Residents presented cases at MR that they felt were unique or rare in presentation or incidence for purposes of discussing management issues. Complete resident freedom in choosing MR cases may narrow the scope of MR and exclude common diagnoses and other issues of import such as medical ethics or economics.

OBJECTIVE:To determine why residents present certain cases and not others at morning report (MR) in an institution that permits residents the free choice of cases. DESIGN / PARTICIPANTS: Prospective survey of 10 secondand third-year residents assigned to the medical service. SETTING:A 241-bed teaching hospital with 55 categorical internal medicine residents. MEASUREMENTS AND MAIN RESULTS:Over a 4-week period, there were 194 admissions to the medical service on 18 call days preceding MR. Of these admissions, 30 (15%) were presented at MR. Cases were more likely to be presented if they were considered unusual or rare in presentation or incidence ( p ‫؍‬ .001), involved significant management issues ( p ‫؍‬ .001), or were associated with remarkable imaging studies or other visual material ( p ‫؍‬ .006). Residents were more likely to present cases in which they disagreed with attending physicians on management plans ( p ‫؍‬ .005). Overall, residents rated few admissions as having notable physical examination findings (29/194) or ethical or cost issues (6/194). Of the seven most common admitting diagnoses, representing 44% of admissions, residents did not present cases involving four of these diagnoses. CONCLUSIONS:Residents presented cases at MR that they felt were unique or rare in presentation or incidence for purposes of discussing management issues. Complete resident freedom in choosing MR cases may narrow the scope of MR and exclude common diagnoses and other issues of import such as medical ethics or economics. orning report (MR) is a universal component of internal medicine training. 1-3 Though there is wide variation in format, attendance, and timing, all MRs share the common goal of case presentation for purposes of educating resident physicians, monitoring patient care, and reviewing management decisions and their outcomes. As a teaching session, resident physicians rank the educational value of MR higher than other conferences or activities. 4 The case mix at MR varies with institution-specific practices and ranges from review of all recent admissions to the selection of cases deemed interesting by the admitting residents, chief residents, or attending physicians. In a recent survey of 286 internal medicine training programs, 75% limited MR presentations to two to four recent admissions, and presented cases were largely selected by the residents themselves. 1 Given that the case mix at MR forms the template for discussion of disease-specific etiology, presentation, and management, case choice determines or at least affects the educational value of MR. Frequent criticisms of MR have included its preoccupation with rare cases or cases selectively chosen to showcase sound management or overall knowledge on the part of the presenting residents. 5,6 Though previous investigations have detailed resident preferences for the number and type of cases, no reports, to our knowledge, have explored the reasons residents present certain cases and not others in an institution that permits the free choice of MR cases. 4 ...

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