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 whether they have cared for patients to whom medications for opioid use disorder (e.g., buprenorphine) were or should have been offered. What are the indications? Are there contraindications?
When medication for opioid use disorder is indicated, how is it accessed? Do your learners know what is involved in receiving a waiver to prescribe these medications in nonspecialty settings? Is there a limit to the number of patients a provider may treat?
How do patients get appointments with such health care providers?
What is an audit study (“secret shopper” study), and what kind of questions does it help to answer? What are the limitations of such a study?
Teach at the bedside! Ask a patient who has received medication for opioid use disorder what challenges were involved in initiating and continuing to receive medication and care.
Why do your learners think more “patients” who were paying for care out of pocket were offered appointments in this study than those receiving Medicare? Use the accompanying editorial to help frame your discussion.
Ask your learners why national guidelines recommend avoidance of PICC placement in patients with advanced CKD.
What did this study find? Why do your learners think PICC placement among patients with CKD remains so common? Use the accompanying editorial to help frame your discussion.
What are the alternatives to PICC placement?
The authors note that being unable to assess whether PICC placement had been approved by a nephrologist was a limitation of their study. How is this a limitation?
What variables might have confounded the study's findings? How did the authors attempt to control for them?
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners what the benefits are to use of drug therapies for osteoporosis. Do the benefits differ among the available drugs? Over what time frame are the benefits realized?
What are the potential harms? What is an atypical femoral fracture? What is osteonecrosis of the jaw? How common are they?
How long should drug therapy for osteoporosis be? What is the rationale for “drug holidays”? How strong is the evidence for such a practice? What did the systematic review find?
What are the gaps in our knowledge, and why do they matter? Use the accompanying editorial to help frame your discussion.
Ask your learners whether they know the criteria for establishing that a patient is transgender or gender-incongruent.
Ask how transgender medical interventions should be considered.
What are the options for transfeminine and transmasculine hormone therapies? What are the potential complications?
What surgical procedures are available?
Does insurance cover these therapies?
What barriers to the care of transgender patients exist at your health center? How might the experiences of transgender and cisgender patients in your hospital differ?
Are the questions on forms completed by patients in your practice problematic for transgender persons? How might they be changed? What about in your EHR?
Use the multiple-choice questions to help introduce topics for discussion. Be sure to log on and enter your answers to earn CME/MOC credit for yourself!
Listen to an audio recording, read by Dr. Michael LaCombe.
Ask your learners whether they have found themselves involved in medical discussions about their own family members and wondered whether their role in the dynamic should be altered by their medical training.
The author notes the problems posed by the conflicting agendas of family members and her own goals for a family meeting. Have your learners experienced such conflict? How should these issues be negotiated to help the patient and his or her family?
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Taichman DB. Annals for Educators - 2 July 2019. Ann Intern Med. 2019;171:ED1. doi: https://doi.org/10.7326/AWED201907020
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Published: Ann Intern Med. 2019;171(1):ED1.
Chronic Kidney Disease, Endocrine and Metabolism, Metabolic Bone Disorders, Nephrology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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