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 risks are associated with surgery among patients with RA.
What do your learners know about the risks of neck manipulation and intubation in patients with RA? Do they know the significance of cervical subluxation?
What are the potential benefits and risks of biologic therapies in patients with RA?
What advice would your learners provide with regard to perioperative management of immunosuppression for a patient with RA? What if any special considerations might be necessary in patients receiving glucocorticoids?
Ask your learners what the potential complications of streptococcal pharyngitis are.
Why is it important to identify infection with Streptococcus pyogenes (group A Streptococcus)? Why is antimicrobial therapy important?
How does acute rheumatic fever present? Scarlet fever? Reactive arthritis? Glomerulonephritis? What are the suppurative complications? How is each diagnosed and treated?
Review the Jones criteria. When and how might antistreptolysin O titers be helpful?
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners to define normotension, sustained hypertension, white coat hypertension, and masked hypertension. What is white coat effect?
Why do recent guidelines emphasize use of ambulatory and home blood pressure monitoring? How do the results of this study inform such practice? Do they suggest that ambulatory monitoring is more or less important, and how? Use the accompanying editorial to help frame your discussion.
How do your learners arrange for ambulatory blood pressure monitoring in their patients? Do they do so when it is indicated? Why or why not?
What are the potential limitations of the studies that were included in this meta-analysis, and how might they affect what may be concluded? The editorialists discuss these issues.
Ask your learners how they would define “physician impairment.”
Why do the authors of this paper distinguish between “functional impairment” and “potentially impairing illness”?
What are our responsibilities with regard to recognition and reporting of potential impairment in ourselves or our colleagues? To whom should we turn when there is concern about impairment?
What are the barriers to such reporting?
What professional challenges remain for a physician who has successfully recovered from impairment?
Use the accompanying editorial to help frame your discussion.
Listen to an audio recording, read by Dr. Virginia Hood.
Ask your learners how we might treat a colleague's privacy differently than that of nonphysician patients. Why might this happen?
How can we avoid such behavior?
How should Ms. Li's teachers have handled this situation? What should others in the room have done? Would students or residents have had the confidence to speak up in such a situation?
Listen to an audio recording, read by Dr. Michael LaCombe.
Ask your learners whether they have experienced events that are inexplicable in the care of patients.
Do your learners believe that miracles occur? Have they ever discussed such things with patients? Why or why not?
Ask whether your learners have ever questioned their assessment of a patient's terminal status.
Have they reconsidered prognostic assessments when patients do better than expected?
What should prompt such thoughts? What might prevent us from doing so as frequently as we should? What might be the harms to a patient if done too frequently?
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Taichman DB. Annals for Educators - 18 June 2019. Ann Intern Med. 2019;170:ED12. doi: https://doi.org/10.7326/AWED201906180
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Published: Ann Intern Med. 2019;170(12):ED12.
Cardiology, Coronary Risk Factors, Hypertension, Nephrology.
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