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 what the Philadelphia chromosome is. Why was its discovery an important event in the history of oncology? How did the discovery of the BCR-ABL1 tyrosine kinase lead to remarkable progress in CML treatment?
What are the 3 phases of CML? How do tyrosine kinase inhibitors prolong survival?
How is therapy for CML monitored?
What are the toxicities of tyrosine kinase inhibitors, and why would TFR be desirable? What is DMR, and why is it a prerequisite for achievement of TFR?
Invite an oncologist with expertise in the treatment of CML to join your discussion.
Watch a video with your team of Mr. W telling his story.
Ask your learners each of the questions posed to the discussants: What risk factors predispose patients (and Mr. W specifically) to delirium in the perioperative setting? If Mr. W experiences delirium, what short-term evaluations should he have? What would you recommend to prevent delirium with Mr. W's next surgery?
Now, watch the video of the Grand Rounds presentations, or assign members of your team to read and summarize the points made by the psychiatrist and the geriatrician.
Review Table 2 with your learners and ask whether they routinely consider each of the listed categories when evaluating a patient with delirium. Do they review and consider whether to continue each of a patient's outpatient medications?
What do your learners recommend be done to prevent delirium in a patient like Mr. W? Will they use antipsychotics for prevention?
Ask your learners how psoriasis most commonly presents. In what other ways may the disease manifest? What is the differential diagnosis? Use the Table to help answer these questions.
Ask what organ systems beyond the skin may be involved. How is psoriatic arthritis diagnosed? When is arthrocentesis needed? What is the Koebner phenomenon?
How is the severity of disease assessed, and how should clinicians choose between topical and systemic treatment for psoriasis? What topical and systemic treatments are available? What are their potential toxicities? What is the role of phototherapy?
Should your learners choose therapy? When should they consult a specialist?
Use the provided CME/MOC questions to help introduce new topics as you teach, and be sure to log on and enter your responses to earn credit for yourself. Download the prepared teaching slides to help prepare for a teaching session.
Prompt discussion among teachers and learners regarding your center's culture. Do your educators believe they model appropriate attitudes and behavior to their learners? Do you? What unintended messages might our day-to-day behaviors be modeling?
Use the accompanying editorial to help frame your discussion.
How can you get honest feedback from your learners regarding what they see and learn from your and other teachers' behaviors and attitudes? Do they feel secure expressing their impressions and concerns?
Review the vignettes in Appendix Table 1 with your learners. How would they have reacted in each situation?
Ask your learners whether they feel empowered to speak up when something is not right. Do they?
Do your learners serve as role models for others (such as other residents or students)? Do they think that they model appropriate attitudes and behavior?
Does the model of care at your institution foster more attention to the “iPatient” than the patient?
Listen to an audio recording of the essay, read by Dr. Michael LaCombe.
Ask your learners whether patients have raised political issues during their appointments. How have your learners responded?
Dr. Imber wonders to what degree it is acceptable or even important to express political views to patients. What do your learners think?
Is it okay to draw on our experiences and authority as medical professionals to try to change the political opinion of people with whom we disagree, even when those people are patients?
Will knowing that you might hold different political beliefs affect the trust a patient places in you? Does letting patients know that you disagree with them politically go against our ethical responsibility to place patients' welfare above our own self-interests?
Do your learners think it is appropriate to display a sign such as the one Dr. Imber did in her exam room? Why or why not?
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Taichman DB. Annals for Educators - 3 April 2018. Ann Intern Med. ;168:ED7. doi: 10.7326/AFED201804030
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Published: Ann Intern Med. 2018;168(7):ED7.
Ethics, Hematology/Oncology, Leukemia/Lymphoma.
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