The study involved 225 participants, comprising 60 clinical residents (26%), 124 interns (55%), and 41 faculty members (18%). Based on the findings, 56% of residents and 67% of faculty members at Hospital 2 expressed disagreement with the idea of conducting morning report sessions without resident participation. Conversely, 78% of residents and 79% of faculty members at Hospital 1 expressed agreement regarding resident involvement in morning report sessions. Moreover, a majority of the interns at Hospital 2 (91%) expressed support for conducting morning report sessions without resident involvement, whereas 60% of interns at Hospital 1 opposed resident participation in these sessions.
In relation to the influence on medical capacities, 40% of residents, 22% of interns, and 60% of faculty members at Hospital 1 expressed the belief that conducting morning report sessions with resident involvement has an impact. In contrast, 18% of residents, 53% of interns, and 19% of faculty members at Hospital 2 held the belief that conducting morning report sessions without resident participation has an impact on medical capabilities.
In relation to the influence on educational capacities, 44% of residents, 26% of interns, and 57% of faculty members at Hospital 1 expressed the belief that conducting morning report sessions with resident involvement has a positive impact on educational purposes. Likewise, 27% of the residents, 65% of the interns, and 27% of the faculty members at Hospital 2 expressed the belief that conducting morning report sessions without resident participation has a negative impact on educational opportunities.
The Chi-square test was employed to investigate the association between demographic variables and students' perspectives on resident participation in morning report sessions. The results indicate that there was no significant correlation between any of the demographic factors, with the exception of participant type, and the viewpoints of students regarding resident involvement in morning report sessions (Table 1).
Table 1
) Background characteristics of the participants at the beginning of the study
Variable | Hospital | Total | P-value |
Hospital 2 | Hospital 1 |
Participant | Clinical resident | 27(25%) | 33(27%) | 60(26%) | 0.001 |
Intern | 57(54%) | 67(55%) | 124(55%) |
Physician | 20(19%) | 21(17%) | 41(18%) |
Gender | Female | 63(61%) | 76(63%) | 139(61%) | 0.05 |
Man | 41(39%) | 45(37%) | 86(39%) |
Marital status | Single | 43(58.1%) | 64(63.4%) | 107(61.1%) | 0.67 |
Married | 31(41.9%) | 37(36.6%) | 68(38.9%) |
Nationality | Iranian | 62(95.4%) | 99(98.0%) | 161(97.0%) | 0.91 |
Non Iranian | 3(4.6%) | 2(2.0%) | 5(3.0%) |
Housing | Native | 40(62.5%) | 54(54.5%) | 94(57.7%) | 0.38 |
Non-native | 24(37.5%) | 45(45.5%) | 69(42.3%) |
Conditional semester | Yes | 1(1.9%) | 0(0.0%) | 1(0.8%) | 0.44 |
No | 52(98.1%) | 65(100.0%) | 117(99.2%) |
Academic year | First year | 6(40.0%) | 5(20.8%) | 11(28.2%) | 0.46 |
Second year | 1(6.7%) | 8(33.3%) | 9(23.1%) |
Third year | 5(33.3%) | 8(33.3%) | 13(33.3%) |
Forth year | 3(20.0%) | 3(12.5%) | 6(15.4%) |
The participants' opinions on the suitability of the morning report quality indicators, as measured on a Likert scale with four tiers, were evaluated, and the findings are detailed in Tables 2 and 3. The findings indicate that more than half of the residents at Hospital 2 (56%) disagreed either completely or partially with the idea of conducting morning report sessions in the absence of residents. Likewise, the majority of residents (78%) at Hospital 1 indicated either full or partial agreement with the idea of holding morning report sessions with resident participation. Among the quality indicators of morning report sessions, residents at Hospital 1 expressed the highest level of disagreement regarding the fear and anxiety associated with achieving educational objectives. In contrast, residents at Hospital 2 identified providing verbal or written feedback and involving interns appropriately as the most significant points of disagreement.
