Original Research

Are Text Pages an Effective Nudge to Increase Attendance at Internal Medicine Morning Report Conferences? A Cluster Randomized Controlled Trial

Fed Pract. 2023 October;40(10):352 | doi:10.12788/fp.0423

References

1. Daniels VJ, Goldstein CE. Changing morning report: an educational intervention to address curricular needs. J Biomed Educ. 2014;2014:1-5. doi:10.1155/2014/830701

2. Parrino TA, Villanueva AG. The principles and practice of morning report. JAMA. 1986;256(6):730-733. doi:10.1001/jama.1986.03380060056025

3. Wenger NS, Shpiner RB. An analysis of morning report: implications for internal medicine education. Ann Intern Med. 1993;119(5):395-399. doi:10.7326/0003-4819-119-5-199309010-00008

4. Ways M, Kroenke K, Umali J, Buchwald D. Morning report. A survey of resident attitudes. Arch Intern Med. 1995;155(13):1433-1437. doi:10.1001/archinte.155.13.1433

5. McDonald FS, Zeger SL, Kolars JC. Associations of conference attendance with internal medicine in-training examination scores. Mayo Clin Proc. 2008;83(4):449-453. doi:10.4065/83.4.449

6. FitzGerald JD, Wenger NS. Didactic teaching conferences for IM residents: who attends, and is attendance related to medical certifying examination scores? Acad Med. 2003;78(1):84-89. doi:10.1097/00001888-200301000-00015

7. Smith J, Zaffiri L, Clary J, Davis T, Bosslet GT. The effect of paging reminders on fellowship conference attendance: a multi-program randomized crossover study. J Grad Med Educ. 2016;8(3):372-377. doi:10.4300/JGME-D-15-00487.1

8. Sheeran P, Webb TL. The intention-behavior gap. Soc Personal Psychol Compass. 2016;10(9):503-518. doi:10.1111/spc3.12265

9. McDonald RJ, Luetmer PH, Kallmes DF. If you starve them, will they still come? Do complementary food provisions affect faculty meeting attendance in academic radiology? J Am Coll Radiol. 2011;8(11):809-810. doi:10.1016/j.jacr.2011.06.003

10. Segovis CM, Mueller PS, Rethlefsen ML, et al. If you feed them, they will come: a prospective study of the effects of complimentary food on attendance and physician attitudes at medical grand rounds at an academic medical center. BMC Med Educ. 2007;7:22. Published 2007 Jul 12. doi:10.1186/1472-6920-7-22

11. Mueller PS, Litin SC, Sowden ML, Habermann TM, LaRusso NF. Strategies for improving attendance at medical grand rounds at an academic medical center. Mayo Clin Proc. 2003;78(5):549-553. doi:10.4065/78.5.549

12. Tarabichi S, DeLeon M, Krumrei N, Hanna J, Maloney Patel N. Competition as a means for improving academic scores and attendance at education conference. J Surg Educ. 2018;75(6):1437-1440. doi:10.1016/j.jsurg.2018.04.020

13. Thaler RH, Sunstein CR. Nudge: Improving Decisions About Health, Wealth, and Happiness. Rev. and Expanded Ed. Penguin Books; 2009.

14. Weijers RJ, de Koning BB, Paas F. Nudging in education: from theory towards guidelines for successful implementation. Eur J Psychol Educ. 2021;36:883-902. Published 2020 Aug 24. doi:10.1007/s10212-020-00495-0

15. Wieland ML, Loertscher LL, Nelson DR, Szostek JH, Ficalora RD. A strategy to reduce interruptions at hospital morning report. J Grad Med Educ. 2010;2(1):83-84. doi:10.4300/JGME-D-09-00084.1

16. Witherspoon L, Nham E, Abdi H, et al. Is it time to rethink how we page physicians? Understanding paging patterns in a tertiary care hospital. BMC Health Serv Res. 2019;19(1):992. Published 2019 Dec 23. doi:10.1186/s12913-019-4844-0

17. Fargen KM, O’Connor T, Raymond S, Sporrer JM, Friedman WA. An observational study of hospital paging practices and workflow interruption among on-call junior neurological surgery residents. J Grad Med Educ. 2012;4(4):467-471. doi:10.4300/JGME-D-11-00306.1

18. Chick RC, Clifton GT, Peace KM, et al. Using technology to maintain the education of residents during the COVID-19 pandemic. J Surg Educ. 2020;77(4):729-732. doi:10.1016/j.jsurg.2020.03.018

Limitations

This study has some limitations. First, it was conducted at a single VA medical center. An additional limitation was our decision to classify learners who arrived after 8:10 am as absent, which likely underestimated total conference attendance. Further, we did not record whether learners stayed until the end of the conference. Additionally, many hospitals are transitioning away from pagers in favor of mobile phones; however, we have no reason to expect that the device on which a reminder is received (pager or phone) should affect the generalizability of these results.

Unfortunately, due to the COVID-19 pandemic and the suspension of in-person conferences, our study ended earlier than anticipated. This resulted in an imbalance of morning report conferences that occurred during each period: 55% during the intervention period, and 45% during the control period. However, because we accounted for the clustering of conference attendance behavior within individuals in our model, this imbalance is unlikely to introduce bias in our estimation of the effect of the intervention.

