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 - 1 March 2016. Ann Intern Med. 2016;164:ED5. doi: 10.7326/AFED201603010
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Published: Ann Intern Med. 2016;164(5):ED5.
Start a teaching session with multiple-choice question 1 below.
Ask your learners to list the ways in which depression might present. How is a diagnosis established? Should we screen for depression?
How would your learners explain the advantages and disadvantages of pharmacologic and cognitive behavioral therapies to their patients? What factors would they discuss to help decide which is best for each patient?
What are the potential side effects of second-generation antidepressants?
What does cognitive behavioral therapy involve, and how is it arranged for a patient? Invite a therapist to join your discussion, or if possible, arrange for your learners to observe a therapy session.
Now, pose multiple-choice question 2 below to your learners. Ask how your learners monitor their patients' response to depression therapy. When should a change in treatment be considered?
Ask your learners to list the health benefits of smoking cessation, and over what time frame they are likely to occur. Use the information contained in the Box to answer.
What are the 5 A's? Do your learners know how to do each?
What pharmacologic and nonpharmacologic aids should be considered to assist in smoking cessation? What are the side effects of the drugs used? How effective are they? Use the information in the Table.
What adverse effects might a patient encounter upon quitting (e.g., weight gain, depression)?
Ask your learners what approach should be taken to smoking cessation in a pregnant woman.
What are the arguments in favor of or against electronic cigarettes as alternatives to combustible cigarettes? Use the concise discussions in a recent pro/con debate (Bartter and Drummond).
Use the already provided multiple-choice questions to introduce topics throughout a teaching session. Log on and enter your answers to earn CME for yourself! Download the teaching slides to help you prepare a teaching session.
Watch the short video, and ask your learners if they have discovered other “hidden” misconceptions regarding a disease or its therapy that impeded a patient's adherence to appropriate therapy.
What might this short video teach us about how to approach a patient's nonadherence? What questions should we be asking?
Teach at the bedside! Ask a patient who uses insulin if s/he would mind discussing with your team the worries s/he had prior to its initiation. How did things work out?
Consider combining the use of this video with a recent, related Annals Graphic Medicine: The Daily Grind: A Day in the Life of Someone Living With Diabetes about the same patient earlier in the course of his diabetes. Start with this video, and discuss the burdens of living with a chronic disease. Ask your learners whether they think they could keep up with the regimens we commonly prescribe. And, here too, discuss how important issues that impede adherence might remain hidden if we don't probe.
Watch this short video in which Dr. Travis Baggett describes the unexpected outcome of his interaction with a homeless man at a shelter.
Ask your learners whether they ever feel helpless themselves when confronting a patient for whom the prospect of “improvement” seems hopeless. Is there truly ever a situation in which there is no way to help a patient start along a better path?
Have your learners ever found themselves doing something unexpected with or for a patient? What? How did it turn out?
Why do your learners think Dr. Travis' actions might have affected his patient so?
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Cardiology, Endocrine and Metabolism, Diabetes, Tobacco, Alcohol, and Other Substance Abuse, Ethics.
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