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 if they know how to order a “sleep study.”
What types of sleep studies are available and what are they used for? Which ones are most appropriate for the evaluation of patients in whom sleep apnea is suspected? What is a type I study? What are split-night studies? Invite an expert in sleep apnea to review the appropriate uses of available studies.
What are the strengths and weaknesses of this randomized trial? Do your learners think that the results are generalizable to the use of data derived from at-home sleep studies?
The accompanying editorial notes that in an effort to reduce costs as reimbursement falls, some sleep programs are reducing the availability of technicians to teach patients about sleep apnea treatment. Why might this be important? Do your learners know how to counsel a patient who reports problems using CPAP?
Arrange a visit to your center's sleep laboratory. Do your learners think that a more accurate evaluation of a patient's sleep would be obtained here or at home? Are the higher fidelity and greater number of monitors with additional information of an in-laboratory study warranted?
Ask your learners to define “overdiagnosis” as it relates to breast cancer.
How could overdiagnosis be harmful? Are the risks only psychological? What are the physical risks?
Ask your learners why they think it may be difficult for some to accept that overdiagnosis may be a real issue in breast cancer, and that screening may cause substantial harm to some individuals. Use the accompanying editorial to help frame your discussion. What does the editorialist mean by, “…considering all small breast lesions to be deadly and aggressive types of cancer is the pathologic equivalent of racial profiling”?
Do your learners think that all women should undergo breast cancer screening at all ages? Who should not undergo screening? Role-play scenarios in which your learners need to discuss the potential benefits and harms of screening with patients of different ages and with different risks.
Ask your learners what other electrocardiographic arrhythmias may be confused with AF. Can they differentiate AF from sinus rhythm with premature atrial contractions? Present Figures 2 and 3 to your learners and ask them to identify the rhythms.
What laboratory studies should be ordered in a patient with newly identified AF?
When should immediate cardioversion be considered, and who requires hospitalization?
How should rate and rhythm control be approached? Use the table to review pharmacologic options. What about electrophysiological approaches?
Find the answers to these and other essential questions in this practical review. And download the already prepared teaching slides to help prepare a teaching session.
Use the multiple-choice questions to help introduce topics during your teaching, and be sure to log on to enter your answers to earn CME for yourself!
Listen to an audio recording of the story, read by Dr. Michael LaCombe.
Ask your learners if they have ever felt their own life was in danger while caring for others. How did they react?
What factors would your learners consider if they had to choose which patients should receive a limited supply of oxygen or other life-sustaining therapies? Likelihood of survival? Age? Would they take oxygen (or another therapy) away from someone already receiving it to provide it to someone with a perceived greater need, or potential benefit?
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Taichman DB. Annals for Educators - 7 March 2017. Ann Intern Med. 2017;166:ED5. doi: 10.7326/AFED201703070
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Published: Ann Intern Med. 2017;166(5):ED5.
Pulmonary/Critical Care, Sleep Disorders.
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