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 look at the cartoons and to read the list of emotions in the second paragraph of the editorial. Do your learners share these feelings? What others are they experiencing as they start their internships?
The editorialists welcome our new colleagues and remind them to share their feelings with others and to ask for help when needed. Why should such a reminder be necessary? Is there anything about the culture of medical practice that makes it difficult for us to admit that we need help?
What can we do in our residency programs to help ensure that we all pay attention to the potential for depression and suicidality? Are we afraid to discuss these issues? What do your interns and residents think they need to do for themselves and others? What are the risks of not paying attention?
Do your learners know who they may turn to for help and what types of support are available? Why might they worry about asking for help? What consequences might they fear? How can you reassure them so that they will ask for help if needed?
Ask your learners what the therapeutic options are for the treatment of rheumatoid arthritis. What is the initial therapy? What are the goals? Use the information in DynaMed Plus: Rheumatoid Arthritis (a benefit of your ACP membership) to help prepare a teaching session.
How is the response to therapy assessed, and what should the next step be in patients with insufficient disease control?
Ask your learners what the purpose of a cost-effectiveness analysis (CEA) is. How does such a study's focus differ from that of a report of a randomized trial? What is meant by the “perspective” that the CEA takes? What are quality-adjusted life-years and incremental cost-effectiveness ratios?
The editorialists contend that being aware of the value of a therapy is critical because providing expensive therapy when less expensive but similarly effective regimens could be used may free up resources for other treatments that save lives and improve quality of life. Do your learners agree? Would they choose a more expensive therapy if they expected at least some incremental benefit, even if at a higher cost?
Invite an expert in CEAs and a rheumatologist to join your discussion and ask whether their perspectives on the study's results differ.
Start a teaching session with a multiple-choice question. We've provided one below!
Ask a radiologist to show your team images of unruptured intracranial aneurysms.
How is an intracranial aneurysm's risk for rupture assessed? What are the potential consequences of rupture, and why do these lesions appear to account for a disproportionate amount of the morbidity and mortality from strokes?
This review concluded that the available evidence was of low quality. On what basis was this determined? See Appendix Table 6. In what ways are the results still valuable even if available evidence is limited? How might these results alter your learners' practices? What will they tell a patient with a small unruptured intracranial aneurysm? How will they explain what is and is not known? How would they help a patient decide whether to undergo therapy?
Ask your learners why the risks from small intracranial aneurysms are hard to study. What are the challenges to performing a randomized trial in this population? Why have such studies had problems with recruitment and retention? Use the editorial to help frame your discussion.
Ask your learners who should be screened for HIV infection, how often, and how.
What signs and symptoms should prompt evaluation for potential acute or chronic HIV infection? What should clinicians do if they suspect HIV infection but test results are negative?
What treatment should be initiated for newly diagnosed HIV infection? What immunizations are necessary? How does pregnancy alter these answers? These and other questions are answered in this article.
Download the teaching slides to help prepare for a teaching session. Use the CME questions provided to help introduce new topics as you move through the teaching session. Be sure to log on and enter your answers to earn CME and MOC credit for yourself!
Take a break with your learners and listen to an audio recording of the essay, read by Dr. Michael LaCombe.
Ask your learners why the results of studies performed for research might not be routinely used for clinical care. What might be the barriers to doing so? How might routinely planning to do so hinder the research enterprise?
Do your learners agree that this is acceptable? Why? How might the problems that are raised be addressed?
Taichman DB. Annals for Educators - 4 July 2017. Ann Intern Med. 2017;167:ED1. doi: https://doi.org/10.7326/AFED201707040
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Published: Ann Intern Med. 2017;167(1):ED1.
Emergency Medicine, HIV, Infectious Disease, Neurology, Rheumatoid Arthritis.
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