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 define chronic constipation. See the definition the investigators used for “severe chronic constipation.”
Ask how constipation should be evaluated. What are the common causes? Less common causes? When should tests be performed, and which ones? Use the recent In the Clinic: Constipation for more questions around which to build a teaching session.
What nonpharmacologic and pharmacologic interventions should be considered?
What effect does chronic constipation have on a patient's quality of life? Might it be a major medical problem? Do we pay enough attention to it?
Review the results of this randomized trial. Would your learners consider referring patients for a trial of acupuncture? Do they think patients would adhere to the intervention schedule required in this study? What more needs to be known about the potential of this intervention?
Ask your learners how they decide whether to cease cardiopulmonary resuscitation (CPR) after initial efforts have not been successful.
Is there a uniform approach to making these decisions? If not, is that problematic? Can there be a uniform approach?
Have your learners ever stepped out from “a code” to inform the patient's family members of what is going on? How have they communicated the possible—and likely—outcomes? Have they ever asked family if CPR should be terminated?
Studies have suggested that some family members “benefit” from observing a code performed on their loved one. Is that done at your hospital? How might it be helpful to the family? How might it be harmful? How might it make the physicians feel? Is that important?
The accompanying editorial discusses the problems faced in deciding if and when resuscitative efforts should be redirected toward the goal of preserving organs for donation. What ethical problems might such decisions pose for physicians involved in performing CPR on a patient? How would one balance the ethical obligations to help the patient with obligations to help society? How would this be discussed with a patient's family?
Ask your learners what variables must be considered when evaluating a patient for noncardiac surgery. What information do they need to know about the planned procedure?
Do your learners ask patients about a personal or family history of difficulty with hemostasis? A history of malignant hyperthermia with exposure to anesthetics? Should they be asking about these issues?
Ask your learners whether they routinely order preoperative chest radiography. An ECG? Labs? Should they be? When and what laboratory tests are needed? What should you do if a surgeon insists on a study that is not indicated?
Use the multiple-choice questions provided at the end to help break up a teaching session and introduce new topics for discussion. Be sure to log on and enter your answers to earn CME credit for yourself!
Use the already prepared teaching slides to help run a teaching session.
Ask your learners whether the results of the research study surprise them. Do they surprise you or your colleagues in practice?
Are your trainees concerned about what practicing medicine will be like on a day-to-day basis after residency? Do they think the settings in which the physicians who participated in this study are representative of those in which they might find themselves?
Does your health system use medical scribes? What do your learners think can be done to address the problems identified in this study? Use the accompanying editorial to help frame your discussion.
Now read the On Being a Doctor essay—or listen to the audio recording available online. Do your learners think that familiarity with using an EHR was the only reason for the differences in styles between Drs. Weinberg and Manning?
Invite several physicians who are good role models to participate in a panel discussion. Try to include a range of practices (primary care or subspecialty) and years since the completion of training. How do they spend their time? What are the most rewarding and most frustrating aspects of their daily routines? What questions do your learners want to ask?
Listen to an audio recording with your learners, read by Dr. Michael LaCombe.
Ask your learners what they have done when one of their patients has had a treatment-related complication. How did they explain what happened?
Have your learners ever continued to “follow” a patient who is no longer on their service? Have any of the patients on your service been transferred to the ICU? Has your team gone to see how the patient is doing and/or to check on his or her family? Consider making such a trip to ask how things are going, how the patient and family are feeling, and if they can help in some way even though they are not the patient's doctors now. How did doing so make them feel?
Do they think doctors sometime “run” from patients in whom a complication of treatment has occurred?
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Taichman DB. Annals for Educators - 6 December 2016. Ann Intern Med. ;165:ED11. doi: 10.7326/AFED201612060
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Published: Ann Intern Med. 2016;165(11):ED11.
Cardiology, Emergency Medicine, Ethics, Gastroenterology/Hepatology, Hematology/Oncology.
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