Table 2
) Distribution of views of interns, residents and physicians regarding the status of the quality indicators of the morning report sessions of the hospital - No. 1
| Interns of Hospital 1 (N = 33) | Residents of Hospital 1 (N = 33) | Physician of Hospital 1 (N = 19) |
Questions | Completely agree | Relatively agree | Relatively opposite | Completely opposed | Completely agree | Relatively agree | Relatively opposite | Completely opposed | Completely agree | Relatively agree | Relatively opposite | Completely opposed |
Appropriate intern participation | 2(6.3) | 12(37.5) | 13(40.6) | 5(15.6) | 17(51.5) | 14(42.4) | 2(6.1) | - | 15(78.9) | 2(10.5) | 2(10.5) | - |
The appropriate role of the intern in holding meetings | 1(3) | 5(15.2) | 14(42.4) | 13(39.4) | 13(39.4) | 13(39.4) | 6(18.2) | 1(3) | 12(63.2) | 6(31.6) | 1(5.3) | - |
Fear and anxiety of achieving educational goals | 1(3) | 14(42.4) | 10(30.3) | 8(24.2) | 18(54.5) | 14(42.4) | 1(3) | - | 11(57.9) | 5(26.3) | 3(15.8) | - |
The intern's satisfaction with holding the intern's specific task meetings | 3(9.1) | 7(21.2) | 7(21.2) | 16(48.5) | 14(42.4) | 14(42.4) | 4(12.1) | 1(3) | 9(47.4) | 9(47.4) | 1(5.3) | - |
Provide verbal or written feedback on appropriate intern participation | 9(27.3) | 18(54.5) | 5(15.2) | 1(3) | 5(16.1) | 10(32.3) | 6(19.4) | 10(32.3) | 1(5.6) | 6(33.3) | 6(33.3) | 5(27.8) |
Educability and appropriate learning, appropriate role of the intern in holding meetings | 1(3) | 3(9.1) | 13(39.4) | 16(48.5) | 10(30.3) | 14(42.4) | 8(24.2) | 1(3) | 12(63.2) | 5(26.3) | 1(5.3) | 1(5.3) |
Good quality of the content of the morning report, the presence of fear and anxiety | 2(6.1) | 4(12.1) | 12(36.4) | 15(45.5) | 10(34.5) | 14(48.3) | 3(10.3) | 2(6.9) | 4(25) | 5(31.3) | 6(37.5) | 1(6.3) |
Achieving the educational goals of the intern's satisfaction with holding meetings | 3(9.4) | 15(46.9) | 8(25) | 6(18.8) | 13(39.4) | 14(42.4) | 4(12.1) | 2(6.1) | 11(64.7) | 3(17.6) | 3(17.6) | - |
Specific tasks of the intern | 2(6.3) | 14(43.8) | 7(21.9) | 9(28.1) | 8(25) | 12(37.5) | 7(21.9) | 5(15.6) | 6(33.3) | 8(44.4) | 4(22.2) | - |
Average total score | 9.63 ± 4.67 | 19.13 ± 4.79 | 8.5 ± 7.35 |
p-value | 0.0001 | 0.004 | 0.0001 |
Table 3
) Distribution of views of interns, residents and attending physicians regarding the status of the indicators of the morning report sessions of the hospital - No. 2
| Interns of Hospital 2 (N = 33) | Residents of Hospital 2 (N = 33) | Professors of Hospital 2 (N = 19) |
Questions | Completely agree | Relatively agree | Relatively opposite | Completely opposed | Completely agree | Relatively agree | Relatively opposite | Completely opposed | Completely agree | Relatively agree | Relatively opposite | Completely opposed |
Appropriate intern participation | 16(80) | 4(20) | - | - | 8(36.4) | 1(4.5) | 4(18.2) | 9(40.9) | 3(20) | 1(6.7) | 1(6.7) | 10(66.7) |
The appropriate role of the intern in holding meetings | 15(75) | 5(25) | - | - | 2(10) | 8(40) | 5(25) | 5(25) | 1(6.7) | 3(20) | 2(13.3) | 9(60) |
