Our study suggests that the combination of TBBX with BAL significantly increases the likelihood that the procedure will provide adequate additional information to allow a confident MDD diagnosis of HP and may reduce the need for SLB in the diagnostic workup of HP.

The hospitalist-consultant interaction is viewed as important for both hospitalist learning and patient care. Multiple barriers and facilitating factors impact the interaction, many of which are amenable to intervention.

Cobalt exposure in the hard metal and bonded diamond tool industry is a well-established cause of ILD. The primary theories regarding the underlying mechanism of cobalt related ILD include an immunologic mechanism and an oxidant injury mechanism. Cobalt related ILD may present in subacute and chronic forms and often has associated upper respiratory symptoms. The evaluation begins with a thorough occupational history and includes PFTs, HRCT, and bronchoalveolar lavage. HRCT findings are nonspecific and may resemble NSIP, UIP, sarcoidosis, or HP. The finding of cannibalistic multinucleated giant cells is diagnostic provided there is a history of exposure and appropriate changes on imaging; however, when these cells are not found on lavage, lung biopsy is required for diagnosis. Giant cell interstitial pneumonia is the classic pathologic pattern, but cobalt related ILD may also present with pathologic findings of UIP, DIP, or HP. When cobalt related ILD is suspected, removal from exposure is the most important step in treatment. Case reports suggest that treatment with steroids results in symptomatic, physiologic, and radiographic improvement.

SUMMARY Background Near- peer teaching is effective in graduate medical education, but it has not been compared with faculty member teaching in resident simulation. In this study, we sought to compare debriefing sessions of internal medicine (IM) intern simulation sessions led by academic faculty doctors with those led by senior IM residents in order to measure the effectiveness of near-peer teaching in this setting. Method Internal medicine interns participated in four simulation cases, two of which were debriefed by faculty members and two of which were debriefed by residents. Pre- simulation knowledge assessment was completed prior to the case. Following each debriefing, interns completed a Debriefing Assessment for Simulation in Healthcare (DASH) survey. Post- simulation knowledge assessments were completed 6 months after simulation. Debriefings were recorded and transcribed. Each statement made during debriefing was classified as either correct or erroneous by blinded reviewers. Results Fifty interns participated in simulation, and the response rate on the DASH survey was 88%. There was no difference between DASH scores (p = 0.13), post- simulation knowledge assessments or error rates during debriefing (p = 0.31) for faculty member and resident instructors. Conclusion Our study suggests that residents and faculty members provide a similar quality of simulation instruction based on qualitative and quantitative evaluation.

The hallmark of vasculitis is autoimmune inflammation of blood vessels and surrounding tissues, resulting in an array of constitutional symptoms and organ damage. The lung is commonly targeted in the more familiar ANCAassociated small vessel vasculitidies, but large and medium vessel vasculitides, including Takayasu arteritis, giant cell arteritis, polyarteritis nodosa, Behcet's disease, and necrotizing sarcoid granulomatosis, may also feature prominent pulmonary involvement. Pulmonary manifestations of these conditions include pulmonary arterial aneurysms, pulmonary hypertension, diffuse alveolar hemorrhage, pulmonary nodules, and parenchymal infiltrates. An understanding of the diverse manifestations of vasculitis and a high index of clinical suspicion are essential to avoid delays in disease recognition that may result in permanent or life threatening morbidity. In this review, we outline the general clinical manifestations, pulmonary manifestations, diagnostic workup, imaging findings, and treatment of medium, large, and variable vessel vasculitides.