DETERMINANTS OF CASE SELECTION AT MORNING REPORT

OBJECTIVE: To determine why residents present certain cases and not ot hers at morning report (MR) in an institution that permits residents t he free choice of cases. DESIGN/PARTICIPANTS: prospective survey of 10 second- and third-year residents assigned to the medical service. SET TING: A 241-bed teaching hospital with 55 categorical internal medicin e residents. MEASUREMENTS AND MAIN RESULTS: Over a 4-week period, ther e were 194 admissions to the medical service on 18 call days preceding MR. Of these admissions, 30 (15%) were presented at MR. Cases were mo re likely to be presented if they were considered unusual or rare in p resentation or incidence (p = .001), involved significant management i ssues (p = .001), or were associated with remarkable imaging studies o r other visual material (p = .006). Residents were more likely to pres ent cases in which they disagreed with attending physicians on managem ent plans (p = .005). Overall, residents rated few admissions as havin g notable physical examination findings (29/194) or ethical or cost is sues (6/194). Of the seven most common admitting diagnoses, representi ng 44% of admissions, residents did not present cases involving four o f these diagnoses. CONCLUSIONS: Residents presented cases at MR that t hey felt were unique or rare in presentation or incidence for purposes of discussing management issues. Complete resident freedom in choosin g MR cases may narrow the scope of MR and exclude common diagnoses and other issues of import such as medical ethics or economics.