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Faculty Supervised Morning Report: A Method for Measuring Resident Competency

Faculty Supervised Morning Report: A Method for Measuring Resident Competency\

Rajkumar Jeganathan, M.D., Tracy Feiertag, M.S., D.H.A., Greg Landis, M.D., James Maurer, M.D., James Turner, M.D.

Background:  Morning Report (MR) is a method used to sign-out overnight events to an incoming shift. Primarily oriented toward transfer of patient information, Supervised Morning Report (SMR) may also be used as a venue to measure resident competency. The objectives of the study are to describe the evaluation of the residents by faculty members and to identify the perceptions of residents on the educational value of SMR.

Methods:  SMR was implemented in June 2006 in our community teaching hospital. In the presence of an assigned faculty member (FM) and the entire surgical team, a “presenting” resident (PR) briefly reviewed all overnight admissions, consults, and ICU-admissions including a discussion of each patient’s history and physical exam, laboratory studies and relevant radiographs. The PR then communicated a plan of care for each patient. The assigned FM assessed the competency of the PR. Surveys were distributed to all surgical residents (n = 28) before implementation of SMR and 1 and 2 years after implementation.

Results:  Most residents agreed that SMR improves communication between shifts [65% strongly agree (SA) or agree (A)] and helps residents communicate in a uniform style (58% SA or A). Most agreed that the presence of a FM was helpful (63% SA or A).  When asked whether SMR improves competency, residents responded as follows:

Competency / % SA or A /
Patient care  / 41%
Interpersonal and communication skills / 41%
PBLI / 35%
Medical knowledge / 28%

The residents identified the presence of an assigned FM, review of relevant radiographs, and case discussion as the most important components of the process with respect to improvement of both patient care and resident education. Evaluation of the PR by the FM rated the residents Excellent (E) or Above Average (AA) in the core competencies the following percent of times.

Competency / % E or AA
Patient care / 72%
PBLI / 69%
Interpersonal and communication skills / 65%
Medical knowledge / 61%

Conclusion:  MR has been the cornerstone in most internal medicine residency programs. As this supervised sign-out has continued to evolve in surgical services it has become an important educational venue for surgical residents. Most residents felt that a positive learning climate was established during this conference. With the 80-hour workweek and necessity of a night-float system, structured supervised sign-out has become increasingly important. SMR serves the purpose of enhancing patient care, teaching residents, and provides a forum for assessment of the resident’s attainment of proficiency of the core competencies. Additionally, SMR, with faculty evaluation of the presenting resident, provides an excellent opportunity for programs to meet ACGME requirements of evaluating resident’s attainment of competency.

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