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 - 7 June 2016. Ann Intern Med. 2016;164:ED11. doi: 10.7326/AFED201606070
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Published: Ann Intern Med. 2016;164(11):ED11.
Start a teaching session with a multiple-choice question. We've provided 2 below.
Review calcium homeostasis. Ask how parathyroid hormone affects serum calcium levels.
Ask your learners to list the possible symptoms of hypercalcemia. When is acute management required, and what does it involve? What are the other complications of hyperparathyroidism?
How is hyperparathyroidism diagnosed? How is primary hyperparathyroidism differentiated from secondary causes? What are the secondary causes? Use the information from DynaMed Plus: Hyperparathyroidism (sign in with your ACP membership).
Ask what the treatment options are for hyperparathyroidism. Will the results of this study influence your learners' opinions regarding whether parathyroidectomy or bisphosphonate therapy should be recommended? What are the potential complications of parathyroidectomy? Of medical therapy?
Ask your learners to generate a differential diagnosis of ALF. How should a patient be evaluated? What tests are needed?
What therapies are indicated, and when? What supportive measures are used? When is N-acetylcysteine indicated?
What are the indications for liver transplantation? How is an evaluation for liver transplantation initiated, and what does it involve? If your center does not have a transplantation service, where do you refer patients? Review the outcomes of the center where your patients in need would undergo transplantation (available at this link ). What factors contribute to the differences in outcomes among centers?
Transplantation centers consider medical and social factors (e.g., ongoing substance use disorders and adherence) when deciding whether to offer organ transplantation. Why? How would your learners explain that to a patient or his/her family with such issues?
Ask your learners to define subclinical hypothyroidism.
Watch the patient interview with your learners. Then ask if they would recommend treatment for this patient's subclinical hypothyroidism.
Review the current evidence and guideline recommendations that are concisely summarized at the beginning of the paper that accompanies this feature.
Watch the video of the discussants—one who is in favor of treatment and the other who is not.
Now, what would your learners recommend?
Ask your learners who is at increased risk for breast cancer. What are the options for prevention of breast cancer in woman at high risk? What are their benefits and harms?
Who should be screened for breast cancer, when, and how often? Ask your learners if they order digital mammography? What other approaches to screening are there? Is the addition of tomosynthesis (3-D mammography) beneficial? Are there harms?
Ask why screening for breast cancer is such a contentious issue. Use a recent editorial to help frame your discussion.
Ask your learners to role-play advising a 30-year-old woman at average risk for breast cancer who requests a mammogram because she recently heard on the news that screening might save her life.
Break up a teaching session with the multiple-choice questions provided to introduce important topics. Be sure to log on and enter your answers to earn CME for yourself.
Download the already-prepared teaching slides to help you prepare a teaching session.
Ask your learners to define a conflict of interest.
Ask what purposive sampling is. Why did the researchers use such a technique in this study? What are the advantages to this type of qualitative research? What limitations does it impose on the findings?
In what ways might interactions between practicing clinicians and representatives from drug or device makers be beneficial? In what ways might they be problematic? Might they cause harm?
Do the results of this study surprise your learners? Ask a nurse leader at your institution to discuss whether you have policies that guide nursing interactions with industry representatives. Ask your chief medical officer to explain the policies related to such interactions and physicians.
Ask your learners if any of their own activities might be viewed as potentially conflicting with their role in deciding therapies for their patients. Have they ever received anything (a book, a meal, a reprint of an article) from someone who might have a personal stake in what treatments are provided?
Do your learners think such activities influence their decisions? An often-heard response to such a question is, “I make my own judgments and interactions with pharmaceutical representatives do not influence my practice.” Do your learners think this is true? If so, why do your learners think drug and device makers spend so much money on these activities?
Read the words of this piece aloud to your learners, without showing them the artwork.
Now, have your readers look at the graphics.
How did it make them feel? Did the pictures alter their reaction to the words?
Do your learners have patients with anxiety? Patients with obsessive-compulsive disorder? Did seeing this graphic narrative help them think about how it might affect a patient's daily life?
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Endocrine and Metabolism, Parathyroid Disorders.
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