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 to explain the mechanism by which anemia is potentially deleterious. What harms may occur, and are the risks different among hospitalized patients?
What is the rationale for red blood cell transfusions in patients with anemia?
What are the potential complications of blood transfusion?
Do your learners have “threshold” hemoglobin values below and above which transfusion will or will not be considered, respectively? Does the clinical context alter the threshold?
What does this study contribute to the conversation regarding the safety of “tolerating” anemia?
Why do the editorialists emphasize that transfusion is a short-term treatment method? What is the best longer-term management for anemia?
Identify the last several blood transfusions performed on your team's service. Review the circumstances with your team. Was it clear that transfusion was needed? Would your learners have considered not performing transfusion in these patients? Do the results of this study alter their thinking?
Ask your learners what therapies are available for Crohn disease. In which patients is infliximab a consideration?
How does infliximab work? What are the potential benefits and harms? How expensive is it?
Ask your learners to define a biosimilar and generic drug. The FDA's definition is noted in the first paragraph of the article. Why is establishing equivalence potentially more challenging for a biosimilar than a generic drug? Use the accompanying editorial to help frame your discussion.
What end points were used in this cohort study? Why were they chosen for a bioequivalence study?
What are the limitations to what may be concluded about efficacy and safety? What more needs to be done? (The editorialists provide an answer at the end of the editorial.)
Take a short break to watch this episode of the consultative medicine talk show with your learners. Before doing so, challenge your learners with the 2 multiple-choice questions provided to help focus their viewing and learning.
Ask your learners what their goals are when they evaluate a patient before surgery.
What key information are anesthesiologists and surgeons looking for from us?
How do your learners assess a patient's risk for perioperative myocardial infarction?
Ask your learners whether they agree that medicine is “a profession to be entered, rather than a trade to be learned.” What is the difference?
What is beneficence, and how do we define what is in a patient's “interest” or “best interest”? Use the accompanying editorial to help frame your discussion.
Under what circumstances may a physician elect to discontinue the relationship with a patient? How should this be done, if at all?
Does telemedicine raise new ethical issues?
Are physicians obligated to provide care to patients if doing so places the physician at risk for harm (e.g., from infection)?
Is it appropriate to accept a gift from a patient?
Review the ethics manual for other topics to discuss with your learners.
Listen to an audio recording, read by Dr. Michael LaCombe.
Ask your learners whether medical school and training have interfered with their ability to lead healthy lifestyles. If so, in what ways?
Do we exercise enough? Do we sleep enough?
Do we eat a healthy diet? What about at the hospital? Is the food available to us (or provided for free) healthy? If not, why not? What might be done about that?
Are there ways your learners can together find ways to encourage and help each other to lead healthier lifestyles? Could the leadership of the training program help?
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Taichman DB. Annals for Educators - 15 January 2019. Ann Intern Med. ;170:ED2. doi: 10.7326/AFED201901150
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Published: Ann Intern Med. 2019;170(2):ED2.
Ethics, Gastroenterology/Hepatology, Inflammatory Bowel Disease.
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