Morning Report Research Articles

Evaluating clinical teaching in a pediatric hospital in Iran: View points of academic members and medical students

Background: Evaluating the state of clinical teaching is a very essential aspect of useful teaching.It helps in determining areas of strength and areas for improvement. Accordingly, the aim of this study was to evaluate clinical teaching activities in a pediatric hospital at the Tabriz University of Medical Sciences, based on standards provided by the Ministry of Health in Iran. Methods: A cross-sectional study was conducted from October to December 2018 in the setting of a pediatric hospital of the Tabriz University of medical sciences. Participants were selected from this hospital: academic members and medical students who were present in the pediatric hospital during this investigation. The evaluation tool was a checklist of standards relating to clinical teaching settings. The outcome measures included four domains, assessed using mean standard scores: teaching round, morning report, journal club, and outpatient clinic. Analysis of variance (ANOVA) was used to compare scores on the checklist among academic members and medical students. Results: A total of 126 participants completed the checklist. Among the participants, 50 (39.6%) were 5th-year medical students, 51 (40.4%) were final-year medical students and 25(19.8%)were academic members. The highest and lowest mean standard scores were 85.3 and 34.5,the morning report and the teaching round by final-year medical students, respectively. No statistically significant differences were found among academic members and medical students’mean standard scores for teaching round (P = 0.983), morning report (P = 0.696), journal club (P= 0.952), and outpatient clinic (P = 0.060). Conclusion: Considering both academic members and medical students, clinical teaching standards were not widely regarded as important in the pediatric wards of the Tabriz University of Medical Sciences. Some interventions are indicated to improve adherence to the Ministry of Health standards.

Inpatient Adherence to Topical Glaucoma Medications before and after an Educational Intervention

To assess the inpatient adherence rate and factors associated with adherence to topical glaucoma medications (TGMs) at a single academic institution throughout hospitalization before and after an educational intervention. Nonrandomized, comparative, retrospective study. Inpatients 18 years of age and older admitted to a single academic hospital from January 2014 through June 2019 with a diagnosis of glaucoma who also received TGMs. The medication administration record during admission was examined closely to determine if the TGMs were reconciled and administered correctly before and after an educational intervention with inpatient providers. A simple intervention reached various health care providers through an educational e-mail, communication in a weekly newsletter, and a morning report presentation. Adherence was defined as administration of more than 75% of recommended doses during the inpatient stay. Other collected variables included length of stay and primary diagnosis on admission. Adherence rate to inpatient administration of TGMs. One hundred eighty-four patients (n= 142 before intervention; n= 42 after intervention) were included. The preintervention group had a total of 275 TGMs, of which 207 (75.3%) were administered in accordance with the adherence definition of this study. After the intervention phase, 49 of 56 (87.5%) TGMs were administered with appropriate adherence (P= 0.047). Adherence was associated significantly with a known outpatient medication regimen (P= 0.006) and correct admission reconciliation (P < 0.001). When glaucoma patients requiring topical treatment are admitted, approximately one quarter of patients seem to not receive their medications appropriately. In this study, a simple educational intervention was able to improve adherence. To prevent daily fluctuations in intraocular pressure for vulnerable glaucoma patients, inpatient adherence to appropriate medication administration should be stressed continuously. While in the care of health care providers, inpatients should be afforded at least the opportunity to maintain adequate adherence, just as is carried out for other medications related to other chronic medical conditions.

Lockdown of an Orthopedic Department during COVID-19 Epidemics, Our Experience in a General Hospital.

