Morning report emails: A unique model to improve the current format of an internal medicine training tradition

Dear Sir,

Morning report is a well-established traditional ritual in internal medicine residency programs. In the last two decades there have been many reports discussing morning report format, related problems and suggested solutions. Barbour & Young (1986) reported that the Chief Resident's systemic review of literature has ensured house staff exposure to pertinent topics and recent studies. On the other hand, Ways et al. (1995) found that the residents believed the journal articles were helpful only if received within 2-3 days of presentation of the relevant case.

From our point of view, morning report, including our own, often lacks an ongoing literature review. To improve upon its current format, we initiated the utilization of electronic mail, we started sending emails to our residents after morning report two to three times per week for 9 months, emails included information about the cases presented and a comprehensive discussion followed by literature review.

A monthly test related to the content of the morning report emails and an 8-item questionnaire at the end of the study, were conducted to assess its effect on their test performance and evaluate residents’ satisfaction with the new format; respectively.

Residents were randomly and double blindly divided into study and control groups. Residents sat for monthly tests over three periods. During the first and third periods both groups received morning report emails, while only the study group did during the second period. Average scores were compared between the two groups using Student's t-test. Analysis of the questionnaire and test score showed that most residents strongly supported morning report electronic mails (>85%). The study group showed statistically significant higher test scores.

(P value < 0.001)

The success of this new model, despite numerous limitations; such as the small number of residents (18 in each group) as well as the small number of questions per test (10 questions), is evident from the significant difference in test performance between the control and study groups and the progressive improvement with time in performance of all our residents.

Morning report emails is a novel and simple way for achieving greater resident satisfaction, improving their test performance, expanding upon case-based discussion and interaction, stress key points, provoke problem-based clinical questions and help optimize information retention.

Ahmad Khraisat, MD (Corresponding Author)

Assistant Professor of Clinical medicine

2224 Ottawa St

Des Plaines

IL 60016

Tel: [phone]

Fax: [phone]

[email protected]

Almothana Shanaah, MD

Assistant Professor of Clinical medicine

MeritCare Hospital

Fargo, North Dakota

Eshraq AlJaghbeer, MD

Endocrine Fellow

Daniel Berland, MD, FACP

Preston B Cannady Jr., MD (Program Director)

Department of Internal Medicine

Finch University of Health Sciences/

The Chicago Medical School

3333 Green Bay Rd

North Chicago

Illinois 60064

Preston B Cannady Jr., MD, FACP