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 multiple-choice questions. We've provided 2 below!
Ask your learners who is at risk for renal cell carcinoma. Use the information in DynaMed Plus: Renal Cell Carcinoma, a benefit of your ACP membership.
How does renal cell carcinoma usually present? What laboratory abnormalities might be seen?
How is it diagnosed? What is the most appropriate imaging study, and how does the choice differ according to clinical variables? Is biopsy always needed before surgery?
Do all patients require surgery? How should the choice among radical nephrectomy, partial nephrectomy, and percutaneous ablation be made? What variables should be used when deciding? How do the results of this observational study help inform that decision? What are the limitations of this study?
When might active surveillance be appropriate?
Invite experts in interventional radiology, nephrology, surgery, and/or oncology to join your discussion. Consider planning a multidisciplinary case conference discussion on the approach to diagnosing and managing renal cell carcinoma.
Ask your learners whether they have provided care to undocumented immigrants. What unique challenges did this present in planning care? How did this differ from caring for other patients who lack insurance?
Review the major themes that describe the clinicians' experiences providing dialysis to undocumented immigrants and the quotes provided in Table 2. Have your learners had analogous experiences?
Ask your learners whether they have ever had to exaggerate findings or otherwise be less than completely honest in how they have reported the severity of a clinical situation in order to get a patient the care they felt was needed. How did it make your learners feel? Is it better to “play strictly by the rules,” even if that means providing less than what you believe is optimal for your patient? Is there a line to be drawn?
How do your learners think the situation addressed in this article might be improved? Do they agree with the approach suggested by the editorialist?
Ask your learners whether they plan to take the ABIM certification examination at the end of their internal medicine training. Why or why not?
Ask if they know what will be required of them to maintain their certification thereafter. How do the requirements differ from and/or overlap with the requirements for maintaining their state medical licenses?
Do your learners believe that certification and maintenance of certification requirements are a good thing? Is completing an internal medicine–accredited residency and/or specialty training enough?
What are the goals of a professional certification system? How would your learners design a system to achieve these goals?
How do your learners interpret the results of this study? How good are HEDIS performance measures at evaluating the care provided by a physician? What is the significance of the differences this study identified in performance on HEDIS measures between physicians who maintained their certification and those who did not?
Read the accompanying editorial. Do your learners agree with the editorialist's assessment? Why or why not?
Take a short break for a relaxing way to learn—watch the video together.
Pause when Howard asks you to name the intervention. What do your learners think?
Log on and answer the multiple-choice questions to earn CME/MOC credit for yourself!
Listen to an audio recording, read by Dr. Virginia Hood.
Ask your learners whether they have had contact with the family of a patient who has died. Have they remained in touch?
Should we call family members after a patient has died? Once? More than once? Who might benefit from such calls?
Do your learners believe that our medical training aims to teach us to “compartmentalize” the death of a patient and just move on?
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Taichman DB. Annals for Educators - 17 July 2018. Ann Intern Med. ;169:ED2. doi: 10.7326/AFED201807170
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Published: Ann Intern Med. 2018;169(2):ED2.
Hematology/Oncology, Nephrology, Urological Disorders.
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