Darren B. Taichman, MD, PhD
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From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University.
Taichman DB. Annals for Educators - 5 January 2016. Ann Intern Med. 2016;164:ED1. doi: 10.7326/AFED201601050
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Published: Ann Intern Med. 2016;164(1):ED1.
Start a teaching session with a multiple-choice question. We've provided one below.
Review with your learners the approach to medical therapy for IBD. Which drugs are used, and what are their potential side effects?
How is disease severity and response to therapy assessed? When is referral required? When are TNF inhibitors indicated? Invite an expert in IBD to help lead your discussion.
Ask what are the dermatologic manifestations of Crohn disease and ulcerative colitis. Review the images of dermatologic lesions seen in this study. What therapies should be tried for each before discontinuation of the TNF inhibitor considered? If the dermatologic problem persists despite therapy, how would your learners weigh the benefits and harms of continued anti-TNF therapy?
Ask your learners how they monitor their patients who receive opioids for chronic pain. What are the alternatives to the use of opioids?
Do your learners know when and how to consider the use of buprenorphine? Invite an expert in chronic pain management to join your discussion.
An editorialist hypothesizes that continuation of these patients' opioids after an overdose may, in part, be due to the prescriber not being made aware of the emergency room visit. Have your learners' patients been seen in the emergency department without them being informed? Ask what systems need to be in place to prevent this from occurring. How might patient safety be affected by such lapses?
Ask your learners what the difference is between “generic substitution” and “therapeutic interchange” (the authors review this on page 42).
Ask your learners whether their patients have ever said that a generic drug did not work as well for them, or that it caused problems. How did they respond?
Are there any situations in which your learners feel they should prescribe a brand-name formulation of a drug when a less expensive, generic version is available?
Role-play with your learners: pretend to be a patient who believes that a generic medicine was “not as strong” or “did not work as well for me.” Perhaps express fear that the “generic medicine” is not as good. What should your learners say, and how will they say it?
Review the normal regulation of thyroid hormone.
Ask your learners what the symptoms of hypothyroidism and hyperthyroidism are.
Ask whether thyroid-stimulating hormone (TSH) alone is adequate for evaluation of the patient with newly diagnosed hypothyroidism? What about a patient already on L-thyroxine monotherapy?
What are the limitations to what the serum TSH tells us about thyroid replacement?
Have your learners encountered patients who report symptoms potentially due to thyroid dysfunction despite a normalized TSH? How do they manage such patients? What are the concerns with increasing the dose of their thyroid replacement?
Use the already prepared teaching slides to plan a teaching session, and use the multiple-choice questions to help introduce topics. Be sure to log on and enter your answers to earn CME credit for yourself.
Ask your learners whether they screen their patients for unhealthy alcohol use. How do they do it? What screening tools are available?
Review the potential adverse health effects of alcohol use. Ask your learners what physical examination findings may suggest unhealthy alcohol use. What laboratory findings might be useful?
Ask your learners whether they think certain terms (such as “abuse” or “alcoholic”) are useful when discussing alcohol use with a patient. What language should or should not be used? This is discussed in the review.
Listen to an audio recording, read by Dr. Michael LaCombe, with your learners.
Ask your learners if they feel that Dr. Coulehan had been too cautious in recommending against a lung transplant.
Have your learners ever personally enjoyed their interactions with a patient so much that they secretly did not want to consider interventions that might alter it? When might such considerations be wrong? How can they be sure never to allow personal desires to hinder making the best decision for their patients?
Are your learners surprised to hear that Max and Sam credited Dr. Coulehan with her good outcome following transplantation? What might this tell us about the things that matter most to our patients?
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Emergency Medicine, Endocrine and Metabolism, Gastroenterology/Hepatology, Pulmonary/Critical Care, Tobacco, Alcohol, and Other Substance Abuse.
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