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!
What are the immediate considerations for evaluation and management of patients with potential UGIB?
Ask your learners what the risk factors are for UGIB.
Do all patients with UGIB require hospitalization? How do your learners decide? Review the variables of the Glasgow Blatchford score. What score is recommended to identify a sufficiently low risk for rebleeding to consider outpatient management? Is this in line with practice at your hospital? Do your learners think it should be?
Which patients require blood transfusion? Note the difference in thresholds for transfusion recommended in the multiple-choice question below and in the guideline. Why might recommendations differ? What do your learners plan to do?
How should proton-pump inhibitors be administered, and for how long? How does a patient's need for anticoagulant or antiplatelet therapy influence the approach to proton-pump inhibitor therapy?
Read the presentation of a 46-year-old woman seeking advice about her risk for cardiovascular disease with your learners.
Ask your learners how they would answer this patient's question regarding a “test” to assess whether “stroke is in her genes.”
How would your learners assess this patient's risk?
Is there a role for genetic testing?
How does this patient's history of migraine influence your learners' assessment of her risk? What other variables influence her risk? Use the Figure.
Watch the video interview of Dr. V, a 69-year-old woman with an asymptomatic episode of tachycardia noted during ambulatory blood pressure monitoring.
Ask your learners whether they would recommend screening patients for atrial fibrillation. Why or why not?
What are the potential benefits and harms?
Review the background material and the arguments made by the 2 discussants. Alternatively, watch the video of the grand rounds presentation.
Have your learners changed their minds about screening?
Ask your learners what conditions increase the risk for OSA. See the Box: Risk Factors for Obstructive Sleep Apnea.
Should we screen for OSA? If so, in whom? How would your learners do so? Are they familiar with the STOP-BANG approach?
What evaluation should occur if OSA is suspected?
Are in-laboratory sleep studies required for diagnosis or treatment?
How is treatment initiated? Is evaluation by a specialist always required?
Use the provided multiple-choice questions to introduce topics during a teaching session. Be sure to log in and enter your answer to claim CME and MOC credit.
Ask your learners whether they have noted differences in their interactions with patients who are veterans compared with those who have not served in the military.
Do your learners ask patients who are veterans about their service history? Should they? When? What questions should be asked? Use the Table. Why might these questions be helpful?
Have your learners encountered the kinds of misunderstanding or miscommunication described by the author?
Listen to an audio recording, read by Dr. Michael LaCombe.
Ask your learners whether they are ever jarred by thoughts of a loved one when they see a patient with an illness.
Is it different to face a loved one's illness as a physician? Do our knowledge of medicine and our experiences with advanced disease make things better or worse?
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Taichman DB. Annals for Educators - 3 December 2019. Ann Intern Med. 2019;171:ED11. doi: https://doi.org/10.7326/AWED201912030
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Published: Ann Intern Med. 2019;171(11):ED11.
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