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!
What questions do your learners ask when a patient reports upcoming travel? Do they discuss vaccinations? What else should be discussed?
Ask your learners what the symptoms and signs of measles infection are. How is measles spread? How is it diagnosed?
What are the potential complications of measles? How urgent do your learners feel it is to ensure vaccination against it? Have they ever seen a case of measles?
The editorialists note that before vaccination was available in the United States, there were 500,000 cases of measles, 48,000 hospitalizations, 500 deaths, and 1000 cases of permanent brain damage due to encephalitis each year. Do your learners think that the success of vaccination in making the disease less commonly encountered by health care professionals has led to a lack of concern? Review the results of this study, which come from centers with dedicated travel clinics.
How would your learners counsel a patient who says she does not want to be vaccinated? Which vaccines are stored and administered at your practice? How does one arrange for administration of other vaccines? Which ones will insurance pay for?
Ask your learners to explain what HbA1c values represent. What is known with regard to what HbA1c values tell us about the risk for complications of diabetes?
Why have differences between black and white persons in the glycation of hemoglobin been postulated?
What are potential explanations for higher mean HbA1c values in black populations than in white populations? Might socioeconomic factors play a role? Is that all? Use the editorial to help frame your discussion.
Look at Figure 1 with your learners. How do they interpret the findings? Why are the findings on albumin and fructosamine (Figure 2) important?
Why might these racial differences in hemoglobin glycation be important? Do the results suggest that we should not use HbA1c for either black or white patients? See what the editorialists say.
Ask your learners what they recommend for patients with chronic low back pain who do not require further evaluation. Do they recommend exercise? What type? Does it matter?
What do the results of this study suggest?
What is a “noninferiority” trial? How does it differ from a superiority trial? What are the noninferiority margins used in assessing whether one intervention is inferior to another?
The authors concluded that yoga is noninferior to physical therapy. How does that differ from saying they are equal? Why might it matter? Invite an expert in clinical epidemiology and/or biostatistics to join your discussion.
What will your learners recommend to their patients?
Ask your learners if they are aware of what 23andMe's DTC genetic test provides.
Review the limitations in the positive and negative predictive values and the other test performance variables noted by the authors. Do your learners think this testing should have been approved by the FDA? Why or why not? What are the potential benefits? What are the potential harms?
How would your learners respond if their patients were to present the results of DTC genetic testing? Do they believe they are responsible for interpreting the results for their patients? What if a patient expects a change in her or his health care based on the results, but your learner sees no need for a change? Review a recent study of the perceptions of patients who presented DTC genetic test results to their physicians.
Should all patients with DTC genetic test results be referred to a genetics expert for interpretation? If so, does the health system have the ability to provide such services?
Take a break and watch this short, informative video with your learners.
Ask your learners what the benefits of post-MI hospitalization are. What are the complications to watch for, when are they likely to occur, and how is being in the hospital beneficial?
How is the readiness of a post-MI patient for discharge to home assessed at your center?
Review the multiple-choice questions with your learners, and 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 ask about the presence of firearms in their patients' homes. Should they? Use a recent article discussing why and how to approach this issue.
After the encounter described in her essay, the author began asking patients more than whether there were guns at home. How might such an approach help to build rapport with a patient in addition to looking out for her or his safety?
Do your learners know what to do if a patient reports concerns about harm at home?
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Taichman DB. Annals for Educators - 18 July 2017. Ann Intern Med. 2017;167:ED2. doi: https://doi.org/10.7326/AFED201707180
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Published: Ann Intern Med. 2017;167(2):ED2.
Gastroenterology/Hepatology, Infectious Disease, Prevention/Screening, Vaccines/Immunization, Viral Hepatitis.
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