The COVID-19 disease is rapidly spreading around the world, affecting many countries and their healthcare systems. Like many other countries, Iran is struggling with the current situation. In this article, we aim to share our perspectives on confronting obstacles mentioned above using appropriate hospital protocols during the COVID-19 crisis. We investigated and compared the number of referred patients to the emergency room, elective, and emergent orthopedic operations in our hospital, along with a number of residents and faculty participants in the morning reports and virtual classes before and after the outbreak of COVID-19 in our hospital. The number of referred patients to the emergency room was significantly reduced; the number of orthopedic operations was also decreased to almost zero in March 2020. Meanwhile, we managed to dismiss our residents and reduce the number of in-hospital morning reports and conferences. Instead, we designed virtual classes, and the number of participants in our virtual classes grew to almost two-third of the whole participant. We also managed to fortify our virtual office system to reduce the number of in-hospital visits. Since our hospital had become a leading center for the treatment of COVID-19 patients, and the number of referred trauma patients, elective, and trauma operations, along with educational activities, was reduced. There was also a significant concern about the management of elective, trauma, and post-operative patients in this era. Orthopedic faculty members needed to react to the current situation cautiously. We were able to manage the situation with consideration of our educational path, along with the management of personal protective equipment (PPE), and the use of communication technologies and specific protocols to overcome the obstacles mentioned above. Yet involved our staff and With orthopedic faculties active involvement at in-hospital activitie and establishment of hospital protocols considering technological facilities and WHO guidelines, we can improve education, management of PPE, and both orthopedic elective and trauma patients.

My Two-Minute Drill (Lapels and All)

My Two-Minute Drill (Lapels and All)

SPE Strong: Strengthening Our Core: The Influential Yet Delicate Balance of Mentoring

President's column “The delicate balance of mentoring someone is not creating them in your own image, but giving them the opportunity to create themselves.”—Steven Spielberg One of my focus areas as SPE President is strengthening the feedstock of incoming talent into our industry. In my January column, I talked about industrywide initiatives under way to attract and retain this talent. This month, I want to engage with our members on the importance of effectively mentoring these bright, young minds. While I reflected upon setting my goals for the new year, I began to think about all of the important people in my career who not only helped me set high goals, but also provided support and guidance in achieving those goals. Some people were assigned to be my mentor, while others did it informally by providing advice during opportune moments. Truthfully, it does not matter how they became my mentor. The key point is that they were. Coaching a young professional in a technical position is critical to their success, but developing a person to have the interpersonal skills to navigate this industry is equally important. For 2020, my goals include being both a mentor and mentee. While I believe I have much to contribute to our younger members, I also have much to learn. I want to encourage more of our members to set goals around mentoring and want to make this the month where we take time to recognize and thank those who have had a positive impact on us as our mentors. Thank you, Don Patterson (retired Chevron), for mentoring me through my years of supervising workover rigs in northern Alberta. You were tasked with mentoring all the young engineers who were supervising rigs in northern Alberta, and phoning in our morning reports to you was often the most anxious part of our day. After looking back, your critiques were the necessary constructive feedback we needed. Fred Brownlee (retired Chevron) and John Patterson (retired ConocoPhillips) were two of my most influential mentors, both in helping me grow my technical skills and for connecting me with industry peers. Mike Mooney (retired ConocoPhillips) taught me how to be a great manager, how to conduct employee performance assessments properly, and how to set my focus on value-adding goals. Karen Draper (retired S&amp;N Pump) and Carol Magney Grande (Magney Grande) provided mentorship on how to succeed in this industry as a working mother, and also gave me my first opportunity to serve on an SPE committee. Finally, I must thank Dr. Jeff Spath (SPE 2014 President). He became my mentor when I first served on the SPEI Board as a Technical Director and has continued to provide critical guidance and constructive feedback since. Without his help, I would not be writing this column as your 2020 SPE President.

Computer access of morning report/ Harrison Club PowerPoint presentations to the medicine residents has improved their confidence in management and in preparation for the monthly exams and for the American Board of Internal Medicine: an innovative education quality improvement project at Harlem Hospital center

ABSTRACT Background Morning report is an important conventional teaching activity of residency programs worldwide. Objectives We aimed at creating a shared digital folder of the morning report/Harrison Club presentations for the training year of 2018–2019. Our primary objective was to assess the residents’ satisfaction regarding its accessibility, as well as to estimate the percentage of residents who felt improvement in confidence levels in their management skills and their preparation for the monthly exams and for the American Board of Internal Medicine (ABIM). Methods This study is a cross-sectional study comparing the three different Post-Graduate Year residents. An anonymous questionnaire was distributed to 44 participating residents, and a multivariate analysis test was conducted. Results Most of the residents thought the morning report/Harrison Club folder was easily accessible. 86.7%, 82.4% and 83.3% found it valuable to improve their confidence in management; 80%, 70.6% and 83.3% found it valuable to improve their confidence in preparation for the monthly exams; and 86.7%, 82.4% and 83.3% found it valuable to improve their confidence in preparing for the ABIM among the PGY1, PGY2, and PGY3 residents, respectively. Conclusion Almost all the residents agreed that they would recommend adoption of a similar digital tool in other residency programs.

