AN ANALYSIS OF MORNING REPORT - IMPLICATIONS FOR INTERNAL-MEDICINE EDUCATION

Objective: To compare the initial diagnosis of cases presented at morning report with the final morning report diagnosis reached at discharge from the Medicine service and the diagnosis as evaluated 6 months after discharge. Design: Prospective cohort study of morning report cases. Setting: A university internal medicine residency program. Measurements: Proportion of morning report cases in which the initial morning report diagnosis differed from the final morning report diagnosis at discharge or, in cases where a firm diagnosis was not reached at discharge, the proportion for which a diagnosis was established by 6 months after discharge. Main Results: In 24% of cases, a firm morning report diagnosis was not available at discharge. For 61% of these, a diagnosis could be established by 6-month follow-up: for 36% the diagnosis differed from the final morning report diagnosis; and for 25% it was the same. Among cases where a firm final diagnosis was reached during morning report, the initial morning report diagnosis differed for 17%. Conclusions: Most patients discharged without a firm diagnosis have one established by 6 months later-often with surprising results. Postdischarge follow-up information could enhance the educational value of inpatient cases.