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Published on: August 4, 2023
A Comparative Study of Scripted versus Unscripted Morning Reports: Results from a Prospective Multicenter Study
Anand D Jagannath1, Brian Kwan1, Daniel B Heppe1
1From the University of California San Diego School of Medicine, San Diego, the Department of Medicine, University of Colorado School of Medicine, Denver, the Department of Medicine, University of Minnesota School of Medicine, Minneapolis, the University of Washington School of Medicine, Seattle, the David Geffen School of Medicine, Los Angeles, California, the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, the Tulane University School of Medicine, New Orleans, Louisiana, the George Washington University School of Medicine, Washington, DC, the Medical College of Wisconsin, Milwaukee, and the Yale University School of Medicine, West Haven, Connecticut.
This study compared scripted and unscripted morning reports in internal medicine residency. Scripted reports focus on didactics, while unscripted reports emphasize early diagnostic skills, suggesting a need for unscripted formats to enhance clinical reasoning.
Area of Science:
- Medical Education Research
- Internal Medicine Residency Training
Background:
- Morning report is a core component of internal medicine residency education.
- Two primary formats exist: scripted (preselected cases, prepared didactics) and unscripted (unprepared case discussions).
- No prior studies have directly compared these two formats.
Purpose of the Study:
- To prospectively compare the characteristics and time allocation of scripted versus unscripted morning report formats.
- To provide evidence-based insights for optimizing internal medicine residency education.
Main Methods:
- A prospective observational study was conducted across 10 academic medical centers in the United States.
- 198 case-based morning reports were observed and analyzed.
- Data collected included case diagnosis, presentation methods, and time spent on specific discussion components.
Main Results:
- Scripted reports (85%) were more common than unscripted reports (15%).
- Scripted reports featured known diagnoses, extensive electronic slides, and more time on didactics.
- Unscripted reports dedicated more time to case history, physical examination, and differential diagnosis.
Conclusions:
- Contemporary morning reports predominantly use the scripted format.
- Scripted reports prioritize prepared didactics, whereas unscripted reports enhance early diagnostic skills.
- Residency programs aiming to bolster diagnostic process training should consider incorporating more unscripted morning reports.
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