Parents still matter: the influence of parental enforcement of bedtime on adolescents’ depressive symptoms

The aim of the current study was to test a multilevel mediation model that examined how adolescent sleep duration might be linked to depressive symptoms via their daytime energy levels. Furthermore, the study examined how parents' enforcement of various types of bedtime rules predicted the duration of adolescent sleep. A total of 193 adolescent (ages 14-17; Mage = 15.7 years old, SD = .94; 54.4% female; 71% Caucasian) and parent dyads completed baseline, online surveys, and adolescents also completed online 7-day, twice-daily (i.e. morning and evening) reports of their sleep duration (morning diary) and their energy levels and depressive symptoms throughout the day (evening diary). Parents (Mage = 47.6 years old, SD = 5.4; 80% female) completed assessments of enforcement of bedtime-related rules (i.e. bedtime, cessation of electronic media usage, prohibiting afternoon/evening caffeine consumption). Multilevel modeling enabled the testing of the mediation model both at the between-person level and within individuals. Results suggested that adolescents' energy levels mediated the association between adolescents' sleep duration and depressive symptoms. Furthermore, both greater enforcement of bedtimes and later school start times predicted longer sleep durations for adolescents, and were indirectly associated with adolescents' depressive symptoms. These findings underscore the importance of adolescents obtaining sufficient sleep to support their mental health and suggest a critical point of intervention for preventing or decreasing insufficient sleep. Given the diverse threats to adolescents' sleep as well as adolescents' desire for greater independence, collaborative, autonomy-promoting bedtime limit-setting is recommended to support adolescents' well-being.

How to facilitate an unscripted morning report case conference.

How to facilitate an unscripted morning report case conference.

When perception is reality: Resident perception of faculty gender parity in auniversity-based internal medicine residency program.

IntroductionAlthough women have entered medical school and internal medicine residency programs in significant numbers for decades, women faculty remain underrepresented in senior and departmental leadership roles. How residents perceive this gender disparity is unknown. We sought to assess resident perception of gender parity among departmental leadership and teaching faculty in our internal medicine department, and to determine the actual gender distribution of those faculty roles.MethodsAn anonymous cross-sectional survey was distributed to evaluate resident perception of gender representation of various faculty roles. Using conference schedules, resident evaluations, and our department website, we determined the actual representation of women faculty in department leadership roles, and in clinical and educational activities.Results88 of 164 residents (54%) responded. Women residents were less likely than men to perceive that women faculty were equally represented in department leadership (45% men agreed vs. 13% women, p < 0.05), clinical teaching roles (55% men agreed vs. 28% women, p < 0.05), or facilitating educational conferences (45% men agreed vs. 28% women, p = 0.074). In 2017, the internal medicine department at our institution comprised 815 faculty members, 473 men (58%) and 342 women (42%). At that time, women faculty held 5% of senior departmental leadership positions and 21% of educational leadership positions. During the year preceding survey distribution, women faculty attended on internal medicine inpatient wards for 33% of the total number of weeks, staffed 20% of morning reports, and facilitated 28% of noon conferences.DiscussionWomen residents in our internal medicine training program perceived a gender disparity among faculty in leadership and educational positions to a greater extent than male residents. The perception of women trainees was accurate. In addition to disproportionate underrepresentation in leadership positions, women faculty were underrepresented in prominent educational positions, including attending on inpatient services and serving as discussants at educational conferences.Electronic supplementary materialThe online version of this article (10.1007/s40037-019-00532-9) contains supplementary material, which is available to authorized users.

