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 why breast density is important. What is the relationship between breast density and risk for breast cancer? What affect does breast density have on the performance of mammography? The authors discuss these in the paper's introduction.
Arrange for a radiologist to show your team mammograms from patients with a range of breast tissue densities. Ask the radiologist to discuss the difficulties faced in evaluating breast density. On what bases do they quantify density?
Does your state require notification of patients regarding the density of their breasts on mammography? How do your learners think such information should be communicated to patients? How would they explain its importance? How does the variation in radiologists' reading demonstrated in this study affect how they might counsel patients?
Ask your learners how they would counsel a patient with dense breast tissue regarding cancer screening. Would their approach to test ordering be different? Use a recent guideline from the U.S. Preventive Services Task Force to help inform the discussion.
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners to generate a differential diagnosis of acute pancreatitis.
What variables do they consider in evaluating the severity of the patients' conditions? How do they decide whether a patient needs hospital admission? Intensive care? Use the accompanying editorial to help inform your discussion.
How do prognostic tools help us? What performance parameters should be considered before using a prognostic tool? Do your learners use any to help explain prognosis to their patients?
How should patients with acute pancreatitis be managed? What interventions are helpful? How should they be monitored? What complications may occur, and how are they managed? Use the information in DynaMed Plus: Acute Pancreatitis (a benefit of your ACP membership) to help prepare a teaching session.
Ask who should be screened for depression. How should one screen for it?
What are the diagnostic criteria?
Who should be referred for psychotherapy? Behavioral cognitive therapy?
Who should start pharmacotherapy, and with which agents? Use the table to compare their indications and possible side effects.
How long should therapy continue? How should it be monitored?
Download the teaching slides to help prepare for a teaching session. Use the multiple-choice questions provided to help break up a session, and be sure to log in to enter the answers and earn CME credit for yourself!
Are physicians at increased risk for depression? What resources are available locally to help (e.g., crisis lines, employee health, counseling)? How might being labeled as “depressed” affect a physician?
Show it to your learners and ask them for their reactions.
What point is the author making? Do your learners agree?
Do they feel they spend enough time with their patients? Why or why not? Is this within their control? If not, are there things they may do to improve the situation?
Teach at the bedside! Show this picture to some of the patients on your team. Ask what the patients think!
Listen to an audio recording, read by On Being a Doctor/Patient editor, Dr. Michael LaCombe.
Have your learners heard some or all of these lessons before?
Do your learners think they do enough to be empathic and avoid the problems Dr. Norden describes in caring for their patients? Why do we seem to require reminders—over and over—of these essential messages? Are there ways to remind ourselves of these essential lessons regularly, and often enough? Do we all need to have been patients to become as compassionate as possible as physicians?
Ask your learners to think about their own experiences. Have they ever experienced impersonal care, or care that was not as compassionate as it should have been? Perhaps they recall the experiences of family members. You might not want to ask them to answer aloud, as learners may not wish to share their own stories or reveal medical histories, but you can ask them to think about it.
Taichman DB. Annals for Educators - 4 October 2016. Ann Intern Med. 2016;165:ED7. doi: https://doi.org/10.7326/AFED201610040
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Published: Ann Intern Med. 2016;165(7):ED7.
Gastroenterology/Hepatology, Pancreatic Disease.
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