1. National Trends in Emergency Medicine Residency ECG Curriculum and Interpretation Practices
Céline Pascheles, MD, Leslie Bilello MD, Jenna Singleton MD, David Chiu MD, Carlo Rosen MD
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Harvard Affiliated Emergency Medicine Residency, Department of Emergency Medicine
Beth Israel Deaconess Medical Center, Boston, MA
Official hospital of the
Boston Red Sox
INTRODUCTION
RESULTS
RESULTS
Sixty one percent of residencies participated (n=102).
70% are three-year programs and 30% are four- year programs.
Eighty-nine programs report an attending as the primary ECG
interpreter (87%; CI %), while only 13 institutions
allow the senior resident to perform primary interpretation (13%;
CI %).
Of these 13 programs, nine require attending interpretation within minutes (69.2%; CI %) and the other four programs state the attending will review the ECG interpretation at another time during the shift (30.7%; CI %).
There are a variety of required and elective ECG curriculum
models.
Seventy-one programs provided information regarding ECG curriculum models (70%; CI %; Figure 2).
The required teaching modalities range from commonly used lecture series (90%; CI %) and textbook readings (40%; CI %) to less popular asynchronous online learning methods (26.8%; CI %).
Twenty programs have a required flipped classroom approach to ECG interpretation (28.2%; CI %).
The flipped classroom is an education model in which learners
review video lectures and educational materials at home while
subsequent in-class sessions serve as a forum for active
discussion, problem-solving and group projects.
Twenty-seven programs have required one-on-one training sessions (38.0%; CI 26.8%-50.3%), while only nineteen require online teaching modules (26.8%; CI %).
These same online models were the most popular element of elective ECG curricula (64.8%; CI %).
About half report utilizing textbooks, lectures and one-on-one training as elective educational adjuncts.
Flipped classroom and simulation were the least popular elective modalities for ECG interpretation education.
There are no mandatory guidelines to standardize electrocardiogram (ECG) curriculum or interpretation practices across emergency medicine (EM) residencies.
Little is known regarding who performs the initial ECG interpretation and how resident reads are supervised by attendings.
Our ECG educational model at Beth Israel Deaconess Medical Center (BIDMC) utilizes the senior resident as the primary interpreter of all ECGs within the emergency department (ED).  
OBJECTIVE
The objective of this study was to investigate the diversity of ECG
interpretation patterns and varied curricula across EM residency
programs.
Figure 1: Geographical Distribution of Participating Emergency Medicine Residencies
METHODS
Design:
Survey was performed to collect data regarding the ECG curriculum and practice patterns of 166 EM residencies recognized by the Accreditation Council for Graduate Medical Education (ACGME) in February 2017.
Each program director received a unique, de-identified survey link via a secure web-based application, Research Electronic Data Collection (REDCap), requesting information regarding their residency’s demographics, ECG reading patterns and curriculum.
Responses were summarized and compared by region, program length, and primary interpreter of ECG. 95% confidence intervals (CI) were calculated. 
CONCLUSION
There is a diverse array of educational methods and clinical practice patterns across EM residencies.
EM attendings are the primary interpreters of ECGs at the majority of residency programs.
A small minority provide senior residents the opportunity to perform primary interpretation.
Most programs utilize mandatory didactic lectures to disseminate ECG interpretation knowledge, while a much smaller portion use innovative teaching modalities such as flipped classroom and online modules.
Further studies are needed to investigate error or miss rates attributed to resident and attending ECG interpretation, and to determine the optimal method by which to teach and assess ECG interpretation skills.
Figure 2: Required Versus Elective Electrocardiogram
Interpretation Teaching Modalities