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.
Ask your learners to list the indications for ICD placement.
What are the short-term complications? How should a patient be monitored immediately following placement?
Ask your learners to list the potential long-term complications. Review this study's findings.
Will the results of this study alter how your learners discuss the potential benefits and risks of ICD placement with their patients?
Review with your learners the current CDC recommendations for the use of PrEP. In which at-risk patients should PrEP be considered? How effective is it? What are the potential concerns to using PrEP? Use the information in DynaMed Plus: Preexposure Prophylaxis for HIV (a benefit of your ACP membership) to help prepare a teaching session.
How should PrEP be prescribed? How should it be monitored? What are the possible adverse effects of tenofovir and emtricitabine?
Discuss the goals of a cost-effective analysis (CEA) with your learners. What variables need to be considered? How might different assumptions regarding each variable's cost, the prevalence of HIV infection among PWID, and the effectiveness of PrEP influence the conclusions of this CEA? Invite an expert in CEA to join your discussion.
Use a concise primer that explains key terms important to understanding CEAs to help teach what comparative effectiveness, cost-effectiveness, and incremental cost-effectiveness ratios are. What does it mean when one intervention dominates another?
Ask your learners how an analysis such as this one should influence planning for public health programs. Are the estimated costs of PrEP program for PWID worth it? Read the accompanying editorial to help frame your discussion.
Ask your learners what the risk factors are for gout. How does diet affect risk? Does altering intake of certain foods reduce risk?
How is a new diagnosis of gout made? Is joint aspiration always required? What is the differential diagnosis? How does one differentiate from septic arthritis?
How is an acute flare managed? Which patients with gout flare require hospitalization?
Which patients with gout require urate-lowering therapy? Which drugs should be used, when, and how are they monitored? When should allopurinol be used? Feboxostat? What are the potential adverse effects?
Use the already prepared teaching slides.
Use the already prepared multiple-choice questions to introduce various topics during a teaching session. Be sure to log on and answer the questions to earn CME for yourself.
Read the comic with your learners.
Teach at the bedside! Ask your team's patients on morning rounds how they pay for each of their medications. What is their copay? How much does their entire regimen cost each month? Ask each if they ever “cut corners” to try to save money? Is there variation in how much the similar (or same) drugs cost your patients? Were your learners surprised?
Review key sections of the position paper's appendix to identify the variables that affect drug pricing in the U.S. Ask your learners to list them. Why are drug prices higher in the U.S. than elsewhere? Why do costs vary from one patient to another? Do your learners think the recommendations will be enacted? Would they work if they were enacted?
Organize a seminar for residents who are looking for jobs for after training.
Invite physicians who have contracts with your health system for each inpatient and outpatient care to discuss what has surprised them in the “real world” regarding the “business” of being employed by others to provide care.
Review the paper's table with your learners. Why do they think the clauses noted in the table are placed in contracts? Are their good reasons? What are the problems?
Listen to an audio recording of this essay, read by Dr. Michael LaCombe.
Ask your learners how physicians may differ from other patients in their response to having an illness. In what ways can our medical knowledge be an advantage in facing disease? Can it be a burden?
What are frontotemporal dementia and frontotemporal lobar degeneration? What language and behavioral disturbances may be seen? How well (or not) do the symptoms correlate with the anatomical sites of neurodegeneration?
Have your learners ever considered how a lack of clear explanation for one's symptoms might affect a patient? How might it add an additional burden to dealing with illness? Do your learners think Dr. Pordy's intellectual curiosity and his medical training have helped him respond to this illness? How does it inspire them? Might his essay inspire and help some other patients?
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Taichman DB. Annals for Educators - 5 July 2016. Ann Intern Med. ;165:ED1. doi: 10.7326/AFED201607050
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Published: Ann Intern Med. 2016;165(1):ED1.
Cardiology, Neurology, Prevention/Screening, Rhythm Disorders and Devices.
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