Identification and Instruction of Core ECG Interpretation Skills Necessary for Emergency Medicine Residency Readiness. Shannon Lovett, MD; Dan Holt, BS;

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Identification and Instruction of Core ECG Interpretation Skills Necessary for Emergency Medicine Residency Readiness. Shannon Lovett, MD; Dan Holt, BS; Amy Hoyt, MEd; William Adams, MA; Trent Reed, DO Loyola University Chicago – Stritch School of Medicine BACKGROUND METHODS OBJECTIVES Formalize a list of ECG findings every GMS entering an emergency medicine residency should be able to recognize. Utilize a flipped classroom approach to teach ECG interpretation of the top 20 ECG findings identified by the survey. Junior doctors have self-reported ECG interpretation as one of their five most common deficiencies. 1 There is no consensus on what ECGs graduating medical students (GMS) should be able to identify, or the most appropriate method to teach electrocardiogram (ECG) interpretation. 2 EM faculty at seven residency programs across the US were surveyed to determine the findings incoming EM residents should be able to recognize. Based on survey results, we created an ECG interpretation test highlighting the top 20 findings identified in the survey. PRE-TEST KNOWLEDGE AQUISITION RETENTION- TEST POST-TEST DISCUSSION/ REVIEW Students pretested during their first week of their four-week EM clerkship. Students completed web based asynchronous learning module and readiness assurance quiz within one week of pre-test. Students attended small group interactive discussion to review ECG findings and clinical correlation questions one week after pre-test. Students post-tested during the final week of their EM clerkship, using same exam as pretest. Convenience sample of 22 students (30%) retested 1-5 months following intervention.

RESULTS Identification and Instruction of Core ECG Interpretation Skills Necessary for Emergency Medicine Residency Readiness. Loyola University Chicago – Stritch School of Medicine Figure 1: Survey of 106 EM residency faculty, asked to judge the ability of incoming Interns to interpret ECGs at their own institution prior to any residency training. Table 1: Pre-test vs. Post-test results, for all enrolled students, of 20 ECG findings most commonly identified as imperative by EM residency faculty, for incoming EM interns. Mdn Pre-test (Interquartile Range) Mdn Post-test (IQR) Mdn Retention (IQR) p Student Performance (N = 22) (14.00 – 17.25) (17.00 – 19.00) (16.75 – 19.00)<.001 Raw scores significantly improved from pre-test to post-test (p =.001) and from pre-test to retention (p =.004). Scores from post-test to retention were comparable (p =.99). Table 2: Pre-test vs. Post-test vs. Retention test results for convenience sample of students (N = 22) who completed retention-test 1-5 months after post-test. Shannon Lovett, MD; Dan Holt, BS; Amy Hoyt, MEd; William Adams, MA; Trent Reed, DO Mean Pre-test (SE)Mean Post-test (SE)p Student Performance (N = 74)15.34 (0.28)18.20 (0.20)<.001 Raw scores significantly improved from pre-test to post test (p <.001, Rosenthal’s effect size r =.78).

REFERENCES Based on survey results from academic EM faculty, 20 core ECG findings were identified as imperative for a first year EM resident to recognize. Our flipped classroom approach was effective in enhancing senior medical students’ recognition and retention of these core ECG findings. Identification and Instruction of Core ECG Interpretation Skills Necessary for Emergency Medicine Residency Readiness. Loyola University Chicago – Stritch School of Medicine CONCLUSIONS RESULTS cont. Figure 2: Pre-test, post-test, and retention test results for 8 ECG findings most commonly identified as imperative (> 90%) for incoming EM interns by EM residency faculty. 20 Imperative ECG Findings: Ant STEMI, Inf STEMI, V-Fib, NSR, Sinus Tach, A-Fib, Lat STEMI, V-Tach, Sinus Brady, Asystole, 3 rd Degree Heart Block, LBBB, 2 nd Degree Heart Block Type 2, 1 st Degree Heart Block, A-Flutter, 2 nd Degree Heart Block Type 1, SVT, Post STEMI, RBBB, Hyperkalemia 1.Ochsmann EB, Zier U, Drexler H, Schmid K. Well prepared for work? Junior doctors' self-assessment after medical education. BMC Med Educ Nov 24;11:99. 2.Fent G, Gosai J, Purva M. Teaching the interpretation of electrocardiograms: which method is best? J Electrocardiol Mar-Apr;48(2): Shannon Lovett, MD; Dan Holt, BS; Amy Hoyt, MEd; William Adams, MA; Trent Reed, DO ACKNOWLEDGEMENTS Special thanks to Renata Barylowicz for assistance with data collection and scheduling.