Who Mastery Level Is For:
Designed for senior residents and attending emergency and acute care physicians who are responsible for making rapid, high-stakes decisions and teaching others. It is also appropriate for any experienced clinician who wants to sharpen expert pattern recognition, reduce interpretive errors, and build a durable teaching framework that improves team performance.
Mastery Level Goals:
By the end of this level, you should be able to:
- Demonstrate expert-level pattern recognition for high-risk ECG presentations and integrate findings into immediate clinical action.
- Apply a consistent “ECG + clinical physiology” decision model across time-sensitive scenarios (OMI, shock, arrest, tox, metabolic crises).
- Teach ECG interpretation in a way that reliably transfers to learners at the bedside.
- Lead quality improvement efforts that reduce missed high-risk ECGs and improve time-to-treatment.
- Maintain expertise through continuous practice, review, and periodic assessment.
How to Use Mastery Level:
- Start with the modules below and use them as a recurring framework, not a one-time checklist.
- Read the linked ECG STAT posts until you can explain the pattern, the risk, and the action clearly and quickly.
- On each STAT post, complete the linked ECG Weekly Workouts and their associated workout quizzes to maintain pattern recognition under time pressure.
- When an ECG Skills exam is available for a topic, use it as your check.
- Regularly review difficult cases and near-misses and use them to refine personal and departmental practice.
Core Topics and Modules
Module 1: The High-Risk ECG Decision Set (The Must-Not-Miss List)
What you should be able to do:
- Instantly recognize high-risk ECG patterns and act without delay when the clinical scenario fits.
- Avoid cognitive traps in “subtle but deadly” presentations.
- Communicate urgency and rationale clearly to consultants and the team.
Recommended ECG STATs:
Practice and assessment
- Use the Related Weekly Workouts on each STAT page and complete their workout quizzes.
- Complete any linked ECG Skills exams when available.
Module 2: Occlusion MI Mastery & Protocol-Level Integration
What you should be able to do
- Recognize OMI patterns and STEMI equivalents rapidly, including those without classic STEMI criteria.
- Integrate ECG interpretation into chest pain pathways and cath lab activation conversations.
- Use serial ECG strategy and risk framing to avoid both delay and unnecessary activation.
Recommended ECG STATs:
Module 3: Rhythm Mastery in Peri-Arrest and Undifferentiated Instability
What you should be able to do
- Rapidly manage bradycardia and tachycardia in unstable patients using physiology-first reasoning.
- Treat wide complex tachycardia safely when the diagnosis is uncertain.
- Recognize when artifact, lead issues, or device behavior is misleading the team.
Recommended ECG STATs:
Module 4: Metabolic & Toxicologic ECGs That Kill Quickly
What you should be able to do
- Recognize time-sensitive metabolic and tox ECG patterns early, before decompensation.
- Link ECG findings to immediate treatment pathways while confirmatory data is pending.
- Avoid anchoring on “cardiac” diagnoses when the cause is metabolic or toxicologic.
Recommended ECG STATs:
Module 5: Shock, Post-Arrest, and "ECG + POCUS" Integration
What you should be able to do
- Integrate ECG with bedside physiology and POCUS findings to prioritize lethal diagnoses.
- Recognize ECG patterns that change immediate management in shock states and post-arrest care.
- Use the ECG to guide disposition, monitoring intensity, and consultant communication.
Recommended ECG STATs:
Module 6: Cardiac Device & Electrical Therapy Emergencies
What you should be able to do
- Recognize pacemaker or ICD-related ECG patterns and identify common device problems.
- Differentiate paced rhythms from ventricular rhythms and interpret ischemia in paced tracings when needed.
- Guide ED workflow for device interrogation and escalation.
Recommended ECG STATs:
Module 7: Differential Diagnosis Thinking for Abnormal ECGs
What you should be able to do
- Generate a focused, high-risk differential for abnormal ECG findings, especially when history is limited.
- Avoid premature closure by pairing ECG findings with a differential that drives next steps.
- Teach others how to think in differentials rather than single-label ECG diagnoses.
Recommended ECG STATs:
Module 8: Teaching, Mentorship, and Quality Improvement
What you should be able to do
- Teach ECG interpretation in a way that improves real bedside decision-making.
- Build a culture where high-risk ECGs are escalated early and reviewed consistently.
- Lead QI initiatives that reduce misses, shorten time-to-treatment, and standardize escalation.
Recommended ECG STATs:
Minimum Standard to Maintain Mastery:
You are meeting the goals of this level when you can:
- Rapidly identify and correctly escalate high-risk ECG patterns across OMI, instability, tox, and metabolic crises.
- Integrate ECG interpretation into protocols and consultant communication with clear risk framing.
- Teach learners in real time on shift and improve their performance predictably.
- Demonstrate ongoing practice through weekly workouts, quizzes, and periodic skills exams.
- Use case review and QI to reduce error rates and improve team response.
Common Failure Modes to Avoid:
- Overconfidence and premature closure in subtle OMI or complex rhythm cases.
- Letting the computer interpretation substitute for clinical reasoning.
- Teaching ECG as memorized patterns without linking to physiology and action.
- Failing to review near-misses and system errors that repeatedly produce delayed escalation.
- Allowing personal skill to outpace team skill by not building shared mental models and protocols.
Designed for medical students, new interns, paramedics, nurses, APPs, and any clinician who wants a solid baseline. Learn a consistent approach to rate, rhythm, axis, intervals, conduction, and normal variants, with constant emphasis on clinical context and common pitfalls.
Designed as a PGY-1 guide, but appropriate for any clinician moving from “I can interpret” to “I can triage safely.” Build speed and reliability with high-frequency ED rhythms, early ischemia recognition, and rapid identification of life-threatening patterns.
Designed as a PGY-2 guide, but useful for clinicians who want deeper confidence with nuance. Expand into conduction blocks, wide-QRS differentiation, subtle ischemic patterns, tox and metabolic ECGs, and higher-level arrhythmia interpretation.
Designed as a PGY-3 guide, but built for anyone tackling complex ECGs under pressure. Focus on STEMI equivalents, difficult OMI patterns, rare syndromes, and the clinical integration that separates correct interpretation from correct decisions.
Designed for senior residents and attendings, and for any clinician who teaches others. Emphasizes rapid pattern recognition, case-based reasoning, avoiding cognitive traps, and practical teaching frameworks you can use on shift.
