Ambulatory morning report: an underutilized educational modality

Many medicine residency training programs include a lecture-based preclinic conference series as part of the ambulatory educational curriculum when more effective teaching formats might be available. Our institution has replaced this lecture-based teaching format with an ambulatory morning report modeled after the inpatient paradigm. This study compares the efficacy of these 2 teaching models and defines the desired characteristics of this new teaching strategy.

We first conducted a background study by obtaining permission to use test questions from the Medical Knowledge Self-Assessment Program to develop pre- and postambulatory rotation tests to validate our ambulatory curriculum. Forty-three of 44 interns completed both pre- and postambulatory block testing. The mean score on these tests improved from 67% to 81%. Although this overall improvement achieved statistical significance, test question subgroup analysis clearly indicated that the improved knowledge in test items relating to our preclinic conference topics contributed negligibly to the overall statistical improvement. As such, we ultimately replaced our preclinic conference with a morning report format. In this study, 82 residents were enrolled in a 2-year prospective observational study. This study group completed an ambulatory curriculum in which the 1st year was completely lecture based, and the 2nd year included the morning report format. We were thus able to survey residents' opinions regarding the effectiveness of the 2 very different teaching formats used in consecutive years.

The survey results from those residents exposed to both teaching formats over 2 years revealed a high degree of satisfaction with the ambulatory morning report format. When comparing the long-term educational value, 94% of the residents found the morning report format more effective than the lecture-based preclinic conference. In addition, many desirable characteristics of the morning report also were defined.

Lecture-based preclinic conferences might not be the most effective way of conveying information over the long term. Residents seem to prefer the more interactive morning report format. When organizing such a teaching format, attention should be directed toward the characteristics that were felt to be desirable by those we are trying to teach.