Background: Despite the risks of immunosuppression, recommendations regarding screening for HIV infection prior to initiation of biologic therapies targeting common rheumatologic disorders, including inflammatory bowel disease (IBD) and inflammatory arthritides, are limited. Few cases of patients started on biologics while living with undiagnosed HIV infection have been reported. Methods:We report three cases of patients initiated on biologics in the absence of recent or concurrent HIV screening who developed refractory disease or unanticipated complications and were later found to have undiagnosed chronic HIV infection. Results:In Case 1, a 53-year-old MSM with negative HIV testing 2 years prior presented with presumed rheumatoid arthritis. He did not respond to methotrexate, so adalimumab was started. HIV testing to evaluate persistent symptoms was positive 9 months later; CD4 þ T-cell count was 800 cells/ml. Antiretroviral therapy (ART) resulted in resolution of symptoms, which were attributed to HIV-associated arthropathy. In Case 2, a 55-year-old woman with injection drug use in remission and no prior HIV testing presented with hidradenitis suppurativa. She started infliximab and methotrexate therapy with good response. After she developed weight loss and lymphopenia, an HIV test was positive; CD4 þ T-cell count was 334 cells/ml. Biologic hidradenitis suppurativa therapy was discontinued, with subsequent poor hidradenitis suppurativa control. In Case 3, a 32-year-old MSM with no prior HIV testing presented with presumed IBD; infliximab and steroids were started. Symptoms progressed despite IBD-directed therapy, and he was diagnosed with extensive Kaposi sarcoma with visceral and cutaneous involvement, likely exacerbated by immunosuppression. HIV testing was positive; CD4 þ T-cell count was 250 cells/ml. Kaposi sarcoma initially worsened due to ART-associated immune reconstitution inflammatory syndrome. He is now improving with systemic chemotherapy and ART. HIV-associated Kaposi sarcoma is presumed to be the underlying diagnosis. Conclusion:All three patients had elevated risk for HIV infection, and two had final diagnoses attributed to chronic HIV infection, not warranting therapeutic immunosupa

Point-of-care ultrasound (POCUS) has been a mainstay of clinical decision-making in the intensive care unit and emergency department for more than a decade, but adoption into hospital medicine has lagged behind. Recently, internal medicine residency programs have started to develop POCUS curricula for trainees, though concurrent hospitalist training programs have been limited to date, with little consensus on what hospitalist-oriented curricula should entail. As such, there is wide variability amongst hospitalists with respect to utilization of, training in, and proficiency in POCUS. We conducted a two-part survey of internal medicine hospitalists at our institution: (1) needs assessment that focused on prior training, attitudes and perspectives, current practices, desired use, and barriers to clinical integration; and (2) knowledge test of exam indications, image interpretation, medical decision-making, and understanding of limitations. Our results demonstrate that a majority of hospitalists felt that POCUS was important for diagnostic purposes and that they would benefit from POCUS-specific education. Inadequate training was the most cited barrier to POCUS use. Hospitalist knowledge was lacking in all domains, particularly image interpretation and clinical integration. As a result, we created a three-tiered training program meant to engage: (1) All hospitalists in basic knowledge and appropriate use of POCUS, (2) Some hospitalists in hands-on skill acquisition and image interpretation, and (3) Few hospitalists in mastery of POCUS with resultant formal credentialing. A tiered approach to POCUS training for hospitalists ensures a fundamental cognitive understanding of POCUS for all, but also facilitates hands-on training for those who are committed to further skillset development.

Objectives We aimed to decrease barriers to acquiring Point‐of‐Care Ultrasound (POCUS) knowledge among attending physicians and improve the safety of trainee POCUS use through a novel flexible and cognitive based curriculum. Methods We developed three educational pathways using varied approaches to educational delivery: a novel and asynchronous cognitive curriculum to allow Educational Supervision, a hands‐on pathway for Limited Practice, and a more robust pathway for Independent Practice and credentialing. Results From November 2018 through June 2021, 102 of 116 hospitalists engaged in some portion of the curriculum. Twenty‐four completed the Educational Supervision pathway, 31 completed the Limited Practice pathway, and 17 enrolled in the Independent Practice pathway with three achieving independent practice. Faculty who completed the Educational Supervision pathway had improved scores on a comprehensive POCUS knowledge assessment, 43.5% [95% Confidence Interval (CI) 38.2–48.8] versus 72.0% [95% CI 65.2–78.8], P < .001. Junior faculty were more likely to engage in the supervision pathway and senior faculty were more likely to complete an intensive course to complete the Limited Practice pathway. Conclusions A flexible, cognitive focused POCUS curriculum was effective in creating high levels of engagement, and a cognitive only curriculum resulted in significant improvement in hospitalists' POCUS knowledge without hands on training. Finally, we found that hospitalist engagement in the curriculum did not follow the lowest barrier to entry or time commitment and engagement varied by time in practice. Training faculty to independent practice remains a substantial challenge.

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As a beginning librarian and MLS student, the phrases “on-the-job-training” and “trial by fire” took on new meaning for me. There was so much I had to learn by doing.Soon after starting my library science program at East Carolina University, I accepted a media coordinator position at Lillington-Shawtown (NC) Elementary School, a moderate-sized public school in a small rural county. The pre-kindergarten through fifth grade school had a population of about seven hundred students.