The Radiology Resident as Teaching Consultant: An Innovative Peer-to-Peer Teaching Consultation Service to Strengthen Relationships With Referring Colleagues in the Era of Imaging 3.0

BackgroundThe American College of Radiology Imaging 3.0 paradigm emphasizes the need for radiologists to serve as imaging consultants to their referring colleagues. However, outside the reading room, teaching interactions between radiology and nonradiology residents are limited. Internal Medicine Morning Report (IMMR) is a resident-run educational program widely employed by internal medicine (IM) residencies. Although medical imaging is regularly discussed in IMMR, radiology residents are not typically involved in case preparation. We aimed to develop a peer-to-peer imaging teaching consultation service (TCS) incorporated into the well-established structure of IMMR. By creating illustrative, “dynamic” teaching slides for use at these conferences, we sought to provide salient radiology teaching material, demystify jargon, discuss appropriate imaging use, and review relevant anatomy. We hypothesized that TCS could improve the quality of IMMR as perceived by the IM presenter. MethodsTCS was piloted over a 7-month period. Each referred case was reviewed by a senior radiology resident who produced a set of “dynamic” teaching slides for each case. These included patient imaging overlayed with extensive annotations and animations highlighting teaching points, with particular attention to radiologic terminology. Slides were shared with the IM presenter, who could use them for preparation and include the animations in the talk if desired. TCS effectiveness was evaluated with a survey distributed to participating IM residents. ResultsIn the pilot period, 12 TCS requests were received and 10 were performed in collaboration with 6 IM residents. Survey results indicated that most IM residents did not consult radiologists prior to TCS (5/6, 83%). IM residents used the “dynamic” teaching slides to both prepare for and present at IMMR (5/6, 83%). TCS improved IM residents’ perceived ability to engage their audience (6/6, 100%), confidence in teaching radiology material (4/6, 67%), ability to understand radiology reports (4/6, 67%) and appreciation for what radiologists do (6/6, 100%). ConclusionsThe TCS pilot resulted in successful radiology-IM collaboration and improved knowledge and confidence in teaching imaging concepts. Continuous program evaluation will be performed and future work will assess the effect of TCS on radiologist confidence in real-world clinical consultations.

Event‐Level Correlates of Drinking Events Characterized by Alcohol‐Induced Blackouts

Prior research identifies a range of potential predictors of blackouts and suggests that blackouts increase risk for additional negative consequences. However, these studies are based on epidemiological work that allows us to draw conclusions about groups of people but not within-person processes. The present study examined within-person, event-level correlates of blackouts. Ninety-six heavy drinking college students (52% female) completed 28days of daily reports of alcohol use and consequences, including blackouts. Thirty-three participants reported 56 blackouts. Hierarchical linear modeling compared morning reports of drinking events on which participants did versus did not report a blackout, controlling for total drinks at the event. Blackout likelihood increased as a function of total drinks consumed and of crossing thresholds for heavy episodic drinking (4+/5+ drinks for women/men) and high-intensity drinking (8+/10+). Participants reported a higher total number of additional negative consequences on blackout events. Specific consequences that were more likely included embarrassing oneself and hangover. Blackouts were associated with morning ratings of less positive mood and a less favorable drinking event. Motives for drinking and simultaneous use of marijuana were not associated with blackouts. Event-level findings of this study document that events leading to alcohol-induced memory loss are associated with other adverse experiences relative to drinking events that do not result in blackout, and offer potentially motivational levers for preventive interventions.

Morning report decreases length of stay in emergency general surgery patients

Objective: Communication in the hospital setting is an easy target for quality improvement. Capturing this change via communication between providers during hand-offs is necessary to reduce delays and errors. While this process has been more widely characterized in medical specialties, we designed this study to address the knowledge gap in surgical specialties.Methods: Our institution’s division of Acute Care Surgery (ACS) implemented Morning Report (MR) in October of 2015. At MR, all admissions and service transfers were discussed from Trauma, Emergency General Surgery (EGS), and Surgical Critical Care services from the previous 24 hours. This study compared patients who underwent a surgical procedure during their hospital stay before and after protocol implementation.Results: 974 patients were included in this study. The average patient was 50.3 years of age, 65.4% were white, and 51.7% were male. The average length of stay (LOS) was 8.3 days with 1.75 days to procedure. The post-MR cohort LOS was 2.7 shorter and had 0.85 fewer days to procedure. In an adjusted regression analysis, days to procedure and LOS decreased by 33% (p &lt; .01) and 17% (p &lt; .01) respectively.Conclusions: Implementation of MR led to a decrease in the overall LOS and days to procedure for operative patients. Our results advocate for the standard use of structured hand-offs in surgical units.

