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 how they choose the duration of antibiotic therapy for pneumonia.
What is recommended? How often do they think antibiotics are used for longer than necessary? What are the potential harms of excessive use? Are there harms to a duration that is too short?
What did this study find?
Why do your learners think that most of the excess antibiotic days occurred during outpatient care?
What is the practice at your institution regarding the duration of antibiotic therapy prescribed at the time of hospital discharge? Can your team identify patients discharged after treatment for pneumonia from your service (perhaps with a clinical inquiry application in your EHR)? What was prescribed at discharge?
How might the total duration of antibiotic therapy be optimized?
Ask your learners why patients with chronic kidney disease are at increased risk for thrombotic complications. Which ones?
Why are they at increased risk for bleeding complications with anticoagulation?
What do we know about the benefits and safety of non–vitamin K oral anticoagulants in patients with chronic kidney disease? Why have these patients so frequently been excluded from clinical trials of these agents?
What did this systematic review find?
What do your learners think is best when considering anticoagulation in patients with chronic kidney disease and which drugs to use? What more do we need to know?
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners how NAFLD is defined. How is it usually identified?
Do your learners think we should screen for NAFLD? If so, in which patients? How would screening be performed?
How should patients with NAFLD be monitored? Should they undergo liver biopsy?
What interventions should be recommended?
How is liver stiffness assessed? Ask an expert to demonstrate performance of the test and interpretation of the results for your team.
Watch the video interview of Mr. L, a 59-year-old man with NAFLD. And, watch the video of the grand rounds presentation or consider asking members of your team to summarize the points made by the 2 experts.
Have your learners' thoughts about screening, monitoring, or management changed?
Ask your learners how SIHD is differentiated from unstable angina. What is the differential diagnosis of SIHD? (See the Box: Alternative Diagnoses to Angina for Patients With Chest Pain.)
What testing should be considered, and how does it differ according to the risk assessment for coronary artery disease? Review the algorithm provided.
Which patients should have stress testing, and how should the appropriate test be chosen?
What are essential elements of patient education regarding SIHD? Who should provide this education?
Which medical therapies can prevent myocardial infarction or death in SIHD?
Which patients should be referred to a cardiologist?
In which patients should revascularization be considered? What are the advantages and disadvantages of coronary artery bypass grafting and percutaneous coronary intervention?
How might the answers to these questions differ in older patients? What about those with chronic kidney disease?
Use the provided multiple-choice questions to introduce topics in a teaching session. And, be sure to log on to enter your answers to earn CME/MOC credit for yourself.
Listen to an audio recording of the essay, read by Dr. Michael LaCombe.
Ask your learners whether they ask patients about their fears and concerns if they are unable to return home.
Do the authors' descriptions alter your learners' views of common occurrences that we as physicians might see as “routine”? How are such views helpful to us?
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Taichman DB. Annals for Educators - 6 August 2019. Ann Intern Med. 2019;171:ED3. doi: 10.7326/AWED201908060
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Published: Ann Intern Med. 2019;171(3):ED3.
Gastroenterology/Hepatology, Liver Disease.
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