Another limitation relates to the evolving landscape of educational conferences in the postpandemic era.¹⁸ Whether our results can be generalized to increase virtual conference attendance is unknown. Finally, it is not clear whether a 4% absolute increase in conference attendance is educationally meaningful or justifies the effort of sending a reminder page.

Conclusions

In this cluster randomized controlled trial conducted at a single VA medical center, reminder pages sent 5 minutes before the start of morning report conferences resulted in a 4% increase in conference attendance. Our results suggest that reminder pages are one strategy that may result in a small increase in conference attendance, but whether this small increase is educationally significant will vary across training programs applying this strategy.

Acknowledgments

The authors are indebted to Kenneth J. Mukamal and Katharine A. Robb, who provided invaluable guidance in data analysis. Todd Reese assisted in data organization and presentation of data, and Mark Tuttle designed the facesheet. None of these individuals received compensation for their assistance.

References

1. Daniels VJ, Goldstein CE. Changing morning report: an educational intervention to address curricular needs. J Biomed Educ. 2014;2014:1-5. doi:10.1155/2014/830701

2. Parrino TA, Villanueva AG. The principles and practice of morning report. JAMA. 1986;256(6):730-733. doi:10.1001/jama.1986.03380060056025

3. Wenger NS, Shpiner RB. An analysis of morning report: implications for internal medicine education. Ann Intern Med. 1993;119(5):395-399. doi:10.7326/0003-4819-119-5-199309010-00008

4. Ways M, Kroenke K, Umali J, Buchwald D. Morning report. A survey of resident attitudes. Arch Intern Med. 1995;155(13):1433-1437. doi:10.1001/archinte.155.13.1433

5. McDonald FS, Zeger SL, Kolars JC. Associations of conference attendance with internal medicine in-training examination scores. Mayo Clin Proc. 2008;83(4):449-453. doi:10.4065/83.4.449

6. FitzGerald JD, Wenger NS. Didactic teaching conferences for IM residents: who attends, and is attendance related to medical certifying examination scores? Acad Med. 2003;78(1):84-89. doi:10.1097/00001888-200301000-00015

7. Smith J, Zaffiri L, Clary J, Davis T, Bosslet GT. The effect of paging reminders on fellowship conference attendance: a multi-program randomized crossover study. J Grad Med Educ. 2016;8(3):372-377. doi:10.4300/JGME-D-15-00487.1

8. Sheeran P, Webb TL. The intention-behavior gap. Soc Personal Psychol Compass. 2016;10(9):503-518. doi:10.1111/spc3.12265

9. McDonald RJ, Luetmer PH, Kallmes DF. If you starve them, will they still come? Do complementary food provisions affect faculty meeting attendance in academic radiology? J Am Coll Radiol. 2011;8(11):809-810. doi:10.1016/j.jacr.2011.06.003

10. Segovis CM, Mueller PS, Rethlefsen ML, et al. If you feed them, they will come: a prospective study of the effects of complimentary food on attendance and physician attitudes at medical grand rounds at an academic medical center. BMC Med Educ. 2007;7:22. Published 2007 Jul 12. doi:10.1186/1472-6920-7-22

11. Mueller PS, Litin SC, Sowden ML, Habermann TM, LaRusso NF. Strategies for improving attendance at medical grand rounds at an academic medical center. Mayo Clin Proc. 2003;78(5):549-553. doi:10.4065/78.5.549

12. Tarabichi S, DeLeon M, Krumrei N, Hanna J, Maloney Patel N. Competition as a means for improving academic scores and attendance at education conference. J Surg Educ. 2018;75(6):1437-1440. doi:10.1016/j.jsurg.2018.04.020

13. Thaler RH, Sunstein CR. Nudge: Improving Decisions About Health, Wealth, and Happiness. Rev. and Expanded Ed. Penguin Books; 2009.

14. Weijers RJ, de Koning BB, Paas F. Nudging in education: from theory towards guidelines for successful implementation. Eur J Psychol Educ. 2021;36:883-902. Published 2020 Aug 24. doi:10.1007/s10212-020-00495-0

15. Wieland ML, Loertscher LL, Nelson DR, Szostek JH, Ficalora RD. A strategy to reduce interruptions at hospital morning report. J Grad Med Educ. 2010;2(1):83-84. doi:10.4300/JGME-D-09-00084.1

16. Witherspoon L, Nham E, Abdi H, et al. Is it time to rethink how we page physicians? Understanding paging patterns in a tertiary care hospital. BMC Health Serv Res. 2019;19(1):992. Published 2019 Dec 23. doi:10.1186/s12913-019-4844-0

17. Fargen KM, O’Connor T, Raymond S, Sporrer JM, Friedman WA. An observational study of hospital paging practices and workflow interruption among on-call junior neurological surgery residents. J Grad Med Educ. 2012;4(4):467-471. doi:10.4300/JGME-D-11-00306.1

18. Chick RC, Clifton GT, Peace KM, et al. Using technology to maintain the education of residents during the COVID-19 pandemic. J Surg Educ. 2020;77(4):729-732. doi:10.1016/j.jsurg.2020.03.018

Are Text Pages an Effective Nudge to Increase Attendance at Internal Medicine Morning Report Conferences? A Cluster Randomized Controlled Trial

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