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 how SGLT2 inhibitors decrease serum glucose levels. Where do these agents fit into treatment for diabetes? What are their potential adverse effects?
Ask your learners what the advantages and disadvantages are of randomized trials and observational studies in evaluating a drug's efficacy and safety. Use the accompanying editorial to help frame your discussion.
What comparison groups would your learners consider using when assessing risk for fractures associated with canagliflozin? What did the authors choose, and why? They explain in the “Study Cohort” section of the Methods.
Ask what the purpose of propensity score matching is when evaluating observational data. In what way does this technique help to address potential confounding? Does it “mimic” a randomized trial? Look at Table 1 and ask your learners whether they think the matching worked.
What are the limitations in what may be concluded from these data? The editorialists note concerns about the generalizability of the findings.
Ask your learners whether vaccination status is routinely reviewed in your outpatient practice. Who does this? How would you find out whether the system is working? How accessible is the information?
Ask whether your learners check if their young adult patients have received human papillomavirus vaccination. What are the recommendations for females up to age 26 years and males up to age 21 years?
What is the difference between the recombinant and live zoster vaccines? Which is recommended? To whom? How do patients access these vaccines?
What is the appropriate timing of pneumococcal vaccination with PPSV23 and PCV13?
Review the brief history of Mr. R and watch the video of his interview with your learners.
Ask your learners what approach they take to fluid management and nutrition in patients with acute pancreatitis.
Ask what imaging is appropriate. When and how does it assist in patient management?
When do your learners recommend surgery be considered?
Now, watch the video of the grand rounds discussion, or have your learners read the manuscript. Have the approaches they plan to take in the future changed?
How would your learners answer Mr. R's concern that the delay in surgery might have caused permanent damage to his pancreas?
Use the provided multiple-choice questions to introduce discussion topics, and log on to enter your answers and earn CME and MOC credit for yourself!
Ask your learners whether they inquire about contraceptive needs. Do they consider how a patient's chronic illnesses might affect the safety of pregnancy or the choice of contraceptive method?
What long-acting, reversible contraceptive methods are available? In whom should they be considered, and what are their relative advantages and disadvantages?
What forms of emergency contraception are available?
What risks are associated with combined oral contraceptives? What about with other forms of contraception?
What conditions increase the risk for complications in pregnancy?
Consider whether your teaching program has discussed the role medical students are now expected to play in chart documentation.
Are teaching physicians aware of expectations? Should this be discussed among the educators at your institution?
What have they been told about the responsibility to review what students write? How might the value of students' chart notes as teaching tools be maximized? Do you and your colleagues share the authors' concerns about unintended consequences?
Are your own progress notes models you wish medical students to emulate? Do they communicate your thoughts about a patient's condition and the rationale for management plans to others, or are they only aimed at fulfilling billing requirements?
Ask your learners what they see as the goals of patient progress notes. What makes a useful note and a not so useful (or even useless) note?
Plan a teaching session with the medical students on your service, focusing on their experiences in discovering what medicine is all about.
Can they relate to what the students portrayed in these cartoons?
Have they felt disillusioned by what they have seen? In awe? Both?
How did their expectations differ from the reality they have experienced thus far?
Use the accompanying editorial to help plan your discussion.
Listen to an audio recording, read by Dr. Michael LaCombe.
Ask your learners if there are patients for whom they feel they do very little or nothing.
Why do such patients return for follow-up?
Do your learners believe they make a difference for such patients? In what way?
Have your learners been thanked by their patients or families in special ways? Did it make them uncomfortable? Did it make them proud?
Does our profession's culture make it difficult to admit if we long for such expressions of gratitude from patients? Why is it important to embrace such experiences? Does it also help the patient?
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Taichman DB. Annals for Educators - 5 February 2019. Ann Intern Med. ;170:ED3. doi: 10.7326/AWED201902050
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Published: Ann Intern Med. 2019;170(3):ED3.
Cardiology, Coronary Risk Factors, Diabetes, Education and Training, Endocrine and Metabolism.
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