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 how many classes of drugs they can name for the treatment of T2DM. Do they know their mechanisms of action? Use the table in this guideline and the recent In the Clinic: Type 2 Diabetes to help.
How do your learners choose among available drugs when considering therapy for their patients?
The accompanying editorial notes the limitations in available evidence to guide the choice among agents to treat T2DM. Ask your learners what are comparative effectiveness studies. Why don't many of the available cardiovascular outcome trials provide the information required to choose among available therapies?
What concerns might limit the use of metformin? Is there reason to worry about renal function? Lactic acidosis? Use the accompanying editorial as well as a recent paper and its editorial addressing the safety of metformin to help guide your answers.
What variables would influence the treatments your learners would consider adding for a patient already receiving metformin who has unsatisfactory glycemic control?
Take a break with your learners to watch the short video.
Review the recommended approach to antiplatelet therapy following stent placement. What difference does it make whether the stent was placed in the setting of an acute coronary syndrome?
Answer the accompanying multiple-choice questions to review what you've learned, and be sure to enter your answer online to earn CME for yourself!
Invite an interventional cardiologist to discuss with your team how s/he chooses the type of stent to place.
Can your learners list physicians whose names have become verbs in common usage? Have them send in their answers to win a Consult Guys T-shirt!
Start a teaching session with a multiple-choice question. We've provided one below.
Ask your learners what the risk factors are for aortic aneurysms. What previously was the most common cause? Use the information in DynaMed Plus: Thoracic Aortic Aneurysms and Abdominal Aortic Aneurysms (a benefit of your ACP membership) to help prepare a teaching session.
Ask if screening for aortic aneurysms is recommended. In whom? How?
How are thoracic aortic aneurysms classified? How should a patient with a thoracic aortic aneurysm be managed? Who requires surgery and when?
How should abdominal aortic aneurysms be monitored? Which require surgical intervention?
Ask your learners if they have assumed the care of a young adult with a chronic condition. What are the challenges? Were the necessary medical records available? Had they discussed the patient's care with her or his prior physician(s)?
Invite a colleague from pediatrics or adolescent medicine to join a discussion on how to best plan for the transition of care from adolescent to adult medical office practices.
Ask your learners what the barriers are in your practice to achieving optimal transitions for these patients. Are there readily achievable changes that they could help implement to improve things?
Ask your learners what is known about the effect of sugar intake on metabolic outcomes. How would they propose to study this question in individual patients? What outcomes would they assess?
Recent laws have aimed at reducing dietary sugar intake (e.g., from sugar-sweetened beverages). On what basis would your learners expect such laws to be based? What studies would they propose to assess the impact of such laws?
How do your learners react to the findings of this review? Do they think it would matter if the evidence behind guidelines is not as strong as one would ideally like, provided most physicians believe that what the guideline recommends makes sense?
The accompanying editorial suggests that the authors of this review cannot be trusted because of their conflicts of interest. Should the presence of any conflict of interest within a field make the results of a study suspect? Are conflicts of interest only financial? Evaluate the conflict of interest declarations of the authors of the systematic review and those of the editorial.
If financial support is required to conduct research, how do your learners suggest that this potential conflict be managed by those seeking support in order to complete their studies? What influence should conflicts have on how readers evaluate the work?
Ask your learners how they would define a catheter-associated urinary tract infection and a catheter-associated central line–associated bloodstream infection. How do clinical definitions differ from those used in administrative databases?
Invite your hospital's compliance officer, chief medical officer, or someone from utilization review to discuss with your learners how penalties (or the threat of penalties) have altered activities at your institution. What “rules” have changed? Has behavior changed? Have infection rates changed? Invite someone from your infection control group to join the discussion.
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Taichman DB. Annals for Educators - 21 February 2017. Ann Intern Med. 2017;166:ED4. doi: 10.7326/AFED201702210
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Published: Ann Intern Med. 2017;166(4):ED4.
Cardiology, Coronary Risk Factors, Diabetes, Emergency Medicine, Endocrine and Metabolism.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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