Fear and anxiety of achieving educational goals | 16(80) | 4(20) | - | - | 3(13.6) | 6(27.3) | 9(40.9) | 4(18.2) | 1(6.7) | 4(26.7) | 1(6.7) | 9(60) |
The intern's satisfaction with holding the intern's specific task meetings | 16(80) | 4(20) | - | - | 4(18.2) | 9(40.9) | 6(27.3) | 3(13.6) | 1(6.7) | 4(26.7) | 1(6.7) | 9(60) |
Provide verbal or written feedback on appropriate intern participation | 5(25) | 5(25) | 2(10) | 8(40) | 3(13.6) | 6(27.3) | 12(54.5) | 1(4.5) | 1(6.7) | 6(40) | 2(13.3) | 6(40) |
Educability and appropriate learning, appropriate role of the intern in holding meetings | 14(70) | 6(30) | - | - | 2(9.5) | 5(23.8) | 12(57.1) | 2(9.5) | 1(6.7) | 3(20) | 4(26.7) | 7(46.7) |
Good quality of the content of the morning report, the presence of fear and anxiety | 16(80) | 4(20) | - | - | 2(9.5) | 10(47.6) | 7(33.3) | 2(9.5) | 1(7.1) | 4(28.6) | 6(42.9) | 3(21.4) |
Achieving the educational goals of the intern's satisfaction with holding meetings | 14(70) | 4(20) | 2(10) | - | 3(14.3) | 4(19) | 11(52.4) | 2(9.5) | 2(13.3) | 3(20) | 2(13.3) | 8(53.3) |
Specific tasks of the intern | 16(80) | 3(15) | 1(5) | - | 3(13.6) | 6(27.3) | 9(40.9) | 4(18.2) | 2(13.3) | 2(13.3) | 5(33.3) | 6(40) |
Average total score | 23.5 ± 2.76 | 13.94 ± 8.98 | 8.5 ± 7.35 |
p-value | 0.0001 | 0.004 | 0.0001 |
Interns at Hospital 1 reported the highest level of disagreement regarding the adequacy of training, the quality of learning, and the appropriate role of interns in conducting sessions. In Hospital 2, interns reported that the level of intern involvement, the role of interns in conducting sessions, anxiety about meeting educational objectives, and the quality of morning report content were the most significant factors affecting their agreement. Furthermore, based on these findings, over half of the attending physicians at Hospital 2 (67%) indicated either complete or partial disagreement with the idea of holding morning report sessions in the absence of residents. In contrast, around 79% of attending physicians at Hospital 1 expressed complete or partial agreement with the notion of conducting morning report sessions in the presence of residents (Tables 2 and 3).
At Hospital 1, 40% of residents, 22% of interns, and 60% of faculty members held the belief that the presence of residents during morning report sessions has an impact on medical competencies. Moreover, the influence of morning report sessions on medical competencies varied significantly depending on the viewpoints of clinical residents, interns, and attending physicians. At Hospital 2, the findings revealed that 18% of residents, 53% of interns, and 19% of attending physicians held the belief that the absence of residents during morning report sessions has an impact on medical competencies. The influence of morning report sessions on medical competencies exhibited notable variations according to the perspectives of clinical residents, interns, and attending physicians (Table 4).
