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.
Listen to an audio recording of the essay, read by Dr. Michael LaCombe.
Ask your learners how often they have felt emotionally exhausted by their work as physicians.
In his essay, Dr. Muller says he and his resident were reluctant to accept help with their overwhelming medical service when it was offered, “…out of a sense of duty to our patients, but we were probably also ashamed of looking like the weak link on our unit”. Do your learners believe they would ask for help if they needed it or accept it if it was offered? Why is refusing to do so dangerous for our patients and ourselves?
How can we support each other? How can we prevent ourselves from hitting “rock bottom”? What should your learners do if they suspect a colleague is in trouble or if they are having trouble themselves?
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners what acute diagnostic tests and interventions they should initiate immediately upon recognition of possible stroke. How should blood pressure be managed? Should they give aspirin immediately or wait? Use the information in DynaMed Plus: Stroke (acute management) , a benefit of your ACP membership.
Which patients with an acute stroke should receive intravenous thrombolytic therapy? How is it given? In whom is such treatment contraindicated?
When should intra-arterial mechanical thrombectomy, such as that used in this trial, be considered? Invite a neurologist to join your discussion. What are the roles of the internist, ER physician, neurologist, and interventional radiologists at your medical center in the management of patients with acute stroke? How might your learners' roles in the management of patients with acute stroke change in other practice settings?
Have your learners generate a list of causes to consider for acute pancreatitis. What studies should be considered in the evaluation? When should a CT or MRI scan be obtained, and why? When should ERCP be considered? Use DynaMed Plus: Acute pancreatitis to help prepare a teaching session.
What is the rationale for avoiding oral nutrition in patients with acute pancreatitis? What are the benefits to the gut of feeding patients with pancreatitis? The authors note these in the paper's introduction. How do your learners decide when to initiate nutritional support in patients with acute pancreatitis?
How do your learners write dietary orders for patients with acute pancreatitis? Are patients fed by mouth or by nasogastric or nasojejunal tubes? Should parenteral nutrition be considered? How do they decide? Invite an expert in pancreatitis and/or a member of your institution's nutritional support team to join your discussion.
What are the strengths and weaknesses of this systematic review? Use the accompanying editorial to help frame your discussion.
Take a break with your learners and watch the short video together.
Ask your learners what differential diagnoses must be considered in patients who have had a syncopal event.
What testing should be ordered? Does everyone need an echocardiogram?
Sign on to answer the multiple-choice questions and earn CME credit for yourself!
Ask your learners why scientists might want to avoid engaging in political discussions. Are there discussions the scientific community should refrain from engaging in? How might a desire to “remain above the fray” create problems for science?
Do your learners think physicians should be involved in the public debate over issues such as climate change?
What is the “politicization of science”? The authors of the second paper offer a definition. Do your learners agree with the authors' opinions?
If physicians are to speak up about issues such as climate change or health insurance, how should they do so? What are the risks of speaking up? What are the risks of not speaking up?
Ask your learners what they think Dr. Al-Shamsi should have done. What would they have done if they were in that situation?
Have your learners ever faced a situation where a patient's religious beliefs were in opposition to what your learners thought was the right thing to do? How did they handle it?
How should we handle such situations when the patient cannot speak coherently for himself or herself? Is it the physician's job to determine whether a surrogate decision maker is expressing what the patient would say? What if the physician disagrees or thinks the surrogate is not saying what the patient would want for himself or herself? How do our own beliefs and values influence whether we believe the surrogate is expressing what the patient would say?
How should a physician's concern for her or his own safety influence how a patient is treated?
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Taichman DB. Annals for Educators - 20 June 2017. Ann Intern Med. ;166:ED12. doi: 10.7326/AFED201706200
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Published: Ann Intern Med. 2017;166(12):ED12.
Gastroenterology/Hepatology, Neurology, Pancreatic Disease, Stroke.
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