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 what symptoms would prompt consideration of PE in a pregnant patient. What is the differential diagnosis?
How would your learners approach the diagnosis of PE in a pregnant patient? Would their approach differ from that for a nonpregnant patient? In what ways, and why?
Review the results of this study. Do your learners consider the rates of VTE during follow-up among patients managed according to the study's algorithm sufficiently reassuring to adopt the approach?
How would your learners have handled study participants who did not have PE at presentation but received prophylactic or therapeutic anticoagulation during the study? How might their inclusion in or exclusion from the analysis influence the results? How did the authors approach this issue, and why?
Ask your learners what advice they give to patients with obesity. If they do, how do they raise the subject of weight loss? Are there constructive approaches to such discussions and approaches that are potentially hurtful?
When should bariatric surgery be considered? What criteria are used to decide whether surgery is appropriate? Invite a specialist in bariatric medicine or a bariatric surgeon to join your discussion. Ask what procedures are available and what considerations influence the choice for each patient.
What are the potential benefits of surgery? Are there benefits beyond weight reduction? Use the accompanying editorial to help frame your discussion.
What are the potential acute and chronic complications of bariatric surgery?
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners how they monitor patients with previously diagnosed CAD. How are “stable” and “unstable” CAD defined?
Is “routine” or “surveillance” cardiac stress testing indicated in patients with stable CAD? Why or why not? The authors note that guidelines recommend against it. Is this common practice at your center nonetheless?
How might the findings of this study be useful? What more needs to be known for the results of this study to alter clinical care? Use the accompanying editorial to help frame your discussion.
Are these results applicable to patients with unstable angina, with or without known CAD?
Ask your learners whether they consider fall prevention in their usual care of patients. Why or why not?
Who is at increased risk for falls? Create a list of intrinsic and extrinsic factors that increase a patient's risk. Use the Box: Intrinsic and Extrinsic Risk Factors for Falls.
How might a patient's fear of falling influence his or her quality of life?
How should your learners evaluate a patient's risk for falls and the variables that might contribute to increased risk?
What home safety recommendations should your learners provide to patients?
Are there interventions (exercise, pharmacologic, or others) that can help reduce the risk for falling?
Is the risk for falls evaluated for hospitalized patients at your institution? Who does this, and how? What is done when a patient is at increased risk? Is it effective? How do you know? Invite someone from your institution's quality improvement group to discuss how your institution approaches these issues.
Use the multiple-choice questions to introduce topics for discussion with your learners, and be sure to log on to enter your answers to earn CME/MOC credit for yourself!
Listen to an audio recording of the essay, read by Dr. Michael LaCombe.
Consider whether you should discuss this essay with your whole team, or separately with those who are and those who are not medical students.
Ask your team's members to consider whether they reach out or make gestures to junior members of the team to help them feel welcome, included, and valued.
Find a quiet spot to listen to an audio recording of this essay with your team, read by Dr. Michael LaCombe.
Allow time for quiet after the reading.
Ask your learners if they have ever experienced things they cannot explain in the care of patients.
How have such experiences affected them?
Taichman DB. Annals for Educators - 4 December 2018. Ann Intern Med. 2018;169:ED11. doi: https://doi.org/10.7326/AFED201812040
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Published: Ann Intern Med. 2018;169(11):ED11.
Cardiac Diagnosis and Imaging, Cardiology, Coronary Heart Disease, Obesity, Prevention/Screening.
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