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.
Have some of your learners insert cotton balls into their external ear canals (not too far!), and bring in commercial hearing protectors for a few others to wear. Now, ask your learners to generate a differential diagnosis of hearing loss. Be sure to ask those with the cotton balls and hearing protectors questions. Ask them how this made them feel. Were they less sure of themselves when participating in a discussion? Were they frustrated? Were they embarrassed when you asked them questions? Can such an exercise be used to help improve our empathy and attention to such disabilities?
Ask your learners to list the ways in which hearing loss may impair physical and mental health.
Ask what evaluation is appropriate for patients with hearing loss. Use the information in In the Clinic: Hearing Loss to help review, including the already prepared teaching slides.
How do your learners arrange for hearing aids when appropriate for their patients? What services/devices are available, and are they covered by insurance? Invite an expert from ENT and/or audiology to help review with your team what they need to know about arranging care for their patients.
Teach at the bedside! There are likely patients on your service with varying degrees of hearing loss, albeit not likely the reason for hospital admission. Has anyone asked them about it? Ask patients during morning rounds about their hearing. Did your team learn anything they did not know? How might hearing impairment affect each patient's health care and quality of life?
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners to define binge eating, bulimia nervosa, and anorexia. What differentiates them? How are they related? The diagnostic criteria for binge-eating disorder are provided in the appendix of this paper.
What are the potential medical complications of each of these eating disorders? What history and physical examination findings may suggest their presence?
Use the information in DynaMed Plus: Anorexia nervosa and Bulimia nervosa or In the Clinic: Eating Disorders to help with teaching.
Ask your learners how we can encourage healthy weight loss among our overweight and obese patients without reinforcing the feeling of guilt that might contribute to an eating disorder. Might our counseling have unintended consequences? Can we avoid them? Use the accompanying editorial to help frame your discussion.
Ask your learners to list the possible presentations and physical findings in a patient with ovarian cancer.
Should we screen for ovarian cancer? Why not? What are the potential benefits and harms? What characteristics must a potential screening test demonstrate to make it appropriate for use for disease screening? Review the recommendations from the U.S. Preventive Services Task Force
Use the information at DynaMed Plus: Ovarian Cancer and Ovarian Cancer Screening (a benefit of your ACP membership).
Are there patients at sufficiently increased risk for ovarian cancer such that screening is appropriate? How should they be managed? Use this paper to help frame your discussion.
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Taichman DB. Annals for Educators - 20 September 2016. Ann Intern Med. ;165:ED6. doi: 10.7326/AFED201609200
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Published: Ann Intern Med. 2016;165(6):ED6.
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