The Problem

Idea Series LogoECG interpretation is a cornerstone of Emergency Medicine (EM). It requires both rapid identification of life-threatening abnormalities and fastidious attention to detail. This pairing can intimidate some junior learners, and identifying an effective and engaging method for teaching ECGs is important to resident education. We report a teaching method that addresses this problem with an annual residency ECG competition.

The Innovation

Emergency medicine residents completed a timed ECG competition. Each resident had 30 minutes to complete a written exam developed by the residency program. A secondary goal was to help residents identify any individual ECG abnormalities or components of interpretation needing personal improvement.

Target Learners

EM residents, combined EM and Pediatrics residents, and combined EM and Internal Medicine (IM) residents ranging from PGY-1 through PGY-6 participated in the challenge. We stratified learners into categories based on post-graduate experience: PGY-1, PGY-2, PGY-3, and higher.

Group Size

We invited all residents (approximately 60 trainees) to participate. Small groups of 10-15 residents rotated through the multiple stations.

Materials Needed

We used previously compiled ECGs of both common and uncommon arrhythmias and diagnoses that EM providers should be able to identify. High quality images are preferred.

Description of the Innovation

In the months preceding the competition, residents received ECG study materials and had opportunities to ask questions during scheduled ECG didactics.

On the day of the competition, we divided residents into groups of 10-15 trainees. Each group rotated between simulation cases and the written ECG competition.

We evaluated ECG interpretation and fund of knowledge through a variety of formats:

  • Identifying classic ECG findings (ischemia and common arrhythmias)
  • Identifying management or next-steps in response to an ECG
  • Short answer and “list” questions to describe more nuanced components of ECG interpretation

At the end of the activity, participants received an answer key, which we reviewed at a subsequent didactic session. Experienced faculty facilitated the review session. The top trainees in each category were recognized at the annual resident graduation dinner.

Dr. Amal Mattu’s ECG Weekly website features EKGs from the competition, as well as answers to prior ECG competition exam questions.

Theory Behind the Innovation

This exercise corresponds to Kolb’s 4-stage cyclical theory of experiential learning, a model of learning that combines experience, perception, cognition, and behavior. According to Kolb, “learning is the process whereby knowledge is created through the transformation of experience.”1,2

During the ECG competition, a learner applies knowledge to specific cases in a safe environment where mistakes can be made without severe consequences. This reflects the “concrete experience” stage of learning. After the competition, learners have an opportunity to review their answers. This represents the observation and reflection stages of experiential learning. Finally, residents progress to the stages of cognition and behavior: identifying areas to improve their ECG interpretation, and influencing behavior by applying this knowledge to patient care.

Lessons Learned

Though a simple concept, the ECG competition is now a popular annual event at our residency program. Residents have expressed enthusiasm for the event and its ability to emphasize key principles of ECG interpretation in a fun, engaging manner.

Closing Thoughts

ECG interpretation is critical to providing emergency medical care. It requires an attention to detail that often intimidates both junior learners and even some experienced providers. Pairing targeted, high yield practice materials with a competitive ECG exam is an effective method for teaching ECGs to residents, and provides an opportunity to develop this skill in a fun and safe environment.

Read more about the IDEA Series.

Kolb D A. Experiential Learning. Englewood Cliffs, N.J. : Prentice-Hall; 1984.
Experiential Learning (Kolb). Learning Theories. Published February 13, 2007. Accessed September 19, 2017.
Sumit Patel, MD

Sumit Patel, MD

Emergency Medicine Resident
Department of Emergency Medicine
University of Maryland
Sumit Patel, MD

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Amal Mattu, MD

Amal Mattu, MD

Professor of Emergency Medicine
Vice Chair
Department of Emergency Medicine
University of Maryland
Amal Mattu, MD

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