Table 4
) Opinions of the participants regarding the impact of morning report sessions on medical capabilities in hospitals 1 and 2
| Hospital 1 | Hospital 2 |
Questions | Attending physician Frequency (%) | Intern Frequency (%) | Resident Frequency (%) | Attending physician Frequency (%) | Intern Frequency (%) | Resident Frequency (%) |
Communication | 26 (72.2) | 36(55.4) | 14(73.7) | 12(33.3) | 36(67.9) | 4(26.7) |
Planning for patient management | 10(27.8) | 19(29.2) | 12(63.2) | 7(19.4) | 24(45.3) | 5(33.3) |
Improving clinical decision-making skills | 19(52.8) | 17(26.2) | 13(68.4) | 8(22.2) | 41(77.4) | 6(40) |
Estimating the prognosis of diseases | 6(16.7) | 2(3.1) | 8(42.1) | 3(8.3) | 19(35.8) | - |
Examination of patients | 27(75) | 24(36.9) | 12(63.2) | 12(33.3) | 41(77.4) | 2(13.3) |
How to monitor and follow up patients | 12(33.3) | 22(33.8) | 12(63.2) | 8(22.2) | 29(54.7) | 2(13.3) |
Disease diagnosis and differential diagnoses | 21(58.3) | 28(43.1) | 16(84.2) | 11(30.6) | 39(73.6) | 5(33.3) |
Indications for hospitalization of patients | 18(50) | 18(27.7) | 16(84.2) | 6(16.7) | 39(73.6) | 3(20) |
Taking a medical history | 29(80.6) | 33(50.8) | 16(84.2) | 10(27.8) | 47(88.7) | 5(33.3) |
Prevention | 4(11.1) | 3(4.6) | 4(21.1) | 3(8.3) | 14(26.4) | - |
Recording clinical information in patient files | 10(27.8) | 9(13.8) | 10(52.6) | 9(25) | 22(41.5) | 1(6.7) |
Semiology of patients | 9(25) | 6(9.2) | 6(31.6) | 4(11.1) | 24(45.3) | 2(13.3) |
Epidemiology of diseases | 6(16.7) | 4(6.2) | 4(21.1) | 2(5.6) | 13(24.5) | 1(6.7) |
How to care for patients | 11(30.6) | 9(13.8) | 11(57.9) | 7(19.4) | 22(41.5) | 2(13.3) |
How to request medical advice | 14(38.9) | 12(18.5) | 13(68.4) | 8(22.2) | 25(47.2) | 1(6.7) |
Evidence-based medicine | 11(30.6) | 6(9.2) | 8(42.1) | 1(2.8) | 20(37.7) | 1(6.7) |
Rational drug administration | 21(58.3) | 19(29.2) | 15(78.9) | 10(27.8) | 31(58.5) | 1(6.7) |
Interpretation of experiments | 26(72.2) | 26(40) | 16(84.2) | 11(30.6) | 41(77.4) | 5(33.3) |
Reasonable request for tests | 16(44.4) | 19(29.2) | 15(78.9) | 3(8.3) | 33(62.3) | 1(6.7) |
Defending the rights of patients | 2(5.6) | 3(4.6) | 5(26.3) | 2(5.6) | 14(26.4) | - |
Ethics | 15(41.7) | 10(15.4) | 11(57.9) | 4(11.1) | 21(39.6) | - |
How to refer patients | 11(30.6) | 2(3.1) | 11(57.9) | 3(8.3) | 23(43.4) | 3(20) |
Average total score | 14 ± 4.76(40) | 14 ± 3.45(22) | 11 ± 1.23(60) | 7 ± 3.12(18) | 28 ± 4.32(53) | 3 ± 1.12(19) |
p-value | 0.001 | 0.001 |
At Hospital 1, 44% of residents, 26% of interns, and 57% of attending physicians held the belief that the presence of residents during morning report sessions has an impact on educational competencies. Moreover, the influence of morning report sessions on educational competencies varied significantly depending on the viewpoints of clinical residents, interns, and attending physicians. In Hospital 2, the findings revealed that 27% of residents, 65% of interns, and 27% of attending physicians held the belief that the absence of residents during morning report sessions has an impact on educational competencies. The influence of morning report sessions on educational competencies exhibited notable variations according to the perspectives of clinical residents, interns, and attending physicians (Table 5).
