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 why it is often difficult for patients to maintain weight loss after initial positive results.
What do your learners advise their patients with regard to maintenance of weight loss? Use In the Clinic: Obesity to review dietary and physical activity recommendations.
The authors note that interventions to maintain weight loss in prior studies have been modestly successful but resource-intensive. Review the intervention used in this study. Do your learners think such an intervention could be readily provided to large groups of patients? Note the costs in the last section of the results. Do your learners think such costs are worth the reported results in maintenance of weight loss?
What are the limitations of this study? How closely do the study's participants match those your learners typically see? Do they think the results of this study apply to their patients?
Ask your learners how they evaluate patients with low back pain. What history and signs do they use to determine whether testing is necessary? Use the information in DynaMed Plus: Acute Low Back Pain and Chronic Low Back Pain (a benefit of your ACP membership) to help prepare and inform your teaching session.
Review the ACP recommendations. Do your learners routinely recommend acetaminophen? Will they continue to do so?
The authors of the guideline stress the importance of explaining to patients the likely course of acute back pain with and without intervention. Why is this important? How do your learners explain this to their patients?
Do your learners recommend nonpharmacologic interventions, such as yoga, acupuncture, or mindfulness? How do they do so? Where do they recommend their patients seek such care?
The editorial notes that the trials included in the systematic reviews and used to inform the clinical guideline may not mimic care provided in real-world practice. How might they differ? Does this affect your learners' approach?
Review the diagnostic criteria for migraine and symptoms suggesting more serious causes of headache (they are presented in the boxes on page ITC51).
When should your learners order tests? Which ones?
What interventions should be tried first? What are their contraindications? When is consultation recommended? Use the table and algorithm to help review with your learners.
What special considerations are necessary for pregnant patients?
How should patients be followed? When should interventions for prevention be considered, and which ones?
Use the multiple-choice questions to break up a teaching session by introducing new topics for discussion. And, log on to enter your answers and earn CME credit for yourself!
Download the already-prepared slides to help with teaching.
Review the brief histories presented for each of the 3 patients. Then, watch the patient interviews with your learners.
Divide your learners into 3 groups, and assign each to discuss how they would approach the use of opioids in 1 of the 3 patients. Then, have each group present what they discussed. Did they agree with the approaches suggested by the expert consultant in the Grand Rounds presentation?
Alternatively, summarize the 3 patients on the board together with your group. Then, discuss how the differences among these patients should influence what your learners would recommend for each.
How would your learners discuss therapeutic options with these patients? What if the patient insisted on an approach with which your learner did not agree? Have your learners role-play these discussions.
Log on and answer the multiple-choice questions to earn CME and MOC credit for yourself!
Ask your learners if they recall the first time they witnessed a death. Was CPR performed? Were they scared? For themselves, or only for the patient?
Have their emotions at “codes” changed over time? How? Do they find they are no longer as disturbed by an unsuccessful code as in the past? Why or why not? Does this bother them in any way?
After a code, have your learners discussed their own actions and emotions with their residents, medical students, or attendings? Why might doing so be helpful? In what ways should we be particularly cautious in these discussions so as to be helpful and not hurtful?
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Taichman DB. Annals for Educators - 4 April 2017. Ann Intern Med. ;166:ED7. doi: 10.7326/AFED201704040
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Published: Ann Intern Med. 2017;166(7):ED7.
Headache, Neurology, Obesity.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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