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.
Ask your learners to define “human trafficking.” Who is at risk? How common is it? Are your learners shocked by the statistics in the paper's introduction? Had they ever thought about this problem occurring in their communities?
What health problems are associated with human trafficking? Use Table 2.
What sorts of complaints are these patients commonly seen for by medical professionals?
The paper quotes a study that found that >85% of female survivors of exploitation had been evaluated by a medical provider at least once before, without identification of the problem. Might we be missing the clues? What clues might help us identify a victim of trafficking? Review Table 3 with your learners.
How should we approach potential victims? Note the author's caution regarding the potential harms of an aggressive pursuit of victim disclosure. What is the best approach? Who should be called to help? Note the resources provided in Table 5.
What is “trauma-informed care”? How might our own reactions—even anger—at the “negative” behavior of trauma victims impede the provision of care, and even cause harm?
Does your health system have a system to help identify and aid victims of human trafficking? If so, ask someone familiar with this program to talk to your learners about available resources. If not, ask your learners to organize action within your system. How will they start, and how will they set goals to make sure their effort does not “fall through the cracks”?
Start a teaching session with a multiple-choice question. We've provided one below!
Ask a radiologist to supply images from an abdominal CT in which an adrenal mass is present. See if your learners are able to identify the abnormality.
Ask them what, if any, evaluation they would perform if this lesion was identified incidentally in a 35-year-old patient whose CT was obtained for evaluation for possible appendicitis. What is meant by an “incidentaloma”?
What tests should be ordered to establish whether an adrenal mass is functional or nonfunctional?
Ask your learners how they would design a study to assess whether “nonfunctional” adrenal tumors increase the risk for cardiometabolic outcomes. Now, review how the authors assembled this cohort study (use Figure 1 to help explain).
All studies have limitations. What assumptions had to be made in this study's design, and what limitations do they impose on the findings? The authors outline these nicely for you in the paper's discussion section.
Review the findings (show Figure 2). How do they change our thinking about “nonfunctional” adrenal tumors? What would your learners suggest be done next to study the potential health implications of such lesions?
Ask your learners if they think their patients would be upset if asked about firearms in their homes. Review the results of this study. Do they surprise your learners? Do they think that patients might actually appreciate being asked?
Do your learners think they should be asking? Why or why not? Use a recent paper that discusses in whom this should be considered, and how to go about it.
Pretend you are a patient and ask your learners to inquire about guns in your home. How will they bring up the subject? How will they respond if you act offended by the question? Are they able to focus the discussion on the health reasons for addressing the issue, rather than on political views?
Play an audio recording of the essay, read by Dr. Michael LaCombe.
Ask your learners what warning signs might signal that a professional colleague might be suffering from burnout. How might physician burnout pose a risk to patients?
Ask the same questions for depression and for substance abuse.
How should we respond when we think a colleague is in trouble and in need of help? Do we have a right or obligation to prod? What resources are available?
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Darren B. Taichman. Annals for Educators - 18 October 2016. Ann Intern Med. 2016;165:ED8. doi: 10.7326/AFED201610180
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Published: Ann Intern Med. 2016;165(8):ED8.
Adrenal Disorders, Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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