Table 5
) The views of the participants regarding the impact of morning report sessions on educational capabilities in hospitals 1 and 2
| Hospital 1 | Hospital 2 |
Questions | Physicians Frequency (%) | Interns Frequency (%) | Questions | Physicians Frequency (%) | Interns Frequency (%) | Questions |
Strengthen presentation skills | 24(66.7) | 38(58.5) | 16(84.2) | 16(44.4) | 43(81.1) | 7(46.7) |
Direct self-learning | 24(66.7) | 38(58.5) | 16(84.2) | 13(36.1) | 35(66) | 2(13.3) |
Problem Solving | 17(47.2) | 14(21.5) | 5(26.3) | 10(27.8) | 41(77.4) | 7(46.7) |
Successfully leading group meetings | 11(30.6) | 9(13.8) | 14(73.7) | 4(11.1) | 22(41.5) | 3(20) |
Participation in the discussion | 11(30.6) | 12(18.5) | 9(47.4) | 14(38.9) | 44(83) | 7(46.7) |
Developing mental curiosity | 22(61.1) | 8(12.3) | 15(78.9) | 10(27.8) | 31(58.5) | 1(6.7) |
Research skills | 14(38.9) | 11(16.9) | 8(42.1) | 4(11.1) | 20(37.7) | 2(13.3) |
How to use evidence in diagnosis and treatment | 4(11.1) | 4(6.2) | 3(15.8) | 8(22.2) | 39(73.6) | 3(20) |
Average total score | 16 ± 4.12(44) | 17 ± 2.67(26) | 11 ± 2.87(57) | 10 ± 2.41(27) | 34 ± 6.15(65) | 4 ± 2.12(27) |
p-value | 0.001 | 0.001 |
Interns at Hospital 1 and Hospital 2 reported differing levels of satisfaction with the quality of morning report sessions. Interns at Hospital 1 reported low satisfaction rates across various aspects, including presentation quality (31%), focused discussions (14%), professional commitment (47%), evidence-based medical discussions (44%), critical thinking-related topics (22%), patient introduction and discussion linkage (43%), participation level (47%), time management (44%), quality of their involvement (22%), patient types (43%) and patient introduction strategies (22%) (Table 6). In relation to the evaluation of the attainment of morning report session objectives, interns at Hospital 2 demonstrated the highest level of accomplishment in the absence of residents, achieving an 84% satisfaction rate (Table 7).
Table 6
) The views of the interns regarding the quality of the morning report sessions
Question | Hospital interns 1 | Hospital interns 2 |
Poor | Moderate | Excellent | Poor | Moderate | Excellent |
Quality of content presentation | History | 2(3) | 28(42.4) | 33(50) | 2(3.8) | 24(45.3) | 27(50.9) |
Physical examination | 4(6.3) | 39(60.9) | 21(32.8) | - | 25(47.2) | 28(52.8) |
Assessment | 8(12.9) | 42(67.7) | 12(19.4) | - | 22(41.5) | 31(58.5) |
Diagnosis, treatment and follow-up program | 12(18.8) | 33(51.6) | 19(29.7) | 3(5.7) | 15(28.3) | 35(66) |
Discussion focused on | Physiopathology | 40(62.5) | 22(34.4) | 2(3.1) | 12(22.6) | 23(43.4) | 18(34) |
Differential Diagnosis | 9(14.1) | 35(54.7) | 20(31.3) | - | 18(34) | 35(66) |
Diagnostic indicators | 10(15.9) | 39(61.9) | 14(22.2) | - | 17(33.3) | 34(66.7) |
Follow-up and treatment indicators | 19(29.7) | 37(57.8) | 8(12.5) | 3(5.7) | 25(47.2) | 25(47.2) |
Follow up | 22(34.9) | 29(46) | 12(19) | 21(39.6) | 26(49.1) | 6(11.3) |
Professional commitment and ethics | Risks and costs of paraclinical treatment | 32(50) | 26(40.6) | 6(9.4) | 16(30.2) | 23(43.4) | 14(26.4) |
