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 your learners to define a P value. Is it easy to do?
What are type I and type II errors?
Read the brief description of the clinical trial and its results to your learners. Ask them whether the results are “negative.” Do they exclude a benefit from the in-home occupational therapy intervention? What else do your learners need to know to answer the question?
What is the meaning of a “clinically meaningful change” in this context? How does knowing what the investigators defined as a clinically meaningful change affect how one interprets the study results?
What do confidence intervals tell us?
What is the difference between “absence of evidence” and “evidence of absence”?
Review the key questions to ask when interpreting a clinical study, which are listed in the Table.
Invite an expert in epidemiology to join your discussion.
Ask your learners whether use of e-cigarettes is harmful. What are the physiologic effects and harms of nicotine?
In whom might e-cigarettes be beneficial?
Do your learners think the growing use of e-cigarettes (e.g., JUUL) among young people who have never used combustible cigarettes is a problem? What might be the risks?
Do your learners agree with the editorialist that the use of e-cigarettes among people who have never used combustible cigarettes is “negligible”?
Do your learners ask patients whether they use e-cigarettes? Do the forms completed by new patients at your learners' outpatient practices inquire about them? Should they? Why or why not?
Start a teaching session with multiple-choice questions. We've provided 2 below!
Ask your learners whether they check their patients' skin for suspicious lesions when they perform a routine physical examination.
Do your learners know how to recognize suspicious lesions? What about basal cell carcinoma or melanoma? To whom do your learners refer patients for biopsy?
Teach at the bedside! Review images of benign and suspicious lesions with your team, or identify willing patients on your service with lesions that would be useful for teaching rounds. Consider inviting a dermatologist to join you.
Watch the interview with your learners of Ms. C, a 47-year-old woman who was informed that dense breast tissue was seen on her mammogram.
Ask your learners how they would advise Ms. C.
Watch the grand rounds presentation, or assign learners to summarize the arguments made by the primary care physician and the radiologist in the published paper.
Now ask your learners again how they would advise Ms. C. How would they explain the clinical meaning of dense breasts to a patient? Should it affect her care?
Use the multiple-choice questions to help teach, and log on to enter your answers and earn CME and MOC credit for yourself.
Ask your learners to name risk factors for C difficile infection.
Ask what clinicians can do to prevent infection.
Ask what symptoms and signs should raise concern about C difficile infection. What is the differential diagnosis? What tests should be performed? How are the results interpreted?
What is the approach to treatment?
What are the potential complications of infection? When might surgery be required?
Should fecal transplant be considered? If so, when?
Use the multiple-choice questions to help introduce new topics during a teaching session. 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.
Ask your learners whether they have had connections with patients that are analogous to the daily milkshake in Dr. Dohlman's experience with her patient.
Do your learners feel guilty when they don't think they have sufficient time to show they care? How do they handle this? How do they show the patient that they do care? Does it relieve their feelings of guilt?
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Taichman DB. Annals for Educators - 2 October 2018. Ann Intern Med. ;169:ED7. doi: 10.7326/AFED201810020
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Published: Ann Intern Med. 2018;169(7):ED7.
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