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 and end a teaching session with multiple-choice questions. We've provided 2 below!
Ask your learners to list the ways SLE might present. How is the diagnosis established? Use the information in DynaMed Plus: Systemic lupus erythematosus, a benefit of your ACP membership.
What are the potential complications of SLE? Which ones are life-threatening?
Teach at the bedside! Identify a patient on the medical service with SLE, and ask whether she or he would be willing (and even would appreciate) talking to your team about how SLE has affected her or his life. What has been the worst part? What has not been as bad as expected? Are your learners surprised by which manifestations of this disease are most troublesome in the patient's daily life?
How is SLE treated?
Look at the Figure in this paper with your learners. How do they interpret these findings? What do they tell us about our ability to manage the complications of SLE? Are your learners surprised by the sex, racial, and geographic discrepancies in mortality rates seen in Table 3? Why or why not?
Ask your learners to list ADLs and instrumental ADLs (IADLs). They are listed in the “Measures” subsection of the paper's Methods section.
Ask your learners how often they think middle-aged adults develop ADL impairments. Look at Figure 2. Are your learners surprised by these data?
Explore the interactive graphic that accompanies this paper. This allows your learners to visualize what happens to a group of people who have anywhere from 0 to 5 impairments. How many recover and become independent again? How many become and remain dependent?
Do your learners ask their patients about ADLs and IADLs? Should they? Why do they matter? Have your learners ask each of their patients about ADLs and IADLs before your next meeting. What did they learn? Were they surprised? Why don't we focus on these more routinely?
How can we help our patients with ADLs? Invite a rehabilitation physician to join your discussion. Invite an occupational therapist to talk to your team about what they do with patients and which types of impairments are more or less amenable to interventions.
Read the first 4 paragraphs of this paper with your learners for a summary of Mr. C's clinical issue. Then, watch the brief video interview with Mr. C.
Ask your learners each of the questions posed to the Beyond the Guidelines discussants: What are the potential benefits of daily low-dose aspirin, and how long do you need to take aspirin to achieve those benefits? What are the potential harms? How do you balance benefits and harms to individualize a risk-based decision for Mr. C in particular and for patients in general?
Now, review the answers of the discussants by either reviewing the paper (use the provided slides) or watching the video of the Grand Rounds presentations. Have your learners altered their opinions?
Answer the multiple-choice questions, and log on to enter your answers and earn CME/MOC credit for yourself!
Ask your learners whether they screen their patients for dyslipidemia. Which ones?
How should screening be performed? Should a fasting lipid panel be used? Should triglycerides be measured? How should the results be interpreted?
Ask your learners which drugs can cause dyslipidemia.
What behavioral modifications should be recommended? How do your learners choose therapy? Use the Table to help review options with your learners.
What are the goals of treatment, and how should patients be monitored? Is repeated testing necessary?
How will your learners counsel patients who are concerned about medication adverse effects? What will they say to a patient who wants to use alternative or complementary therapies?
Download the teaching slide set. Use the provided multiple-choice questions to help introduce topics during a teaching session. And, log on to enter your answers and earn CME/MOC credit for yourself!
Look at the cartoon (yes, a cartoon in a serious medical journal) with your learners.
Ask whether they believe the emergency room physician is likely to be as callous as he seemed to his patient's family members. Does it matter whether he meant to be rude? Is there another side to the story? The author makes clear that other members of the emergency department team were wonderful.
Do your learners think that their behavior has ever inadvertently offended patients or their families? What can we do to prevent this?
Listen to an audio recording of each, read by Drs. Michael LaCombe and Virginia Hood.
Ask your learners whether hearing about a physician's devastating diagnosis affects them differently from hearing such news about a patient or a family member. Why?
Do we learn to put up walls between ourselves and our patients? In what ways are they detrimental? Are they useful in some way? Are there solutions to these opposing effects?
Do we all have to endure an illness ourselves or with a family member to shatter the wall?
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Darren B. Taichman. Annals for Educators - 5 December 2017. Ann Intern Med. 2017;167:ED11. doi: 10.7326/AFED201712050
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Published: Ann Intern Med. 2017;167(11):ED11.
Lupus Erythematosus, Rheumatology.
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