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 what evaluations are necessary for incidentally detected adrenal masses (“incidentalomas”). Why are these masses potentially concerning?
How is it determined whether the adrenal mass is functioning or nonfunctioning, and why does it matter?
What did this study find with regard to growth of incidentalomas and development of overt Cushing syndrome?
How reassuring are the findings of this study regarding the need for follow-up? Which incidentalomas should be resected? What questions remain unanswered about the potential development of cortisol excess? Use the accompanying editorial to help frame your discussion.
Ask your learners how they treat pain in the hospital. Do they use opioids to treat pain more or less often than in outpatients?
This study noted that most opioid-naive patients received narcotics without prior attempts to control pain with nonopioid analgesics. Ask your learners if they think this happens at your institution. How could this be studied?
Do your learners believe that the needs of clinicians (nurses and physicians) influence the use of opioids to treat pain in hospitalized patients? Why might the physician and/or nurse be motivated to use them?
How is a patient's ongoing need for opioids or other analgesics assessed and monitored at your institution? Why might that be important in light of this study's findings regarding long-term opioid use if these agents are still in use immediately before discharge?
Ask your learners how they think epilepsy affects a patient's quality of life.
Teach at the bedside! Talk to a patient with epilepsy and ask how it affects his or her daily life. What about their work? Their daily activities? Their family members?
What is a self-management program? What are its components in epilepsy care? Invite an expert in epilepsy care to join your discussion.
What did this study find with regard to the benefits of self-management programs for patients with epilepsy? Is seizure control the only factor that leads to disability in epilepsy? Use the accompanying editorial to help frame your discussion.
The authors concluded that meta-analysis was difficult because of the heterogeneity and risk of bias among the identified studies. What do each of these mean, and why do they make pooling the evidence in meta-analysis problematic?
Ask your learners whether they believe the work environment at your institution is free of gender bias or other forms of bias. What sorts of bias do they see?
Are expectations the same for men and women during residency? What about for faculty?
What are your residents' expectations for pay when seeking jobs after residency? How do they know what is and is not fair compensation? In what other areas might there be disparities in the jobs they are offered?
In what ways are students and residents subjected to sexual harassment? To whom should they turn for help if such behavior occurs? What should the response be? What if the response is inadequate?
Show the graphic piece to your learners.
Ask whether they have had similar experiences that challenged their self-confidence.
How should we handle such experiences? Is feeling guilty for our mistakes a bad thing?
Listen with your learners to an audio recording, read by Dr. Michael LaCombe.
Ask your learners to list the circumstances that have led patients to leave “AMA.”
What are common features of such occurrences? Are there problems with communication? With trust? How have the physicians and nurses involved tried to address the problems?
Do we always make as good an effort as we should to improve communication and trust in such situations? Might we be motivated by our own desires and large workloads to “just let the patient leave”?
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Taichman DB. Annals for Educators - 16 July 2019. Ann Intern Med. 2019;171:ED2. doi: 10.7326/AWED201907160
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© 2019
Published: Ann Intern Med. 2019;171(2):ED2.
DOI: 10.7326/AWED201907160
Adrenal Disorders, Endocrine and Metabolism, Endocrine Cancer, Hematology/Oncology.
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