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.
Start a teaching session with a multiple-choice question. We've provided one below.
Review with your learners the epidemiology of diverticulosis. Is the consumption of certain foods (e.g., popcorn) associated with an increased risk for diverticulosis or diverticulitis? Use the information in DynaMed Plus – Diverticulitis, a benefit of your ACP membership.
Ask your learners what the symptoms of diverticulitis are. What is the differential diagnosis? How is a diagnosis of diverticulitis established? Is a CT scan always needed?
When are antibiotics required, and which ones should be used? Which patients require hospital admission?
What are the complications of diverticulitis? Ask when a surgical consultation is required. Can recurrent bouts be prevented?
The primary end point of this study was the number of “reoperations”—which included stoma reversal. Do your learners think it was appropriate to count stoma reversal (an anticipated sequela of one of the trial's interventions, the Hartmann procedure) as a “reoperation?” Read the authors' thoughts in the Discussion section of their article (pages 142-143), and use the editorialists' comments to help frame your discussion.
Although this randomized trial compared surgical approaches to the management of perforated diverticulitis, internists are frequently involved in the care of these patients. Ask what roles a medical consultant might serve in patients with ruptured diverticulitis.
Ask your learners what advice they give to their patients who are troubled by hot flashes. Use In the Clinic: Perimenopause to help prepare a teaching session, including multiple-choice questions and already prepared teaching slides.
Do your learners ask their patients about the use of “alternative therapies,” such as acupuncture? Do your learners think that they should be asking? Are there possible direct or indirect harms to such practices? How would your learners discuss these issues with their patients?
This trial found no benefit to acupuncture as compared with sham acupuncture for the treatment of hot flashes. Review with your learners what the “sham” treatment involved in this trial. In their discussion, the authors note that “noninsertive” acupuncture is not the ideal “control” for such a trial. Why not? Note also that the treating acupuncturists were not blinded to treatment allocation, although the patients and outcome assessors were. What effect(s) might each of these issues have had on the study's results?
Ask your learners if they are aware of whether their patients have undergone cosmetic surgical procedures. Why might it matter?
Do your learners inquire about breast implants in the evaluation of potential rheumatologic or other systemic symptoms? Do they think they should? Why or why not?
How would your learners design a registry to help more definitively answer the questions for which available evidence fails to provide confident answers? Read the editorials and the researchers' discussions to provide ideas for discussion. What does the often-cited phrase “Absence of evidence is not evidence of absence” mean? Is that applicable here?
Ask your learners why it is important to differentiate an isolated seizure from epilepsy. How do the differential diagnoses differ?
What evaluation should be pursued following a first seizure? Following a “breakthrough” seizure? When is an electroencephalogram (EEG) needed? When and what imaging is required? What other tests and why?
Arrange for a neurologist to review EEG readings with your team.
Ask whether epilepsy can be prevented. What treatments are effective? How are pharmacologic therapies chosen? When are other therapies, such as surgery or devices (e.g., vagus nerve stimulators), to be considered? What safety concerns need to be discussed (e.g., precautions related swimming, stairs, street crossing).
What responsibilities do physicians have regarding driving restrictions for patients with epilepsy? What are the laws in your state regarding driving by patients with epilepsy?
Are your learners familiar with sudden unexpected death in epilepsy (SUDEP)? How should this be discussed? The authors note addressing modifiable risks (e.g., drug adherence).
Use the already prepared teaching slides and the multiple-choice questions provided to help introduce new topics as you proceed through a teaching session. Sign on and enter your responses to earn CME for yourself!
Review the adult immunization schedule with your learners.
Ask what is new this year. The authors point these items out in the introduction (e.g., an interval change for the 13-valent pneumococcal conjugate vaccine, serogroup B meningococcal vaccination for persons at increased risk, the addition of 9-valent human papillomavirus vaccine).
Who checks on whether patients in your practice are up-to-date with immunizations? Do your learners know where this should be documented? Do your learners think the system works well to ensure your patients are protected? How might they improve it? Which vaccines are stocked in your practice, and how do your learners provide them if not stocked?
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Taichman DB. Annals for Educators - 2 February 2016. Ann Intern Med. ;164:ED3. doi: 10.7326/AFED201602020
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Published: Ann Intern Med. 2016;164(3):ED3.
Gastroenterology/Hepatology, Infectious Disease, Prevention/Screening, Vaccines/Immunization.
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