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.
Teach at the bedside! Osteoarthritis is a common problem in both inpatients and outpatients, even if it is not the presenting complaint. Review with your learners the essential history and physical examination elements for osteoarthritis of the hip, knee, and hand. Practice examining the joints. Use the information in Table 1 of a recent In the Clinic: Osteoarthritis to help prepare.
Ask your learners what the major risk factors are for osteoarthritis. Can it be prevented, and which modifiable risk factors are most important to address? What is the differential diagnosis of osteoarthritis? The answers may also be found in In the Clinic: Osteoarthritis.
The investigators of this trial found that although participants in the intervention group more often received referrals for specific osteoarthritis treatments, the number of participants who actually received these treatments did not increase. Why do your learners think that may have happened? What are the barriers?
The “intervention” in this trial combined actions directed at health providers and the patients. Implementing interventions found to be effective can be costly. Ask your learners if the design of this study allows one to discern between the effects of the patient and the provider interventions. How would they design a follow-up study to do that? Discuss what a “2×2 trial” involves.
Review how to place a purified protein derivative (PPD). If permissible, have your learners practice on each other using normal saline. How deep should the infiltration be made?
How is a PPD test read? When? Review how to interpret the results. How do the cutoffs for positive results differ according to the patient's risk factors?
Ask your learners when they place a PPD, and whether they have ordered an interferon-γ release assay. What do the results of each indicate? Review the limitations of each, as outlined in this paper. Which test do your learners think they should use when evaluating a patient for possible latent tuberculosis?
What is the purpose of screening for latent tuberculosis? Does the PPD have a role in the evaluation of possible active tuberculosis?
Start a teaching session with a multiple-choice question! We've provided one below. What information regarding a patient's history and treatment of a childhood cancer is needed to provide appropriate care in adulthood? Use In the Clinic: Care of the Adult Cancer Survivor to find the answers.
This study found a substantial number of adult survivors of childhood cancer had asymptomatic cardiac abnormalities. Although further study is required to assess whether screening for cardiac abnormalities will result in improved outcomes, should the results of this study alter your learners' approach to monitoring patients with a history of childhood cancer?
In addition to cardiac conditions, what pulmonary, cognitive, bone health, sexual, and reproductive issues should your learners consider in these patients? What is the risk for secondary cancer, and how should this be addressed? These issues are also discussed in In the Clinic: Care of the Adult Cancer Survivor.
Intersperse your teaching session with the other multiple-choice questions provided with In the Clinic: Care of the Adult Cancer Survivor to introduce important topics for discussion. Be sure to log in and enter your answers to claim CME for yourself!
Teach your learners the meaning of several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Each is defined in the paper's table.
Ask your learners what the current incentives are in the provision of care.
Break your learners into 2 groups and have them debate the pros and cons of a fee-for-service model and reimbursements based on the quality of care. What are the benefits and the potential unintended consequences of each?
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Taichman DB. Annals for Educators - 19 January 2016. Ann Intern Med. 2016;164:ED2. doi: 10.7326/AFED201601190
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Published: Ann Intern Med. 2016;164(2):ED2.
Cancer Survivorship, Cardiology, Hematology/Oncology, Infectious Disease, Mycobacterial Infections.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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