keeping a running patient list of all of the patients you have seen.  Keep a separate list of the interesting cases that could be presented for morning report. In general, your case should be in the specialty of the faculty facilitator. If it isn’t, it should touch on symptoms that may prompt a consult or discussion with the faculty facilitator’s specialty.  The case should be uncommon presentation of a common disease, common presentation of an uncommon disease, or otherwise highlight systems issues that prevented rapid diagnosis or management.  The case should not be so esoteric that no-one could reasonably make the diagnosis based off the information given. Ideally, the case should originate from the hospital where you are presenting. We understand that this is not always possible 

Presenting the case 

  • Come prepared to the morning report with all needed information to answer questions from your colleagues. This may require creating a document beforehand with important labs and history. If you choose to bring your computer or smartphone, your colleagues should not have to wait for you to look up information when they ask questions. 
  • You should budget about 30 minutes from the beginning to the end of the case.  
  • You should have patient name and MRN available for the chief resident, however these are not necessary to give to the audience. The chief resident may request this information if the case would make a good potpourri case. 
  • The ideal case should start with a broad potential differential diagnosis that can be narrowed by focusing on specific aspects of the HPI/physical exam/labs (i.e. history of eating queso fresco = brucellosis).
  • If your case hinges on specific imaging, these should be downloaded and sent prepared to the chief resident beforehand to present at the appropriate time.  
  • If your colleagues are asking for history/exam/labs that were not checked or tested, feel free to use artistic license. 
  • If your audience is asking for the definitive  diagnostic test too early, it is ok to say the test was obtained and is pending. This may tip off your audience to the diagnosis, however.  
  • Do not needlessly withhold important clinical information (i.e. minimizing the presence of adenopathy in a patient presenting with lymphoma).