Ingenuity, Sweat and Software:
The Birth of a New Medical Training Tool

By Steve Townsend

Each morning, internal medicine residents and attending physicians at teaching hospitals across the country begin the new day by coming together in a uniquely American medical tradition known as Morning Report. This sharing of ideas gives residents the chance to present to their peers any admissions they’ve gotten over the past 24 hours. At the same time, they gain invaluable insights from the years of experience of the department’s general internists and sub-specialists.

According to Wayne State University School of Medicine Associate Dean Robert Frank, Morning Report is more than just a tradition; it is the single most important event of the day in any academic internal medicine unit. “We can teach students all we want to in the classroom,” said Dr. Frank. “But none of it really sinks in until they have that vital patient contact. The learning curve really starts to take off when students are able to mentally link a situation with a specific patient.”

Now, thanks to the efforts of a handful of Wayne State University School of Medicine faculty members, medical students, residents and practicing physicians throughout the world can experience the benefits of Morning Report by logging onto Morning Report Reviews, a website that offers users the chance to work through actual cases that have been presented in the internal medicine department at Detroit Receiving Hospital.

Traditional morning rounds bring students and faculty members together to discuss interesting patient cases.

Morning Report Reviews features four to six new cases every other month that have been carefully chosen for their training merit, and have been peer-reviewed by WSU internists. Cases come complete with pictures of blood slides, x-rays and other visual aids relevant to diagnosis. After examining a case, users are presented with a question and are asked to enter their answer into an open-ended text box. A system has been installed to search responses for the necessary key words, and to determine whether or not the user is then allowed to move onto the next question.

According to Gurdev Singh, MD, WSU assistant professor of internal medicine, and co-creator of the website, Morning Report Reviews represents a teaching tool that is entirely new to medicine, with Wayne State at the forefront of its application to the field.“There is no other interactive teaching site like this anywhere in the world. Wayne State is the leader in using the available technology in this manner,” Dr. Singh said, adding that his own Internet searches and those of news reporters who have covered this groundbreaking use of technology have uncovered nothing of its kind.

In addition to its obvious use as a training tool for medical students and internal medicine residents, the website also serves as a breakthrough in the application of technology to continuing medical education (CME). After successful completion of a case, practicing physicians can print out a certificate acknowledging CME credit that can be used toward the 50 credits needed each year for re-certification.

Dr. Singh was instrumental in putting morning reports online for wider access.

Ironically, the creators of Morning Report Reviews did not start out with the intention of creating such a technologically unique teaching resource. When they began looking for a way to better present case-specific medical issues to a broad physician and student audience, Dr. Singh and his co-creators, Lavoisier Cardozo, MD, professor and chief of medicine, and Nelia Afonso, MD, assistant professor and director of medical education, assumed that their best means would be a new, paper-based, medical journal.

As the group continued to bounce ideas off one another and their peers, they realized that yet another paper-based journal was not the best vehicle for what they wanted to achieve. “A paper-based journal would be swallowed up by all that is already out there,” Dr. Singh admitted. “We needed to do something different to have the impact we wanted to have. We needed to put it online.”

Not having the technical expertise to make such an idea a reality, the creators hit what could have easily been the downfall of the project when they sent their idea out to the web development market for bids. What they got back were estimated start-up costs ranging from $250,000 to $3 million.

Instead of simply accepting that the concept was financially unfeasible, Dr. Singh went to a local computer store and purchased $500 worth of web development software and instructional literature. With the help of his peers, who covered much of his clinical caseload for the entire month of February, Dr. Singh made himself a web expert and created the website, using “every hour that God gave me.”

The early results of their efforts have been more positive than the creators could have ever imagined. In the first two weeks after its launch, Morning Report Reviews received more than 27,000 hits. In the months since, the website has averaged 2,500 to 3,000 hits from users all over the world.

Acknowledging that a major key to the continued success of the site as an effective learning tool is ease of use, Dr. Singh and his co-creators do not intend to rest on their laurels. A series of improvements are already in the works, including the addition of a user “guest book” and feedback box. “We need to know where our users are coming from and what they think about the site to insure its long term success,” says Dr. Singh.

So far, however, the $500 worth of software and the frustrating February afternoons he spent in front of his computer have been more than justified.

To access Morning Report Reviews, visit: www.mdmorningreport.com