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 whether your learners have cared for patients who used CGM to manage their type 1 diabetes. What have been the challenges? Use the accompanying editorial to help frame your discussion.
Invite a diabetes specialist to discuss the use of CGM with your team. In whom should it be considered? Are there contraindications?
Is the difference between the changes in hemoglobin A1c values achieved in the trial's 2 groups clinically important? What is the difference between clinically important and statistically important? The authors discuss how many patients achieved a goal of a hemoglobin A1c level less than 7%. Why? What do your learners think is the best way to judge the performance of a diabetes intervention?
Should CGM be considered for the management of patients with type 2 diabetes?
Teach at the bedside! Is there an outpatient or inpatient who has used CGM with whom your team might discuss the experience? Did CGM improve the patient's glycemic control? At what cost (or benefit) to the patient's quality of life?
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners whether they have discussed PrEP with their patients and whether they have prescribed it. For whom is PrEP recommended?
What other practices should we discuss with our patients to prevent HIV infection?
What are the goals of phase 1, 2, 3, and 4 clinical trials? Why is this study a phase 2 trial and not a phase 3 trial?
What properties would your learners want to consider when choosing an agent for PrEP in women? See what the authors say in the paper's introduction.
On the basis of this trial, what may we conclude about the safety and efficacy of maraviroc? What is needed before this approach to PrEP would be recommended? What end points would your learners suggest be evaluated in future studies?
Some have expressed concern that the availability of PrEP might provide some patients with a false sense of security and thus encourage high-risk behaviors. How would your learners propose studying this concern? How would they counsel patients?
Ask your learners what “Trousseau syndrome” is.
What is required to designate a VTE event as “unprovoked”? What needs to be excluded? How is this done?
What is the risk for a subsequent cancer diagnosis among patients with unprovoked VTE? Is there a benefit to extensive testing for cancer? What did this systematic review find?
Why do your learners think that despite the frequency of cancer among patients with unprovoked VTE, a clear benefit has been established only for age-appropriate screening tests? What is the difference between a screening test and one performed to evaluate a symptom?
What should the approach to cancer screening be among patients with unprovoked VTE? Use the accompanying editorial to help frame your discussion.
Take a break and watch the video.
Use the provided multiple-choice questions before viewing the video to check your learners' knowledge or after viewing it to see whether they were paying attention. And, log on to enter your responses to earn CME and MOC credit for yourself!
Ask your learners whether they have seen a lack of insurance affect a patient's outcome.
Why do your learners think it is difficult to study the relationship between insurance status and mortality? Use Table 2, and see what the authors say in the paper's discussion.
In what ways might insurance reduce mortality? Are there ways in which it might increase mortality? The authors provide 2 examples in the discussion.
What other benefits to individuals and society might result from health insurance?
Do your learners think physicians should be vocal in the national debate over health insurance?
Listen to an audio recording of the essay, read by Dr. Michael LaCombe.
Ask your learners whether they have felt the way Dr. Molitor described feeling before he entered his patient's room. Have they ever doubted whether what they do matters?
Ask your learners to list the things they do for their patients. If they need help or are too modest, read the list provided in the penultimate paragraph of a recent letter to new interns. Now how do they feel?
Are there ways to remind ourselves of the ways in which we make a difference to help carry us through the tough times?
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Taichman DB. Annals for Educators - 19 September 2017. Ann Intern Med. ;167:ED6. doi: 10.7326/AFED201709190
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Published: Ann Intern Med. 2017;167(6):ED6.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, HIV.
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