A bitter pill: attempting change in a pediatric morning report.

Objective: To assess and address participants' dissatisfaction with departmental morning report (MR).

Methods: Three consecutive MR sessions were observed, and those data, in combination with findings from the literature, were used to guide creation of a quantitative survey. The survey was administered to all faculty and housestaff. Survey items addressed the educational focus, leadership, and format of MR and the value of specific educational conferences. Subsequently, 2 interventions were developed to increase participants' level of satisfaction with MR. The interventions' effect was measured 1 year later using a second survey.

Results: Eighty-two percent of housestaff and 43% of faculty responded to the first survey. Our findings are contrary to those in the literature. For example, respondents rated the presence of all faculty at MR as desirable, and both subspecialty and general pediatric contributions were considered important. Housestaff assigned greater educational value to all teaching conferences than did faculty. Similarly, housestaff believed more strongly than faculty that MR leadership should be changed. A follow-up survey demonstrated a decrease in mean perceived value of MR after our interventions.

Conclusions: Despite aggressive research, we failed to identify the source of participants' dissatisfaction. Although our interventions were based on research data and reflected participants' perceptions and concerns related to MR, they were not supported by the faculty. This demonstrates the inherent difficulties in changing an "institution" such as MR. Thus, examination of MR goals and satisfaction by individual training programs should be conducted within the confines of the conference's preexisting structure, without attempt to apply literature-driven expectations.