Introduction: A workshop was designed to evaluate whether high-fidelity simulation with interactive case discussion could improve resident physician knowledge and comfort interpreting and managing bradyarrhythmias. Methods: All the residents completed a pre-test and then participated in a one-hour interactive presentation, which included practice interpreting rhythm strips and 12-lead electrocardiograms. Forty-four residents were assigned to the intervention group and completed 10 simulated cases using a mannequin, a real defibrillator/external pacemaker, a medication cart, and a simulated telemetry monitor displaying real-time electrocardiograms under the guidance of two instructors. Seventeen residents were assigned to the control group and completed the same 10 cases using interactive discussion with the same instructors but without the use of the high-fidelity simulation models. All residents underwent post-testing. Results: For the intervention group, the mean pre-and post-test knowledge scores were 13.93 and 17.28 (p=0.0001), and the mean pre-and post-test comfort scores were 2.92 and 4.24 (p=0.0001). For the control group, the mean pre-and post-test knowledge scores were 14.52 and 18.00 (p=0.005), and the mean pre-and post-test comfort scores were 2.97 and 4.35 (p=0.001). There were no statistically significant differences between pre-test and post-test knowledge and comfort scores for the two groups (p=0.633, p=0.421, p=0.177). Conclusion: Interactive workshops help improve resident knowledge and comfort with identifying and managing bradycardias. The use of high-fidelity simulation models may not be superior to a similar interactive learning experience without the use of high-fidelity simulation tools.

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The first-line treatment for advanced epidermal growth factor receptor (EGFR) mutation positive non-small cell lung cancer (NSCLC) includes the use of afatinib and other EGFR tyrosine kinase inhibitors (EGFR-TKIs). While generally well tolerated, a small subset of patients will develop drug-induced interstitial lung disease (ILD) which could lead to drug discontinuation or even death.A 58-year-old female with stage IV NSCLC treated with afatinib presented with dyspnea and rapidly progressive hypoxemia. Imaging of the lungs demonstrated ground glass opacities. Infectious workup was unrevealing, and since drug-induced ILD was suspected early on presentation, high dose corticosteroids were initiated leading to clinical improvement.While the incidence of afatinib-induced ILD is rare, the consequences may be serious and potentially fatal. The presentation is often non-specific and may mimic other common respiratory pathologies making the diagnosis challenging. If therapeutic measures such as corticosteroids are initiated promptly, they can be life-saving.

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