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 where they get information regarding the safety of drugs for use in pregnancy. Review the FDA classification. What about for women who are breastfeeding?
How common is hypertension during pregnancy? Why might uncontrolled maternal hypertension be harmful to the fetus?
The authors note that to reduce the potential for confounding by indication, they restricted their analysis to pregnancies with a diagnosis of hypertension. Ask your learners to define “confounding.” What is “confounding by indication”? Why might that be applicable here?
How frequent were congenital malformations in the exposed and unexposed groups of mothers (look at Table 2)? While it is good that overall the “end points” occur infrequently, what challenge does that pose for epidemiologic studies such as this? Hint: Why are the confidence intervals around the point estimates for risk wide in this study? How are the confidence intervals to be interpreted?
How will your learners treat hypertension in pregnant women? Use the accompanying editorial to help frame your discussion.
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners to describe RP.
What is meant by primary and secondary RP? What are potential causes of secondary RP? Use the information at DynaMed Plus: Raynaud Phenomenon to help prepare for teaching, a benefit of your ACP membership.
What should the evaluation of a patient with RP include? What are the potential complications?
How should patients with RP be managed? What advice should they be given? Invite a rheumatologist to join your discussion.
Ask your learners if they know when to consider the risk for firearm injury to their patients or those around them. Use a recent, concise paper to begin learning.
How often do your learners see patients with alcohol use disorder, at risk for intimate partner violence, suicidality, other poorly controlled severe mental illness, or serious life stressors? How about patients with children or grandchildren in the home?
Do they ask each about the presence of firearms and whether they are stored safely?
Do your learners know how to counsel patients? Use the concise information at this Web site to help learn how.
Whether firearm injury is “in our lane” as physicians has recently been a topic of national interest and in the news. What do your learners think? Should the ACP and other physician organizations be involved? Why?
Ask your learners whether they think they should commit to discussing firearm safety with their patients when risks for harm are present. Consider taking such a pledge with your learners.
Consider whether your training program has assessed how frequently and in what forms your learners are subject to sexual harassment. Talk to others involved in teaching at your institution.
Are your learners asked if and in what ways they have been harassed, recalling that sexual harassment may occur in ways other than sexual coercion, as is explained in the essay? How often does gender harassment occur at your program? Would the leadership of your program know about it?
What can be done to prevent it?
Do your learners know from whom they should seek advice and help if they are the victims of harassment?
Listen to an audio recording , read by Dr. Virginia Hood.
Ask your learners whether a mistake in a patient's care has “haunted” them. Tell your learners about your own experience, and share a cartoon from Annals Graphic Medicine to help them feel comfortable sharing their stories.
How have they dealt with their grief? Do they feel guilty? How might these experiences be helpful or harmful? Dr. Kittleson describes examples of both.
With whom do your learners discuss poor patient outcomes and their emotions surrounding them? How about lesson learned? Do your learners feel safe discussing such issues?
Does your program have a structured mechanism to help clinicians support each other and grieve together? Should it? What might be discussed at such events? Who should lead them?
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Taichman DB. Annals for Educators - 20 November 2018. Ann Intern Med. ;169:ED10. doi: 10.7326/AFED201811200
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Published: Ann Intern Med. 2018;169(10):ED10.
Cardiology, Emergency Medicine.
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