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 multiple-choice questions. We've provided 2 below!
Ask your learners when a surrogate decision maker should be involved in deciding about a patient's care plans. How is a patient's capacity to make decisions for herself or himself evaluated?
Teach at the bedside (part 1)! Ask surrogate decision makers for patients on your service if they would be willing to discuss the experience with your learners.
Ask the surrogates what they understand their role in the patients' care to be. Do they know what the patient wants? Ask whether they feel conflicted in any way. Is it difficult to separate what the patient wants from what the surrogate wants?
Teach at the bedside (part 2)! Ask these same questions of patients who have the capacity to make decisions together with their designated surrogates in case of future need.
Ask if your learners have encountered a surrogate whose assessment of a patient's prognosis seemed unrealistic. How was this discussed? How might your learners approach such a discussion?
Why do your learners think the decision aid in this randomized trial did not improve prognostic concordance between clinicians and surrogates or alter patient or surrogate outcomes? Use the accompanying editorial to help frame your discussion.
Ask your learners what topical analgesics are available. When are they considered for localized, chronic pain, and what are their potential advantages and disadvantages compared with systemic analgesics?
Have your learners heard of compounded topical pain creams? How are they prepared, and by whom? Invite a member of your hospital's pharmacy staff to discuss with your learners whether these compounding services are provided and, if so, how the formulation is determined for a patient.
Review the results of this study. Do they surprise your learners?
Why do your learners think the compounded topical pain creams were ineffective in this trial? The authors provide some potential explanations in the paper's discussion.
Invite an expert in pain management to review the mechanism of action of the drugs used in this study's compounded formulations. Does the expert from your center's pain service use compounded topical creams?
How are “overweight” and “obese” defined? How and when should waist circumference be measured? Why is it useful?
Ask your learners what the health consequences of overweight and obesity are. Use the information provided in the box. What outcomes have been shown to improve with intentional weight loss?
Are your learners aware of drugs that are associated with weight gain? Are there alternatives? See Table 1. How do you decide when the risk for weight gain is outweighed by the drug's benefit?
What are the secondary causes of obesity? How do the history and examination help in their evaluation? What testing should be considered, and when?
Do your learners counsel patients about lifestyle modifications to achieve weight loss? What exactly do they discuss? Should the instructions be specific? How should an approach to dieting be discussed, and how should one be chosen? What are reasonable goals?
When should medications for weight loss be considered? When should bariatric surgery be considered?
Invite a bariatric medicine specialist to join your discussion. Which patients with overweight or obesity should be referred?
Use the multiple-choice questions to help introduce discussion topics. Log on to enter your answers and earn CME and MOC credit for yourself!
Listen to an audio recording of the essay, read by Dr. Virginia Hood.
Consider what rounding style you prefer, and why. Do you allow your learners to determine where and how rounds will be conducted?
Ask your learners which rounding practices they have experienced and what they think are their relative benefits and problems.
Do you conduct rounds at the patient's bedside? If not, why not? Should you try it?
Ask your learners whether they believe there are issues that are too difficult or even inappropriate to discuss with the patient or family present. Does everyone agree? Do some members of your team think there might be value in discussing these issues at the bedside? Is there an appropriate way to do so?
Listen to an audio recording of the essay, read by Dr. Michael LaCombe.
Ask your learners what “DNR” means. Is the definition always the same?
Should the definition vary? When might it be appropriate to rediscuss a “DNR” status with a patient to allow for more aggressive interventions than in the past?
Why was Marcia's son upset at the idea of discussing code status again? What essential information regarding the issues and potential interventions might not have been effectively communicated to him, resulting in his anger?
Taichman DB. Annals for Educators - 5 March 2019. Ann Intern Med. 2019;170:ED5. doi: https://doi.org/10.7326/AWED201903050
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Published: Ann Intern Med. 2019;170(5):ED5.
Emergency Medicine, Ethics, Mechanical Ventilation, Obesity, Pulmonary/Critical Care.
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