Social issues related to the patient | 35(54.7) | 25(39.1) | 4(6.3) | 14(26.4) | 21(39.6) | 18(34) |
Topics related to evidence-based medicine | 16(27.1) | 38(64.4) | 5(8.5) | 5(9.6) | 25(48.1) | 22(42.3) |
Topics related to critical thinking | 24(40) | 32(53.3) | 4(6.7) | 5(9.6) | 21(40.4) | 26(50) |
The relationship between the discussed topics and the introduced patient | 11(20) | 30(54.5) | 14(25.5) | 1(2.1) | 20(41.7) | 27(56.3) |
The amount of participation in the discussion | Intern | 39(83) | 4(8.5) | 4(8.5) | 8(28.6) | 12(42.9) | 8(28.6) |
Intern | 32(51.6) | 19(30.6) | 11(17.7) | 6(12.2) | 20(40.8) | 23(46.9) |
Physician | 3(4.9) | 23(37.7) | 35(57.4) | 3(6.8) | 15(34.1) | 26(59.1) |
Resident | 9(15) | 28(46.7) | 23(38.3) | 6(21.4) | 12(42.9) | 10(35.7) |
fellowship | 10(16.9) | 23(39) | 26(44.1) | 6(21.4) | 8(28.6) | 14(50) |
Time Management | Scheduling of meetings | 12(21.8) | 29(52.7) | 14(25.5) | 1(2) | 25(49) | 25(49) |
Keeping priorities in mind | 15(27.8) | 28(51.9) | 11(20.4) | 9(17.3) | 18(34.6) | 25(48.1) |
Quality of participation | Involvement of all students | 37(67.3) | 11(20) | 7(12.7) | 8(15.4) | 20(38.5) | 24(15.4) |
Appropriate management of challenges | 25(45.5) | 22(40) | 8(14.5) | 3(5.9) | 26(51) | 22(43.1) |
Creating a research field | 38(70.4) | 13(24.1) | 3(5.6) | 18(36) | 17(34) | 15(30) |
Ask open-ended questions that require thinking | 28(52.8) | 22(41.5) | 3(5.7) | 6(11.8) | 25(49) | 20(39.2) |
Type of patient | New items | 10(19.6) | 25(49) | 16(31.4) | 9(19.6) | 26(56.5) | 11(23.9) |
Common cases | 24(44.4) | 20(37) | 10(18.5) | 3(6.1) | 20(40.8) | 26(53.1) |
Patients last night | 2(3.8) | 24(45.3) | 27(50.9) | 1(2) | 23(46.9) | 25(51) |
Patient with past complications | 16(32.7) | 28(57.1) | 5(10.2) | 2(4.3) | 32(69.6) | 12(26.1) |
Patient referral strategy | Traditional and differential diagnosis | 7(14.9) | 28(59.6) | 12(25.5) | 2(4.2) | 25(52.1) | 21(43.8) |
Problem-based reporting | 8(17.8) | 29(64.4) | 8(17.8) | 3(6) | 26(52) | 21(42) |
Both | 6(17.6) | 19(55.9) | 9(26.5) | 1(2.4) | 25(61) | 15(36.6) |
Mean of total sum | 18 ± 2.43(31) | 27 ± 4.17(47) | 13 ± 4.12(22) | 6 ± 3.12(14) | 21 ± 7.32(44) | 22 ± 6.12(43) |
Table 7
) The views of the interns regarding the evaluation of the realization of the objectives of the morning report sessions
Questions | Hospital 1 (with the presence of professors) | Hospital 2 (without the presence of professors) |
Communication skill | 35(64.8) | 47(92.2) |
Create information for the medical team | 38(71.7) | 49(94.2) |
Management of the education department | 20(37) | 44(86.3) |
Strengthen reasoning/critical thinking | 19(35.2) | 40(78.4) |
Strengthen decision-making skills | 26(48.1) | 46(88.5) |
Creating research context | 8(15.1) | 27(54) |
Motivation in education Students | 12(22.2) | 40(76.9) |
Ethics | 23(42.6) | 41(78.8) |
Professional communication | 20(37) | 44(84.6) |
Evidence-based medicine | 30(55.6) | 45(88.2) |
Expression of scientific findings | 41(75.9) | 51(98.1) |
Average total sum | 25 ± 3.16(46) | 43 ± 7.43(84) |