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 properties are required of a test and a disease to recommend screening?
Ask your learners what options are available for colorectal cancer screening. Has each method been proven to reduce mortality from colorectal cancer?
What are potential reasons why sigmoidoscopy seems to reduce colorectal cancer incidence and mortality in men but not women? Use the accompanying editorial to help frame your discussion.
Does your outpatient practice have a means to remind clinicians and patients about colorectal cancer screening? Does it work? Ask your learners to check the charts of each of the patients they see in the outpatient practice over the next month to confirm whether each is up-to-date with screening. If not, why not? How might that be improved?
What is an “intention-to-treat” analysis? Look at the Appendix Figure. What numbers do you look at to assess the intention-to-treat analysis? What is a “per protocol” analysis? Why might a per protocol analysis bias the results? In this study, there was little difference between the two, but why might a per protocol analysis have been helpful? Invite an expert in clinical epidemiology to join your discussion.
Ask your learners to list common situations in which patients are readmitted to the hospital. What conditions are associated with frequent readmissions? What care process issues?
In what ways are readmissions harmful? To whom?
Review the results of this study. How would your learners identify a preventable readmission? How did the authors do it? Look at the items listed in Table 3. How might each category increase the risk for an early or late readmission? What variables did the authors identify as being associated with early readmissions and more likely to be preventable by hospital-based interventions?
Does your team discuss the potential for readmission when considering whether to discharge a patient? If not, try it with each patient your team plans to discharge this week. What variables put the patient at risk for readmission? Is there anything your team can do to reduce or eliminate that risk? What practices and services are (or should be) in place in your system to help reduce readmissions?
Watch the video of the patient interview with your learners.
Pose the questions being debated to your learners: Would you monitor a patient with osteoporosis who is receiving a 5-year course of alendronate? If so, how? Would you monitor a patient who has completed a 5-year course of alendronate? If so, how? When and how would you treat a patient whose bone density decreases during or after a 5-year course of alendronate?
Watch or read the presentations made at the Grand Rounds.
Now ask your learners the same questions. What would they do?
Log on and answer the questions to earn CME and MOC credit for yourself!
Ask your learners what the risk factors for heart failure are. Will treating these risk factors prevent heart failure?
Are diagnostic tests needed in the evaluation of patients with suspected heart failure? If so, when, and which ones? How does each assist management?
Which drugs are used for the management of heart failure, and when should others be added?
When should inotropic agents be considered? Is there a benefit to anticoagulation in patients with heart failure? When should an intracardiac device be considered?
What advice about exercise should your learners give to their patients with heart failure?
Use the provided multiple-choice questions and teaching slides to help prepare for a teaching session. And, log on and enter your answers to earn CME and MOC credit for yourself!
Listen to an audio recording of the essay, read by the Associate Editor for On Being a Doctor, Dr. Michael LaCombe.
Ask your learners about their “difficult patients.” What has made each “difficult”?
Are the limits in our abilities as “healers” only with regard to curing disease?
Taichman DB. Annals for Educators - 5 June 2018. Ann Intern Med. 2018;168:ED11. doi: https://doi.org/10.7326/AFED201806050
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Published: Ann Intern Med. 2018;168(11):ED11.
Cancer Screening/Prevention, Colonoscopy/Sigmoidoscopy, Colorectal Cancer, Gastroenterology/Hepatology, Gastrointestinal Cancer.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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