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 if and how they assess their patients' abilities to maintain independent mobility. What are the consequences of a loss of mobility (e.g., depression, social isolation)?
The accompanying editorial notes that although only about 1 in 5 adults meet physical activity guidelines, and despite overwhelming evidence of its benefits, only one third of adults say their physicians have advised them to exercise. Do your learners discuss exercise with their patients?
How would your learners discuss exercise? Would they know what to recommend? How might their recommendations need to be tailored to the individual?
The editorial notes a study in which health assistants asked about and recorded patients' exercise habits as a “fifth vital sign.” It resulted in more physician–patient discussions and reductions in health risk factors. Do your learners think this might work in your practice? How would they propose to study such a program in your outpatient practices?
Start a teaching activity with a multiple-choice question. We've provided one below!
Ask your learners which immunizations are recommended during pregnancy. Which are contraindicated during pregnancy?
Review the 2016 recommended adult immunization schedule from the American Committee on Immunization Practices. Be sure to look at the second figure, which presents recommendations according to medical conditions (including pregnancy).
What are the true potential adverse events associated with immunizations?
What do your learners know of the inaccurate belief among some patients that there is a link between certain vaccinations and autism? What factors perpetuate such belief (despite evidence to the contrary and the retraction of the original and fraudulent study upon which it may be based)? What are the possible public health consequences of this belief? What role should your learners play in educating their patients and the public? See a recent short discussion of this issue to help frame your discussion.
Ask your learners how they would arrange for serial ultrasonography to assess for propagation of an isolated distal thrombosis. How do they ensure that the studies occur and that the results are acted upon if necessary? What if the follow-up studies are not completed?
Ask your learners what the indications are for an IVC filter. What are the acute and long-term risks? Should the availability of “removable” filters alter practice?
Ask your learners whether they think there should limits to how much a manufacturer may charge for a treatment. What are the arguments in favor of or against restrictions?
Have your learners heard of industry-sponsored copay assistance programs, such as those described in the second paper? Why might they be helpful for individual patients, yet harmful to society? How do your learners feel about informing patients about such programs and helping them to enroll? Is their responsibility to the patient alone, or might their participation be perpetuating a problem? Do your learners think there is a conflict?
What do your learners think would be the best way to approach addressing the high cost of therapies? The authors of the third paper offer ideas. Do your learners agree with them?
Ask your learners if they have ever had to help a family member navigate a multistep process for medical care. Did the experience alter their view of how easy (or how difficult) it can be for their own patients?
What do your learners think are probably the most frustrating aspects for patients in your health care system to navigate their care?
Ask your Chief Medical Officer or Chief Quality Officer to discuss your system's patient satisfaction scores with your learners. How are such scores generated?
What responsibility do your learners feel they have for the satisfaction of the patients cared for at your health system? What variables are within and outside of their control?
Can your learners identify 1 or 2 problematic areas in your system and propose solutions? Is there a way they could become involved in trying to institute solutions? How would they measure if they have been effective?
Listen to an audio recording read by Dr. Michael LaCombe.
Ask your learners if they have had to carry out orders of more senior physicians that they thought were ill-advised. Did they voice their concerns? How were their concerns received?
What should your learners do in such situations? To whom should they turn when they are uncomfortable with what they are being asked to do by those with more medical experience?
How do your learners think they will respond if a trainee questions their plans of care for a patient? What would be a constructive and educational way to handle such a situation?
Do your learners believe they are capable of recognizing and admitting when the plans of care they made should be reconsidered?
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Darren B. Taichman. Annals for Educators - 20 December 2016. Ann Intern Med. 2016;165:ED12. doi: 10.7326/AFED201612200
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Published: Ann Intern Med. 2016;165(12):ED12.
Infectious Disease, Prevention/Screening, Vaccines/Immunization.
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