Morning Report

Morning Report is a fixture in most internal medicine training programs. Replies from 117 of 124 university departments of Medicine surveyed revealed that 115 conducted this ritual each weekday and occasionally on the weekends [1]. Despite the universal practice of having the ward residents meet with the Chairman and the program director, usually without interns, there is little consensus about format [2]. The Residency Review Committee of the American College of Graduate Medical Education does not require a daily residents' report, so the exercise must satisfy certain objectives of both residents and training program directors.

Wenger and Shpiner, in this issue of Annals, address the content, rather than structure, of Morning Report at the UCLA Medical Center [3]. Given the reality of greatly diminished length of stay and a lack of continuity of care involving the residents caring for the hospital inpatients, they tested the hypothesis that a substantial number of patients remain undiagnosed by discharge or transfer. Within 6 months of discharge, 24% of patients presented at morning report had been assigned a diagnosis that differed from that initially presented at Morning Report. The authors contend that the failure of residents to learn of these changes is a major educational shortcoming stemming from heavy reliance on inpatient medical education.

Even if these findings are broadly applicable, I take the position that the accuracy of diagnoses presented at Morning Report 6 months later does not affect its educational value. …