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 what natriuretic peptides (NPs) are. What is the difference between BNP and NT-BNP?
How do your learners use measurement of these in their practices? To assess treatment response in patients hospitalized for acute heart failure?
Ask your learners to read this study's abstract. Then, ask whether they should measure NPs to guide discharge decisions in acute heart failure. Pay attention to whether your learners focus only on the changes in outcomes reported (e.g., “achievement of absolute BNP thresholds reduced postdischarge all-cause mortality”) or also on the quality and strengths of the available evidence (e.g., “high risk of bias” and “low-strength evidence”).
How was the “risk of bias” assessed for each of the studies included in this systematic review? The authors explain on page 181 and in the Appendix. Why does it matter? Ask your learners how, for example, a failure to adjust for LVEF or NYHA functional class when comparing the outcomes of patients who did or did not achieve a target NP might bias the results of a study.
Use this review to emphasize to your learners why they need to pay attention to the details and methods of a study, and not only the ‘”one-liner” conclusion. Indeed, one of the most important things a good systematic review does is to tell us the quality of available evidence. Use the accompany editorial to help frame your discussion of this important point.
Start a teaching session with a multiple-choice question. We've provided one below!
Review with your learners the changes to this year's recommended immunization schedule (e.g., chronic liver disease conditions for which hepatitis B vaccination is recommended). These are detailed in the paper's introduction.
Do your learners know when and how to report a vaccine-reportable disease? Why is this important? What about clinically significant postvaccination reactions? The guideline provides a link in the table.
How is a patient's immunization record accessed in your learners' outpatient practice? Are your learners prompted in some manner to review their patients' immunization status? Or, is there a system that informs them that a patient is due for a vaccination? Is there a system in place to promote influenza vaccination each year?
Ask your learners to design a practical way to study whether their practice does a good job assessing their patients' vaccination status. How would they define “good”? What information will be needed to assess ways to improve (e.g., who asks about immunizations and how, where it is recorded)? Might thinking about this ahead of time allow for collection of useful information to identify where change might be helpful?
Ask your learners when they use metformin.
What are the potential benefits of metformin? What are the potential adverse events?
The FDA recently altered its recommendations and contraindications for the use of metformin. Do your learners know whether it remains contraindicated in patients with heart failure? With kidney or liver disease?
Although warnings have been relaxed, what else might your learners want to know about the potential benefits or harms of metformin? What do (or don't) we know about its benefits in patients for whom the drug was previously not recommended? Use the accompanying editorial to help frame your discussion.
How will your learners use metformin in patients with heart failure, liver disease, or kidney disease in the future?
Watch an interview with the patient, a 62-year-old man with a history of recurrent sinusitis who has previously been prescribed antibiotics for episodes of sinusitis.
Ask your learners how they would manage this patient. Would they prescribe antibiotics? What are the potential benefits and harms? What does the ACP and CDC recommend?
Watch the discussion by 2 experienced clinicians who differ in whether they would recommend antibiotics. Has the discussion altered your learners' opinions?
Log on and answer the multiple-choice questions provided to earn CME/MOC credit for yourself!
Ask your learners who should be screened for TB. How should it be done?
What advice do your learners give to patients with TB to reduce the likelihood that they will infect others?
How should latent TB be managed?
How do your learners approach the diagnosis of TB? Which tests do they order? Do your learners know what the physicians' public health responsibilities are after diagnosing active TB?
Which patients with TB should be referred to a specialist? What is the best way to monitor therapy? What is followed?
What are the extra-pulmonary manifestations of TB?
Download the available teaching slides to help conduct a learning session.
Use the CME/MOC questions provided to break up a teaching session, and to introduce new topics for discussion. Be sure to log on and enter your answers to earn CME/MOC credit for yourself.
Listen to an audio recording of the essay, read by Dr. Michael LaCombe.
Ask your learners if they draw on any of their nonmedical life experiences to help them to be better physicians.
Can your learners imagine a campfire at the end of their patient's bed as they sit and listen?
Dr. Hund notes that, “The price of experience is sometimes regret.” How have your learners learned from tragedies?
Do your learners see themselves as “guides” for their patients?
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Taichman DB. Annals for Educators - 7 February 2017. Ann Intern Med. ;166:ED3. doi: 10.7326/AFED201702070
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Published: Ann Intern Med. 2017;166(3):ED3.
Infectious Disease, Prevention/Screening, Vaccines/Immunization.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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