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 frequently they think patients take antibiotics without a prescription. Do the results of this study surprise them?
What are the potential dangers of this practice?
Why do your learners think patients take antibiotics without a prescription? Review the reasons found in this study (use Figure 4, for example, as a summary). How might we as individuals and as health care systems help to address each of these reasons for inappropriate antibiotic use?
What instructions do your learners give to their patients when prescribing antibiotics? Do they discuss the need to complete the entire prescription? When asking patients whether they have taken antibiotics for a symptom, do they ever ask where they were obtained? Have they ever discussed the dangers of taking antibiotics without a prescription?
Ask your learners whether they have used a handheld ultrasound device. In what setting?
What are the potential benefits of FoCUS? Are there potential dangers? How would your learners design a study to evaluate whether FoCUS is beneficial or harmful? What should the comparisons be? What should the outcomes be? What are potential sources of bias in the study designs they propose?
Review the studies identified for inclusion in this review (see the Table). Do the number of patients included, the severity of their cardiac conditions, or the person who performed the clinical examinations and the FoCUS matter? Why might these matter in assessing the reported results in these studies?
The authors note that most of the included studies were judged to be at high or unclear risk of bias. Why does that matter when your learners interpret the reported results? What are potential sources of bias in studies such as these?
Teach at the bedside! Ask an expert in FoCUS to demonstrate its use.
Do your learners think their physical examination skills could be improved? Should they be replaced with technological approaches to patient evaluation, such as FoCUS?
Ask your learners whether they ever show patients x-ray or other test results on the computer. Has it been useful? How?
Teach at the bedside! Show a patient with a markedly abnormal radiograph the results of her or his tests. Ask the patient whether seeing the results was helpful in understanding what is going on.
How are the chairs and computer screens set up in your outpatient examination rooms? How might the setup be improved?
Review the simple suggestions these authors have for improving patient engagement using the computer. Do your learners think these are reasonable? Will they try them?
Ask your learners what can cause flushing.
Why might a history of flushing after alcohol consumption be important?
What is the role of acetaldehyde in such flushing? Why does the physician think to ask Mr. Liu about this symptom?
What is “precision medicine”? Can your learners think of examples of when differences in a group's genetic predisposition alter their thinking about a clinical problem?
Taichman DB. Annals for Educators - 20 August 2019. Ann Intern Med. 2019;171:ED4. doi: https://doi.org/10.7326/AWED201908200
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Published: Ann Intern Med. 2019;171(4):ED4.
Cardiac Diagnosis and Imaging, Cardiology.
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