SHM Converge Scientific Abstract ePoster Gallery-What Internal Medicine Attendings Talk About at Morning Report: A Multicenter Study

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This multicenter prospective study examined what attending physicians actually say during internal medicine morning report across 13 VA academic medical centers. Observers recorded 2,344 attending comments from 250 reports, along with report structure and format.<br /><br />The main finding was that attending comments were mostly educational and clinically focused. The most common themes were:<br />- differential diagnosis,<br />- management,<br />- and diagnostic testing.<br /><br />When attendings discussed differential diagnosis, they often framed cases around syndromes such as delirium, polyarthritis, rash, shortness of breath, and hyponatremia, and diseases such as tuberculosis, endocarditis, histoplasmosis, adrenal insufficiency, and lymphoma. Management comments most often concerned medications, followed by diagnostic approach, surgery indications, disposition, and fluid management. Diagnostic testing comments frequently involved imaging, biopsy, serum chemistry, peripheral smear, and lumbar puncture.<br /><br />The study also found that attending participation varied by morning report format and local culture. More comments were associated with:<br />- in-person reports,<br />- unscripted reports,<br />- longer report duration,<br />- and a higher number of non-hospitalist internists attending.<br /><br />In contrast, the presence of a program director and the total number of attendings were not independently associated with more comments after adjustment.<br /><br />There were also substantial differences between institutions in both the number of comments per report and the average comment duration, suggesting that the local learning environment differs meaningfully across programs.<br /><br />Overall, the study shows that attending physicians at morning report primarily provide bedside-style clinical teaching, especially about diagnosis, management, and testing, and that conference format strongly influences how much they participate.

Asset Subtitle

Craig Gunderson

Meta Tag

Author List Anand Jagannath, Andrea Smeraglio, Brian K. Kwan, Cherinne Arundel, Christine Mitchell, Craig Gunderson, Daniel Heppe, Erik Ehlers, James D. Laudate, Jeffrey Redinger, Jessica Cyr, Joel Bradley, Jonathan Chun, Joseph Sweigart, Kirsha Gordon, Laura Ca

Category Research

Concept Morning Report

Concept Attending Comments

Concept Clinical Teaching

Concept Differential Diagnosis

Concept Attending Comment Frequency

Distinguished Non-Finalist

Presenter Organization Va

Presenting Author Craig Gunderson

Track Education

Keywords

morning report

attending physicians

internal medicine

clinical teaching

differential diagnosis

management

diagnostic testing

multicenter study

medical education

VA academic medical centers

Morning Report

Attending Comments

Clinical Teaching

Differential Diagnosis

Attending Comment Frequency