Seizing the Window of Opportunity to Enhance Resident Skills in the Inpatient Setting.

Seizing the Window of Opportunity to Enhance Resident Skills in the Inpatient Setting.

Failure in Residency Education: Lessons Learned From Harry Potter, Oprah Winfrey, and the Marigold Hotel.

Failure in Residency Education: Lessons Learned From Harry Potter, Oprah Winfrey, and the Marigold Hotel.

Morning report innovation: Case Oriented Report and Exam Skills.

Morning report is a valuable educational conference but is often a stand-alone classroom-based discussion which misses the opportunity for bedside education. In this report, we describe an innovative morning report structure - the Case Oriented Report and Exam Skills (CORES) - that addresses this pitfall of the traditional case conference format and brings learners to the bedside. The key components of CORES include highlighting concepts of clinical reasoning, emphasizing evidence-based and hypothesis-driven physical exam (HDPE), and integrating emerging bedside technologies such as point-of-care ultrasound (POCUS).

(297) Linking Pain Intensity and Pain Interference: Pain Catastrophizing as a Mediator and Sleep Quality as a Moderator

When pain repeatedly interferes with individuals’ daily activities, their psychosocial well-being is at risk. However, the mechanisms through which pain elicits pain interference in chronic pain patients’ daily lives remain unclear. Identifying a targetable mediating and moderating variable in the pain intensity-pain interference link is important for developing strategies that can efficiently disconnect this association. To addresses this knowledge gap the present study examined pain catastrophizing as a mediator of the association between pain intensity and pain interference, and sleep quality as a moderator of the association between pain intensity and pain catastrophizing. A sample of 220 individuals who have fibromyalgia were included in the study. Sleep reports were collected as soon as participants woke up in the morning and subsequent pain-related reports were also collected every day for 21-days. Multilevel moderated mediation analysis was conducted. Morning pain catastrophizing significantly mediated the prospective association between morning pain intensity and afternoon pain interference [95% CI (0.005-0.007)]. Moderation analyses revealed that the relation between morning pain intensity and morning pain catastrophizing was significantly moderated by the previous night's sleep quality (p

Medical Librarians may be Underutilised in EBM Training within Pediatric Resident Programs

A Review of: &#x0D; Boykan, R., &amp; Jacobson, R. M. (2017). The role of librarians in teaching evidence-based medicine to pediatric residents. Journal of the Medical Library Association, 105(4), 355-360. https://doi.org/10.5195/jmla.2017.178&#x0D; Abstract&#x0D; Objective – To identify the use and role of medical librarians in pediatric residency training, specifically in the teaching of evidence-based medicine (EBM) to medical residents. This research also aims to describe current strategies used for teaching evidence-based medicine in pediatric residency training programs.&#x0D; Design – Web-based survey.&#x0D; Setting – Pediatric residency programs within the United States of America.&#x0D; Subjects – 200 members of the Association of Pediatric Program Directors (APPD).&#x0D; Methods – The 13-question, web-based survey used multiple choice and short answer questions to ask how pediatric residency programs used medical librarians. The survey collected demographic information such as program name, geographic region, and program size. Where respondents indicated their programs utilised librarians, the survey asked about their specific role, including involvement in EBM curricula. For respondents who indicated their programs did not use librarians, the survey asked about their reasons for not doing so, and to describe their EBM curricula. Researchers used SPSS software to analyse the quantitative data.&#x0D; Main Results – Overall 91 (46%) APPD-member program directors responded to the online survey. Of these, 76% of program directors indicated a formal EBM curriculum in their residency programs. Medical librarians were responsible for teaching EBM in 37% of responding pediatric programs. However, only 17% of responding program directors stated that medical librarians were involved in teaching EBM on a regular basis. The EBM skills most commonly taught within the pediatric residency programs included framing questions using PICO (population, intervention, comparator, outcome), searching for relevant research literature, and critical appraisal of studies. The strategies reported as most effective for teaching EBM in pediatric residency training programs were journal clubs, regular EBM conferences or seminars, and ‘morning reports.’&#x0D; Conclusion – The study concluded that medical librarians may be important in the teaching of EBM in pediatric residency programs, but are likely underutilised. The librarian might not be seen has having a significant role in forums such as journal clubs, despite these being a predominant venue for EBM teaching. The authors recommend that program directors and faculty work together to better integrate medical librarians’ expertise into clinical teaching of EBM.

