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 can name the 3 major subtypes of MPNs.
In what ways do patients with each of these MPNs present? How is each diagnosed? Use the information in the DynaMed Plus sections on polycythemia vera, essential thrombocythemia, and primary myelofibrosis (a benefit of your ACP membership!).
What is the relationship between JAK2 and each MPN subtype? The accompanying editorial explains this.
What does this study tell us about risk for thrombotic events in patients with MPNs?
Look at Figure 3. What change in the risk for venous thrombosis has occurred with time? The authors believe this is likely due to improved management. How are patients with MPNs treated? In addition to the risk for thrombosis, what other complications occur?
PFOs are highly prevalent. What are the potential complications?
What should the poststroke work-up include? The authors of the second review provide a concise list in their paper's discussion.
When should closure of a PFO be considered? What patients were included in the trials used for these meta-analyses (i.e., were they patients with incidentally noted PFOs or those who had experienced 1 or recurrent strokes)? Why does that matter when considering which patients should undergo PFO closure?
How is PFO closure accomplished? Invite an interventional cardiologist to join your discussion and to show films of the procedure.
What are the potential complications of PFO closure? What more do we need to know? Should these papers alter practice? Use the accompanying editorial to inform your discussion.
Ask your learners how the updated ACC/AHA guideline differs from the prior version and from guidelines from other organizations, such as the American College of Physicians and the American Academy of Family Physicians. Why are these differences so important?
Look at the figures in the guideline synopsis. Do your learners believe they should use home and ambulatory blood pressure measurements more often than they do?
What limitations in what is known about the risks and outcomes related to hypertension and its treatment are noted by the editorialists? What are the limitations of the clinical trials on which guidelines are based? Why might these be important?
What approach will your learners take to diagnosing patients with and treating hypertension?
Ask your learners what the differences are between palliative care and hospice care. Who is eligible for each?
Why might patients' perceptions, misconceptions, and fears of hospice care influence their interest in palliative care? How would your learners discuss this with their patients? Look at the Patient Information sheet at the end. Would this be helpful to your patients?
When do your learners consider consultation with a palliative care team? What should they expect from such a consultation? Invite a member of your institution's palliative care service to join your discussion.
Do your learners use a systematic approach to evaluating and managing pain? In what ways should the approach differ according to the cause? How should adverse effects of opioids be managed?
Are your learners comfortable prescribing narcotics for patients with dyspnea? When is it appropriate? How much?
How do your learners ask patients about their goals of care? Are they comfortable doing so? How might the manner in which they pose questions matter? Use Table 4 to help spark discussion.
Download the teaching slides, and use the multiple-choice questions to help introduce topics for discussion. Be sure to log on and enter your answers to earn CME and MOC credit for yourself!
Listen to an audio recording of the essay, read by Dr. Michael LaCombe.
Why does the author suggest that we ask our patients what they would never give up?
How do your learners react to this essay? Is this an issue of “older” versus “younger” doctors?
Have your learners ever felt that other physicians have failed to adequately consider a patient's circumstances and desires? Have others ever suggested that your learners have done so? Why do such differences in opinion occur? Are they harmful to patients?
Show the graphic to your learners. How do they react?
Do the images make them think differently about patients with depression? How? Does it alter their impressions of what is and is not within the control of the patient?
Do such graphic depictions help us to foster our sense of empathy in ways that differ from other experiences?
Might sharing these images with a patient who has depression be helpful? Might it be hurtful?
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Taichman DB. Annals for Educators - 6 March 2018. Ann Intern Med. ;168:ED5. doi: 10.7326/AFED201803060
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Published: Ann Intern Med. 2018;168(5):ED5.
Cardiology, Coronary Risk Factors, Hematology/Oncology, Hypertension, Nephrology.
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