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Mycobacterium haemophilum is a rare pathogen, predominately present in the immunocompromised population. It is especially studied in HIV and haematological malignancy patients. Given its unique living conditions, it is often difficult to establish its diagnosis, but it is often suspected by its classic association with ulcerating skin findings. Our case is unique in that our patient is immunocompromised by his rheumatoid arthritis treatment, and presented without any skin lesions, but was found to have this rare pathogen causing a constellation of unusual symptoms.

RATIONALE :We created a formal medical intensive care unit (MICU) curriculum for medical students with the goals of improving medical knowledge, increasing comfort level in a critical care setting, and ultimately improving patient care. Data from our initial assessment of the curriculum showed that student knowledge improved after implementation of the curriculum. However, not all students who participated felt that the curriculum improved their clinical skills or that it should be continued. To improve upon our course from 2018-2019, we re-structured our curriculum based on feedback from students to enhance their experience. METHODS: A pre-test (PT1) will be given to medical students to assess medical knowledge and comfort level prior to beginning their four-week MICU rotation. During their rotation, students will receive one to two 30-minute teaching sessions per week. Lectures are interactive and case-based. For the 2019-2020 year, we will have the same educator for each topic for the entire academic year. The educators were selected from a group of residents who have a particular interest in medical education. This was done to establish continuity and enhance the quality of the lectures. After completion of their rotation, the medical students will complete a post-test (PT2). While the knowledge assessment for PT1 and PT2 will be similar in content, the questions will be unique. RESULTS: From our preliminary results, 100% of students strongly agreed that the curriculum should be continued for medical students. In 2018-2019 the average PT1 score was 63% and the average PT2 was 77%. However, with the new curriculum for 2019-2020, knowledge scores increased from average 71% in PT1 to 93% in PT2. Students felt more comfortable managing shock, mechanical ventilation, sedation, acid-base disturbances, arrhythmias, acute liver failure and gastrointestinal bleeding after their rotation. CONCLUSION: The addition of a formal curriculum for medical students improved student knowledge and comfort levels within the MICU. With the incorporation of consistency in resident teachers with those who were interested in medical education, we found an increased post-test score compared to 2018-2019 when resident educators were assigned at random. Moving forward, it may be beneficial to plan an introductory session for the residents to further enhance the experience and to include more topics. Additionally, attending physicians will be evaluating and giving feedback to the resident teachers during the year. We will also obtain feedback from the students regarding topics they wish to have included.