How e-learning creates new opportunities in hospital settings? Innovations in a low resource setting

Background: E-learning and telemedicine have become common methods in changing and developing medical education and clinical processes. The purpose of this study was to describe the innovations of blending e-Learning into the educational and medical processes of hospital services Methods: The process of action research included plan, act, observation and reflection was followed. Implementation, which took 18 months, included purchasing and installing the required software and administration of new educational and medical processes. The result reflected in regional and national innovation councils among universities of medical sciences and minister of health and in Iran. Results: Incorporation of eLearning into medical and educational processes resulted in practical innovations. The first was setting up an e-clinic, which was formed based on virtual and online communication between the hospital's clinic and distant rural health centers. It prevented from unnecessary referrals and created an accountable paradigm of medical education based on a triple consultation between family physicians (GPs), specialists and patients in rural and urban communities. Another innovations were the development of a joint clinic of diabetes and ophthalmology specialists, running online medical classes, online morning reports meetings and holding OSCE using virtual reality technology. Moreover, with the establishment of virtual reality technology, novel productions in medical education also emerged. Conclusion: the result reveled eLearning and telemedicine create novel opportunities in health systems toward accountable education and improving both equity and efficiency in health service provision.

Development and Evaluation of High-Value Pediatrics: A High-Value Care Pediatric Resident Curriculum

Low-value health care is pervasive in the United States, and clinicians need to be trained to be stewards of health care resources. Despite a mandate by the Accreditation Council for Graduate Medical Education to educate trainee physicians on cost awareness, only 10% of pediatric residency programs have a high-value care (HVC) curriculum. To meet this need, we set out to develop and evaluate the impact of High-Value Pediatrics, an open-access HVC curriculum. High-Value Pediatrics is a 3-part curriculum that includes 4 standardized didactics, monthly interactive morning reports, and an embedded HVC improvement project. Curriculum evaluation through an anonymous, voluntary survey revealed an improvement in the self-reported knowledge of health care costs, charges, reimbursement, and value (P < .05). Qualitative results revealed self-reported behavior changes, and HVC improvement projects resulted in higher-value patient care. The implementation of High-Value Pediatrics is feasible and reveals improved knowledge and attitudes about HVC. HVC improvement projects augmented curricular knowledge gains and revealed behavior changes. It is imperative that formal high-value education be taught to every pediatric trainee to lead the culture change that is necessary to turn the tide against low-value health care. In addition, simultaneous work on faculty education and attention to the hidden curriculum of low-value care is needed for sustained and long-term improvements.

Attitudes of general hospital consultants towards psychosocial and psychiatric problems in Netherlands

ABSTRACTPsychosocial and psychiatric problems are common in patients admitted to general hospitals, and can negatively influence course of somatic diseases. Hence, early identification and adequate management is important. The aim of this study is to investigate attitudes towards psychosocial and psychiatric problems by non-psychiatrist consultants in an academic hospital. Data were collected by anonymous, self- administered questionnaires which were provided to all consultants during morning reports and by email. Of 431 eligible participants, 187(43%) completed the questionnaire: 64% during morning reports, and 36% by email. Almost all consultants report generally positive attitudes towards mental health problems. However, we identified several obstacles towards management. First, there was a discrepancy between positive attitude and the willingness to take on management responsibility. Reported reasons for this discrepancy were time constraints and lack of skills. We also found that consultants feel little responsibility for the management of depression and chronic drinking. Physicians have generally more positive attitudes than surgeons. Finally, all consultants are less likely to refer patients with dementia and treatment non-compliance to psychiatry, for reasons of perceived ineffectiveness and fear of stigmatizing patients.We conclude targeted education on the management of these problems for hospital consultants is still warranted.