Morning Report

Contents 

1. Morning Report Schedule 

2. Welcome to Morning Report

3. Presentation Guidelines

4. Unacceptable Behavior

5. Six reasons why it makes sense to arrive early

6. So... Why WERE you late?

As the team structure at GW has changed, so has the crowd that attends Morning Report every day. Of course, housestaff on GW wards rotations will be there (except red team); in addition, nightfloats, dayfloats, and medicine consult are expected to attend. Once a week, Primary Care residents will attend as well. As usual, morning report will start promptly at 7:30, so we appreciate everyone’s presence on time (arriving 5 minutes earlier is always appropriate and highly encouraged).

The schedule for Morning Report activities is posted online at: http://www.gwmed.com/index.php?pagename=Morning_Report. If your name is in a box, then you’re expected to present at that particular morning report.  Of course, it is difficult to predict how long a particular presentation will last, so there may be changes in the schedule as we go along. In order to maximize our time in morning report, please come prepared!!. Presentation should be thorough but succinct. All pertinent positives and negatives should be included, and there should be no need for further questions or clarifications. As opposed to Intern Report presentations, the focus will be placed on differential diagnosis and management rather than interviewing and physical examination skills.

A brief guideline for preparing your presentations   ( return )

1. Nightfloat (NF). Every morning, one of the two nightfloat residents should be prepared to present a patient from that shift. Choose the most interesting one, or the one you’re clueless about. You’ll present the H/P, and the group will discuss. We will particularly interested to know what your thought process was, what problems have you identified, how did you approach those problems and what orders did you write. Have all the clinical data with you; know all the available lab results and review the available images before morning report.

2. Ward Residents (Post). The medicine ward resident is expected to present a patient that has been in the hospital long enough to have answers to most of the initial clinical questions. You’ll present the H/P including initial laboratory data. We will focus on identifying problems and building a differential. Someone from the group will discuss. Be prepare to disclose further clinical data upon request, and to provide a summary of the hospital course. Start thinking about your case presentation at least a couple of days in advance, and run it by the chiefs. You’ll be expected to look up information and share with the group a few pearls learned from the case.

3. EBM (Evidence-Based Medicine). EBM presentation should be gauged to last no longer than 15 minutes (this is not your TR talk!!).  These presentations are an exercise to learn how to come up with clinically relevant questions (and answer them) in your daily practice. The EBM presentation should be based on a case of your experience (it doesn’t necessarily have to be from your ward rotation). You should create a clinically relevant, well constructed question and answer it by finding appropriate/relevant literature. You should review/critique the literature found, and apply it to your case.  Here are some resources to help you prepare your EBM case: 

http://www.cebm.utoronto.ca/practise/ : This is a great resource, brought to you by the very same people who coined the term “EBM”.

http://www.ebmny.org/

http://www.cebm.net/?o=1011

http://library.umassmed.edu/EBM/index.cfm

Here are two examples of appropriate EBM presentations: brief (relevant) case introduction. Background info followed by clinical questions. A presentation and critique of the available evidence and a conclusion follows, where the results are applied to a specific patient. I will leave the issue of “length” to your own discretion: expect to count with 15 minutes to go over your slides.

http://www.gwmed.com/docs/File/PPTs/2008_07_23%20EBM%20Levalbuterol_archivos/frame.html

http://www.gwmed.com/docs/File/PPTs/Primary%20biliarycirrhosis_archivos/frame.htm

4. Consult Case. As a general internal medicine consultant, you will be asked specific questions, or you will be asked to manage a specific general internal medicine condition in the setting of another active disease (a surgery, a neurologic disorder, etc). When you are assigned to present in morning report, we expect you to share with the group the literature search required to answer your consult. Pick one of your consults, briefly present the case and the dilemma you were asked to solve, and present the evidence you’ve found. It’s up to you whether you want to bring slides or not. You’ll have 15 minutes for this presentation.

(generally) Unacceptable behavior   ( return )

“Off-the-cuff” presentations.  Be prepared!. Review the case you will present. Try to anticipate things that may be required of you…  If you forgot to ask something in your interview or you are missing an important part of your physical exam, go ahead and complete your work! Preparing a case for presenting should be an opportunity to mentally review the case and identify potential shortfalls in your thinking… before morning report.  

“Oh… yes, I think the biopsy showed…”.  Again… be prepared!! The day before your presentation get a printout or review your patient’s results. Never underestimate your colleagues’ inventiveness in asking for bizarre labs (after all… that’s what presentations are for! Your colleagues may find a new exiting twist to the evidence you have collected). Never assume a specific piece of information is unimportant just because you didn’t include it in your thinking process.

