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 - 21 June 2016. Ann Intern Med. 2016;164:ED12. doi: 10.7326/AFED201606210
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Published: Ann Intern Med. 2016;164(12):ED12.
Start a teaching session with a multiple-choice question. We've provided one below.
Ask your learners how aspirin works. How does its effect on cyclooxygenase and subsequent molecules relate to the pathogenesis of cardiovascular events? How is aspirin thought to reduce the risk for colorectal cancer? How does aspirin increase the risk for gastrointestinal (GI) bleeding?
Review the Task Force's recommendations for using aspirin to prevent cardiovascular disease and colorectal cancer. Ask your learners why the recommendations target, among other criteria, patients willing to take aspirin for at least 10 years.
Will your learners recommend aspirin to their patients? Which ones? At what dose? See what an editorialist has to say.
The Task Force estimates cardiovascular risk using the ACC/AHA pooled cohort equations but notes the lack of well-validated tools to identify those at heightened risk for GI bleeding. How will your learners evaluate this risk?
These reviews and guideline focused on the risk for GI bleeding. What other adverse events may occur with aspirin use?
Ask your team why a patient's occupation might be relevant in the evaluation of hematuria.
Then watch this short video with your team.
What is the differential diagnosis of microscopic hematuria? How should patients be evaluated? Do all patients require an evaluation for possible malignancy? Use a recent concise and practical review to prepare.
Log in and answer the brief multiple-choice questions associated with this video to earn CME for yourself!
Ask your learners why Medicaid expansion has occurred in some, but not all, states under the ACA. Why does it matter?
Why is this study characterized as “quasi-experimental”? The authors used a “difference-in-difference” design to compare changes in patient outcomes in expansion and nonexpansion states before and after the Medicaid expansions. Ask your learners to explain how such an analysis works. How does it help to mimic a randomized trial?
Could a randomized trial of Medicaid expansion be performed? Do your learners think it would be ethical?
What key questions remain to be answered in assessing the success of Medicaid expansion? Use the accompanying editorial to help frame your discussion.
The editorialist notes that until now states' decisions regarding whether to expand Medicaid under the provisions of the ACA have been based largely on opinion rather than fact. Support for (or opposition to) the ACA and its provisions is a divisive political issue. Do your learners feel that they have a role (or responsibility) to play as physicians in this debate? When, and in what ways, is it appropriate to use our “physician title” to interject our opinions?
Find articles for use at a journal club.
You may also search by topic for journal club articles, and ideas on how to use them, at Annals Teaching Tools
Assign members of your team to read a single article summary from ACP Journal Club, and to concisely summarize the key points during teaching rounds. Remind them to pay attention to their chosen study's limitations—an important habit to develop as they learn to read the medical literature.
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Cardiology, Coronary Risk Factors, Prevention/Screening.
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