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 whether they discuss primary prevention of CVD with their patients. What do they talk about? Do they use a tool to assess cardiovascular risk?
Do your learners recommend aspirin for primary prevention? If so, how do they weigh the risks versus the benefits? Will the results of this study help them?
What are the barriers to use of the PREDICT model reported in this study? Why is external validation of a prediction model necessary? Use the accompanying editorial to help frame your discussion.
How is the performance of a predictive model assessed? What are discrimination and calibration? How are receiver-operating characteristic curves and reclassification indices useful? Invite an expert in epidemiology or biostatistics to help discuss these important topics with your learners.
Ask your learners whether they screen patients for depression. Is screening recommended?
Why do your learners think that despite being so common among patients requiring maintenance hemodialysis, depression is usually not treated? Do we fail to recognize the problem? Are patients reluctant to accept the diagnosis?
How would your learners assess a patient for possible depression? What questions would they ask? Are there screening tools they would use?
How would your learners counsel a patient who they thought was depressed but reluctant to accept treatment? What treatments would they discuss? Use the accompanying editorial to help frame your discussion. How do you arrange for cognitive behavioral therapy? Are commonly used drugs for depression safe among dialysis patients?
Ask your learners what the indications for central venous access are.
Read the presentation of the patient to your learners and ask whether they believe central venous access is required. If so, what kind of line?
What are the relative benefits and risks of traditional central venous catheters (CVCs) and peripherally inserted central venous catheters (PICCs)?
What are the options for central venous access at your institution? Who places each type, and how is placement arranged? Does the availability or ease of arranging for one type of line versus another (e.g., a CVC vs. a PICC) sway the decision at your institution? Should it?
Are central lines ever placed for inappropriate reasons or left in longer than they should be? Is patient or provider convenience an appropriate reason for central access?
Listen to an audio recording, read by Dr. Michael LaCombe.
Ask your learners whether they have heard more senior physicians telling stories of “the old days.” Have the old days ever been referred to as “the days of the giants”? Were they?
What was better in “the old days,” and what has improved? Invite physicians who have practiced medicine for decades to join your discussion.
Do your learners seek out the wisdom of the most senior members of your staff? What might they offer that others cannot? What can your learners offer them?
Taichman DB. Annals for Educators - 19 March 2019. Ann Intern Med. 2019;170:ED6. doi: https://doi.org/10.7326/AWED201903190
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Published: Ann Intern Med. 2019;170(6):ED6.
Cardiology, Coronary Risk Factors, Hospital Medicine, Nephrology, Prevention/Screening.
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