“Made-up” facts. The only thing worse than a questionably interesting case, is a hypothetical (fake) interesting one. It is not ok (nor necessary) to ‘tweak’ the facts to enhance the learning experience of a case. Rather, if you think your case is not interesting enough, try looking deeper into it. There may be sides to the story you haven’t explored yet.

“I don’t really know how the patient presented, but I’ll improvise”. If it’s not your case, just don’t present it. If you assumed care of the patient half way though his/her hospital course, you should be familiar with the details of the case presentation, and you should have as much first hand info as possible (you will obviously not be able to reproduce physical exam findings, but you should at least corroborate the elements of the story.

“Sorry I forgot my jumpdrive”. If you question your own reliability… just email the file to yourself.

“I don’t have any interesting case”. Really? Look deeper! No case is ever interesting upfront; in fact, many cases that seem interesting from the get-go often end up not being so interesting after closer scrutiny. Cases become interesting when you invest time in thinking about them and find new ways to approach the same problems. So don’t wait until the last minute to choose your case!

... and please, be there on time!

Six reasons why it makes sense to arrive early. by Mike St. Pierre.   ( return )
Mike St. Pierre is the host of The Daily Saint, a productivity blog focusing on work-life balance. www.thedailysaint.com

So, why WERE you late? by Susan Sabo.    ( return )
Susan Sabo is the creative mind at Productivity Cafe. She works with clients to help them get more done and to get home at a reasonable time. Susan learned punctuality from her Dad who is always 10 minutes early.

"Time management begins with one of the absolute basics - arrive on time. In his book Copy This!, the founder of Kinko’s (now FedEx Kinko’s) Paul Orfalea recounts that he would make hiring decisions based on key basic modes of operating. One of those is being punctual. I’m sure that Mr. Orfalea isn’t the only one making career decisions based on being on time and other fundamentals of operating in a business context.

If you’re not the one, you undoubtedly know people who show up late. Sometime they cause a group of people to stop their momentum while the latecomer is brought up to speed. Those on time drum their fingers (figuratively if not actually), change their train of thought and engage in other time filling activities while the latecomer is briefed. I have heard those who were interrupted mumbling under their breath, rolling their eyes, and give other negative feedback – even if the latecomer can hear or see them.

Here are the negative associated with people that arrive late:

• Latecomers are holding up others and hurting the productivity of everyone who has to wait
• Latecomers are demoralizing those who do bother to show up on time. This sometime starts a chain reaction where everyone starts showing up 5 then 10 then 15 minutes late to the detriment of all.
• Showing up late disrespects others’ time. It is interpreted as ‘The latecomer thinks he is more important or has better things to do than I do.’
• Other people extend lateness to meeting to expect tardiness in other arenas such as project deadlines. Thus, managers label late comers as high maintenance and dependant on others since the manager infers latecomers will be unreliable to be self-regulating. The manager has additional work to check on the work of the late contributor.
• Late people start a domino affect that can set entire groups, departments, and projects back. That hurts reputations as well as budgets and plans.
• Latecomers can get a reputation as ‘in need of attention’, ‘show boater’, ‘egomaniac’, and more.

Some of the positives associated with people who are on time and early: These attributes may not be earned but they are applied as an extension of being on time.

• They’re reliable and easy to count on.
• They won’t let a person, manager, or department down.
• They can be trusted with important (career building) activities and responsibilities.
• They are predictable in a positive way.
• They are proactive and contributors.
• They are conscientious.

If being on time is an opportunity for development for you consider these steps down the path to being on time:

• Mentally reprogram yourself to arrive 5 minutes early to every meeting. Put them on your calendar for 10 minutes before start time. For example, a 2:00pm meeting is put as 1:50pm on your calendar.
• Practice exit strategies so you leave previous commitments with enough time to get to the next one.
• Do not stop at your computer to check email just before a meeting.
• Plan your usual departure to a meeting and leave 10 minutes “early.”
• Call if it’s the rare occasion that you’re running late.
• DO NOT set your watch or clocks 5 or 10 minutes ahead. The rest of the world runs on real time so you need to synchronize with actual time.
• Set alarms in your computer calendar to remind you to wrap-up current work and get off to a meeting on time.
• Visualize the possible surprise and recognition you’ll receive for leading by arriving early."