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 - 2 August 2016. Ann Intern Med. 2016;165:ED3. doi: 10.7326/AFED201608020
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Published: Ann Intern Med. 2016;165(3):ED3.
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners if they think the presence of firearms in the home poses a risk to patients or their families. Who is at increased risk for firearm-related violence? What are the risk factors for suicide? The authors review the answers to each.
Ask what firearm storage practices increase and decrease the risk for accidental harm to children in the home. These also are reviewed in this paper.
Have your learners ever asked their patients about the presence of firearms in their homes? Why or why not? What do they know about physician “gag laws”? Review the concise discussion in this paper and explain that physicians are permitted to discuss firearms when they think it is important for their patients' safety, even where such laws have been enacted. Why is this important? Use the accompanying editorial to help frame your discussion.
Would your learners be comfortable asking and counseling patients about firearm safety? Is a lack of experience in this area an acceptable excuse for not doing so? In what other potentially “difficult” areas, or subjects about which your learners have no personal hands-on experience, have they learned to counsel patients (e.g., intravenous drug use, risky sexual behavior, or end-of-life care)? Should firearm-related safety be any different?
How can your learners learn to effectively counsel patients? Look at the resources listed in Table 5. For example, go the “Means Matter” Web site, quickly register and start the online course for health care providers, “Counseling on Access to Lethal Means” (CALM). Use the precourse questions to assess your learners' knowledge and help focus their attention to important points as they view the free online program.
Ask your learners what is known about the transmission of ZIKV. What important information do we lack?
What other diseases are transmitted by mosquitoes?
How would your learners counsel a patient who is considering a trip to Brazil? What should patients returning from an area at high risk for ZIKV exposure know regarding the potential for spreading the infection? Are any precautions needed regarding sexual contact upon return home to protect others?
What should our learners advise patients regarding how best to reduce the risk for mosquito bites? Use the recent, concise review that provides targeted, practical advice on avoidance and repellants.
Watch the patient interview with your learners. Now ask your learners if they would recommend breast cancer prevention for this patient.
Ask who is at heightened risk for breast cancer. How should a patient's risk be assessed? At what risk threshold is consideration of preventive therapy recommended by the U.S. Preventive Services Task Force and by the American Society of Clinical Oncology?
Ask your learners to outline the major points in favor of and against recommending breast cancer prevention medication. How effective are they? What are their side effects? Use the already prepared slides to help you prepare.
Have your learners pretend to explain the risks and benefits to a postmenopausal woman with an estimated 5-year risk for breast cancer of 1% who asks if she should take breast cancer prevention medication.
After reviewing the Grand Rounds discussion, ask your learners what they would recommend to the featured patient.
Be sure to log on to complete the CME questions to earn credit for yourself.
Ask your learners why venous insufficiency increases the risk for ulceration.
Can they name other risk factors?
Download the already prepared teaching slides and show the figures to your learners. Do they know what lipodermatosclerosis is? What about atrophie blanche? What do they signify?
What testing should be considered in patients with venous leg ulcers? When should biopsy be considered?
Practice at the bedside! Have your learners measure each other's ankle-brachial index or that of patients. How is the index calculated, and how are the results interpreted?
How should ulcers be managed? Use Figure 5 to help teach. When are medications needed? When should surgery be considered?
Can recurrence be prevented?
Use the already prepared multiple-choice questions to introduce topics during a teaching session. Be sure to log on and enter your answers to get CME credit for yourself!
Listen to an audio recording of the story, read by On Being a Doctor editor, Dr. Michael LaCombe.
Ask your learners whether they think they could practice in a resource-poor setting, such as the one described in this piece.
Does Vatsala's actions inspire your readers? In what ways?
Does hearing the limitations in available resources described here alter your learners' thinking about our health care system? Should it? Should the fact that others might be in a worse situation vis-à-vis access to treatments alter efforts to improve things at home? Should we feel spoiled? If so, how should we react? Are there patients in your communities whose access is similar to that described in this essay?
Show the cartoon to your learners.
Have any of them had patients or their families express a desire for an approach to end-of-life care similar to that requested by the man illustrated in the comic?
How have your learners responded?
What questions would your learners ask a patient such as the man portrayed here? What do they want to know about the patient's goals? What goal would they have when explaining what resuscitation and life-support measures might or might not be used?
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