Old Green Tomes

September 10, 2017

Hi everyone,

Three old tomes stand watch over my office, perched atop a bookcase, guarding decades of residency tradition.  They were bound fifty years ago in covers of forest green.  Today their spines are stiff and their pages dry, but the text is clear. They are time capsules, created in the 1960s by Yale Chief Residents who dutifully documented cases from morning report—patients with pneumonia, endocarditis, and heart failure, long past by now—their stories safeguarded for the ages. 

Back then, report served a crucial supervisory function as residents presented their patients to Dr. Beeson. Supervision like that would be superfluous today with our omnipresent ward attendings, but the march of history and tradition carries on.

Today's report serves several purposes.  We dive into medical subjects unimpeded by the time pressure imposed by work rounds.  We work through differential diagnoses, honing our clinical reasoning skills with evidence and logic.  We model succinct presentation skills and foster lucid discussions by adhering to the Yale Way.  Our conversations reinforce standards of patient care, push us to think critically about the value of the tests we order, and to reflect upon our role as internists collaborating with specialists.

Everyone at report has a job to do.  Presenting residents need to tell their stories succinctly and coherently, defend their clinical reasoning, and share what they’ve learned.  Participating residents have to voice their opinions, ask questions, debate when they disagree, and be prepared to respond when called upon.  Chiefs facilitate discussions, give feedback on presentations, ask probing questions, and make crucial teaching points.  Faculty serve as honored guests, making critical corrections and drawing connections when asked,  fostering dialog and sharing pearls of wisdom acquired through years of experience.  At the best reports, everyone talks; sitting passively is not allowed.

Just a little over a month from now, our first residency applicants will join us at report.  Year after year, applicants tell us that the quality of report drives their ranking decisions.  The most talented applicants go where the discussions are lucid, where the residents are bright, and where the faculty and chiefs encourage exploration and debate.

The old green tomes in my office preserve a rich legacy of Yale morning report, which we honor every time we come together at YNHH and the VA.  I like to think that fifty years from now, another Program Director will pause for a moment on a Sunday to look back on our own reports with similar awe.

Enjoy your day, everyone, and please hold in your hearts and minds our friends, families, and colleagues lying in the path of Hurricane Irma,

Mark

Submitted by Mark David Siegel on September 10, 2017