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 a multiple-choice question. We've provided one below!
Ask your learners to define delirium. Why is a precise definition important? Is a patient with dementia necessarily delirious? What is the difference? Why does it matter?
What do your learners do when informed that a hospitalized patient is delirious? What evaluation should they perform? What are the potential causes?
Teach at the bedside! Are your learners familiar with diagnostic tools such as the Cognitive Assessment Method (CAM) for delirium? Demonstrate the use of CAM or another validated approach to evaluate potential delirium.
Are all patients with delirium agitated? What is “calm delirium”?
In what ways is delirium dangerous?
What do these systematic reviews tell us about the use of antipsychotics for prevention or treatment of delirium? What can we do when a patient is delirious? What behavioral interventions can be helpful? What causes are reversible?
Will your learners be tempted to “just order a drug” the next time they are called about an agitated patient who is delirious? Will they feel pressured to do so? How should they respond?
How would your learners evaluate the effect of an intervention to treat delirium? What “end points” would they use to assess success? The editorial discusses these challenges.
Ask your learners whether screening for HCV infection is recommended for patients with CKD. If so, why? Use this opportunity to discuss the criteria for an effective screening test.
What therapy should be used for the treatment of HCV infection in a patient with CKD? Review the algorithm in Figure 1.
What kidney diseases are related to HCV infection itself? How is each managed?
Ask your learners what organisms should be considered when patients present with cellulitis. What signs and symptoms should raise concern about fasciitis and the need for surgical debridement?
Have your learners heard of Vibrio vulnificus? Where are infections with this organism most commonly reported?
What changes appear to have led to an increase in Vibrio infections outside its more commonly reported geographic distribution?
How might climate change alter how we approach the differential diagnosis of infectious diseases?
Watch the video of Ms. K's interview.
Ask your learners what the risks and benefits are of aiming for tight glucose control in patients with T2D. What target hemoglobin A1c level should be used? When should one consider deintensifying hemoglobin A1c goals?
Watch the video of the Grand Rounds presentations, or assign members of your team to summarize the arguments made by each of the 2 discussants.
What questions would your learners ask Ms. K? How might her answers influence what your learners recommend? How would they explain the risks and benefits of tighter or less intense glycemic control to Ms. K?
Teach at the bedside! Ask a patient with T2D who uses insulin how she or he felt about starting it. What challenges has it posed? Watch a short cartoon depicting patient worries about “going on the needle.”
Log on to enter answers to the multiple-choice questions to earn CME/MOC credit for yourself!
Ask your learners when they should suspect a patient has asthma. How is the diagnosis established?
Do normal spirometric values rule out the diagnosis?
What alternative diagnoses should be considered?
What advice should your learners provide to patients about environmental exposures in the management of asthma?
Review the “step therapy” algorithm provided in the Figure.
How do your learners explain “maintenance” and “rescue” therapy to patients? What language do they use?
Teach at the bedside! Ask a patient to demonstrate the use of his or her inhaler. Do your learners know how inhalers should be used? Is it easy? Why does such an evaluation matter? Invite an expert in asthma education to demonstrate how they teach appropriate use.
When should a patient be referred to a specialist?
What are the potential complications of asthma?
Use the provided self-assessment questions to help introduce teaching topics. And, log on to enter your answers to earn CME/MOC credit for yourself!
Listen to an audio recording of the essay, read by Dr. Virginia Hood.
Ask your learners whether the challenges faced by the author's grandmother persist today.
Are the contributions of women in medicine valued less than those of men today?
Are the expectations of women and men in medicine the same?
Do women in medicine receive the same compensation and support as men?
Why do inequalities persist? What should be done to address them?
Listen to an audio recording of the essay, read by Dr. Michael LaCombe.
Ask your learners whether they enjoy hearing from older physicians about how things used to be.
Ask whether the “old days” were the “days of the giants.”
Do your learners believe it is a problem if they don't have the same acumen in physical diagnosis as physicians who trained decades ago?
Might some of the more senior faculty members at your institution and your trainees enjoy talking about such issues? What can they learn from each other?
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Taichman DB. Annals for Educators - 1 October 2019. Ann Intern Med. 2019;171:ED7. doi: 10.7326/AWED201910010
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Published: Ann Intern Med. 2019;171(7):ED7.
Delirium, Diabetic Nephropathy, Nephrology, Neurology, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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