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 - 3 May 2016. Ann Intern Med. 2016;164:ED9. doi: 10.7326/AFED201605030
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Published: Ann Intern Med. 2016;164(9):ED9.
Start a teaching session with a multiple-choice question. We've provided one below.
Ask your learners what the barriers are to smoking cessation. Are they physical addiction alone?
Review the recent In the Clinic: Smoking Cessation . Review the 5 A's, which recommend that we set a quit date with our patients. Have your learners encountered patients who are interested in cutting down gradually rather than stopping abruptly? What do your learners advise them? What might be the advantages to a firm quit date? To gradually cutting down?
What do the results of this trial tell us about gradually cutting down before quitting? Do the results indicate that cutting down is harmful? Why or why not? If a patient cuts down but does not quit, is that not better than nothing? Is it better than nothing if it interferes with quitting completely? Use the accompanying editorial to help prepare for such a discussion.
This trial used prequit nicotine replacement in the lead-up to the planned quit date. What do your learners teach their patients about when and how to use nicotine replacement?
The Advisory Committee on Immunization Practices currently recommends that eligible hospitalized patients receive the influenza vaccine before discharge. This preventive strategy is measured in quality metrics of inpatient immunization by the Joint Commission and the Centers for Medicare & Medicaid Services. Yet, patients hospitalized for surgical procedures are often not targeted for immunization. Ask your learners why not. What fears might surgeons have about vaccinating their patients? See this paper's introduction for ideas.
When your learners perform medical consults on surgical patients, do they use the opportunity to make recommendations regarding needed immunizations? Do they think that they should? After reading this study, will your learners recommend influenza vaccination for surgical patients they see as medical consultants?
The use of administrative records is common for health services outcomes research. Use this study to help your learners understand the benefits of large administrative databases and why they enable certain kinds of studies that might otherwise be difficult or impossible to conduct, while appreciating their weaknesses.
Review the design of this cohort study. What was the target population? What were the key exposure and key outcomes? How were they measured? Was this a prospective or retrospective cohort? Why does it matter? Look at how the exposure and outcomes were assessed (through administrative records). What limitations might this place on their ascertainment?
Break up a teaching session using the multiple-choice questions provided to introduce key topics. Be sure to log on after and enter your answers to earn CME for yourself.
Ask your learners what they should advise their patients regarding prevention. Is there a role for prophylactic antibiotics for patients in high-risk situations? See the answer in the review.
Review the potential clinical manifestations of Lyme and the differential diagnosis (see the Table). How is Lyme diagnosed?
How should Lyme be treated? Can a person be infected more than once?
Why is there controversy over “chronic Lyme disease”? Review the epidemiologic material and randomized studies presented in this section of the In the Clinic review. What do your learners think? Role-play talking to a patient with a prior exposure who requests treatment for “chronic Lyme disease” to help with fatigue. What will your learners say?
Download the already-prepared teaching slides to help present material to your learners.
Ask your learners if they know how air quality is measured, and what it means when they hear on the news that it is poor on a given day. Do they know what the Air Quality Index (AQI) is, and how to interpret it? Do they consider what the AQI might mean for their patients with respiratory disease? Cardiovascular disease? Those who are pregnant?
Go to the authors' Web site (Outdoor Air Quality and Health ). Review the information provided on the adverse health effects of poor air quality. Pay particular attention to the charts and figures that provide advice to patients regarding changes to activities according to the AQI.
Review briefly the actions called for by the ACP regarding climate change. Do your learners believe that such statements are useful? Do they really influence change or governmental actions? Do they believe that physician groups should be involved? Do they think that your health system, and they individually, can influence change? Could your system emulate what the editorialists have done? Would your learners like to make a plan? To whom should they talk?
Play an audio recording of this On Being a Doctor, read by Associate Editor Dr. Michael LaCombe.
Ask your learners whether they worry that burnout might affect them.
What conditions contribute to burnout? Which can we control? Which are out of our control? Can we learn skills to help us deal with these conditions and our reactions to them in a manner that is helpful?
Dr. Lynes notes that he never sought the help of his colleagues. Why might that happen? Is there anything about the culture of medical practice that might make physicians feel “weak” in admitting such feelings to colleagues? Does that contradict with the advice we give our own patients? How can we change that?
Invite a mental health professional to join your discussion. What advice might help us help ourselves and each other deal with the fact that, as Dr. Lynes puts it, “The life of a physician is stressful, period.”
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Cardiology, Infectious Disease, Tobacco, Alcohol, and Other Substance Abuse, Coronary Risk Factors, Vaccines/Immunization.
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