Learning the ABCs of EKGs

Residency is a period in medical training in which physicians learn about various aspects of patient care, including diagnostic testing. One area where residents do not receive any formal training? Electrocardiograms (or EKGs).

“In my clinical experience, there’s been a lot of unspoken expectations around EKGs. Residents order EKGs, perform EKGs when the techs are unavailable, and receive EKGs in hand to make decisions about them, but we haven’t had any formal training in residency around EKGs,” says Chris Teng, MD, a rising chief resident at CHOP who’ll be applying to Cardiology fellowship next year.

After wondering if it was “just [him]” who wanted more of a structured education around EKGs, Dr. Teng spoke with several of his fellow residents who shared similar feelings. This revelation prompted Dr. Teng to create a formal EKG curriculum with the help of co-residents Mary Teresczuk, MD, and Nicholas Santaniello, MD, and medical education mentors, Meryl S. Cohen, MD, MSEd; Chris Janson, MD; Rebecca Tenney-Soeiro, MD, MSEd; Jeanine Ronan, MD; Levon Utidjian, MD, and Dorene Balmer, PhD.

Assessing the need for an EKG curriculum

With the help of this well-rounded team, Dr. Teng created a needs assessment survey and rolled it out to the entire residency program in fall 2020. The results indicated that very few residents had a clear idea of what was expected of them when it comes to EKGs. Similarly, very few residents had pediatric-specific EKG training.

Utilizing the results of this needs assessment, Dr. Teng plans to take a three-pronged approach to increase residents’ comfort levels around working with EKGs:

• The first step is using a modified Delphi method to ask faculty from the Cardiac Center, Division of General Pediatrics, Emergency Department, Pediatric Intensive Care Unit (PICU) and Adolescent Medicine which EKG findings are most critical for residents to know. Dr. Teng chose to collaborate with these departments because they frequently order EKGs for patients.
• The second step is using these intended learning outcomes to create and evaluate a curriculum that will span across the three-year residency program. In addition, Dr. Teng is partnering with the hospital’s EKG techs to help train residents and equip them with a set of tips and best practices.
• Finally, Dr. Teng plans to look at EPIC, and note the patterns in which residents order EKGs, as well as link EKGs with Cardiology’s interpretations so he can get a sense of exactly what residents are seeing.

“Hopefully, it’ll be a way for us to quantify the utility and exposure of EKGs for residents in our program and build the way we track the efficacy of our curriculum,” notes Dr. Teng.

Seeking support to create bedside tool

In terms of next steps, Dr. Teng recently applied for a grant from the Center for Leadership and Innovation in Medical Education (CLIME) that he hopes will advance the team’s early work. He hopes to use the grant money to develop a “bedside tool” focused on the intended learning outcomes he’s defined in the hopes of helping residents in their approach to handling EKGs and improve their clinical decision-making.

Additionally, he’d like to present his work at national conferences and meetings and submit a manuscript to a peer-reviewed pediatric or cardiology journal. In the meantime, Dr. Teng is focusing on getting IRB approval for the various branches of the project so he can continue the task of creating and evaluating a solid curriculum around EKGs, while simultaneously increasing resident confidence.

And although there’s still much work to be done in order to see his plans fully come to fruition, Dr. Teng says he’s already learned a lot about himself while pursuing his chosen area of scholarship.

“In thinking about other areas of my training, have I truly picked up what I’ve learned? Should I seek more formal training in these things? Not to say that my past training hasn’t worked, but how can I be even better,” Dr. Teng says.

Team support impacts project

Dr. Teng also reiterates the importance of having team support. “It’s my first time leading an education project of this scale and it’s been such a pleasure working with so many team members,” he says. Of course, it’s been a growing process, but Dr. Teng says he feels grateful to have the input, guidance and help from so many individuals and areas of the hospital. “It’s shaped the project in a way that I wouldn’t have been able to achieve on my own,” he says.

Dr. Teng hopes to roll out the first round of his curriculum in 2021, with the goal of collecting additional data and hosting resident-centric learning sessions in the fall and winter.

When asked what he hopes others will learn from his scholarly work, his response is two-fold: “I hope my fellow residents will come to enjoy working with EKGs more. I’ve also learned I enjoy teaching; it’s been rewarding for me to create this curriculum and teaching program.”