Who Advanced Level Is For:
Designed as a PGY-2 guide for emergency medicine residents who already have a reliable ECG foundation and now need speed, nuance, and broader differentials. It is also appropriate for any acute care clinician who wants to get better at subtle ischemia, wide QRS decision-making, complex conduction disease, and tox or metabolic ECGs.
Advanced Level Goals:
By the end of Advanced, you should be able to:
- Improve speed and accuracy through deliberate repetition and case exposure.
- Recognize subtler findings and expand your differential diagnoses without overcalling.
- Integrate nuanced ECG changes into clinical decisions, including when to escalate, observe, or recheck.
- Teach junior learners a safe approach and help them avoid predictable mistakes.
How to Use Advanced Level:
- Start with the modules below and work in order.
- Read the linked ECG STAT posts until you can explain the pattern and the “so what” out loud.
- On each STAT post, complete the linked ECG Weekly Workouts and their associated workout quizzes to build pattern recognition.
- When an ECG Skills exam is available for a topic, use it as your check.
- Revisit modules where you miss questions, feel slow, or feel uncertain.
Core Topics and Modules
Module 1: High-Risk Conduction Disease Beyond the Basics
What you should be able to do:
- Recognize high-grade AV block patterns quickly and understand why they are high risk.
- Avoid false reassurance when the patient looks okay but the conduction disease is dangerous.
- Identify when conduction disease should raise concern for ischemia or structural disease.
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: Wide Complex Tachycardia, Defaulting Safety
What you should be able to do
- Approach wide complex tachycardia with a safety-first mindset and avoid reflex SVT assumptions.
- Differentiate VT from SVT with aberrancy when it matters, and know when you cannot.
- Recognize VT mimics and common traps that lead to dangerous mismanagement.
Recommended ECG STATs:
Module 3: Subtle Occlusion Patterns You Cannot Miss
What you should be able to do
- Recognize high-yield OMI patterns that frequently lack classic STEMI criteria.
- Tie subtle findings to symptoms, risk factors, serial ECG strategy, and escalation decisions.
- Avoid both extremes: overcalling benign changes and undercalling high-risk ischemia.
Recommended ECG STATs:
Module 4: Ischemia with Wide QRS, LBBB, and Paced RHythms
What you should be able to do
- Recognize OMI patterns when baseline QRS is wide and repolarization is abnormal.
- Use appropriate discordance concepts to avoid false reassurance and false alarms.
- Escalate correctly when the ECG is limited and the clinical stakes are high.
Recommended ECG STATs:
Module 5: Electrolyte & Metabolic ECGs That Masquerade
What you should be able to do
- Recognize atypical presentations of electrolyte disturbances before they become unstable.
- Distinguish conduction and repolarization changes from ischemia when the clinical picture fits.
- Identify when the ECG should trigger immediate treatment while the labs are pending.
Recommended ECG STATs:
Module 6: Toxicology Patterns & High-RIsk Medication Effects
What you should be able to do
- Identify sodium channel blockade patterns and understand why they are time-sensitive.
- Recognize beta blocker and calcium channel blocker toxicity patterns and the associated hemodynamic implications.
- Avoid anchoring on a single ECG finding and missing the toxidrome.
Recommended ECG STATs:
Module 7: Combined Physiology Problems, BRASH & Overlapping Causes
What you should be able to do
- Recognize when bradycardia, hyperkalemia, renal failure, and AV nodal blockers are interacting.
- Avoid treating only one piece of the puzzle.
- Use the ECG as a clue to a combined physiology problem, not as a single-diagnosis label.
Recommended ECG STATs:
Module 8: Teaching & Mentoring with a Safety-First Approach
What you should be able to do
- Teach juniors a systematic approach that works on shift.
- Correct common early mistakes without turning ECG learning into a memorization contest.
- Reinforce the principle: ECG findings guide decisions only when paired with the clinical scenario.
Recommended ECG STATs:
Minimum Standard to Move On:
You are ready for the next level when you can:
- Recognize high-grade AV block and wide complex tachycardia patterns quickly and manage them with safety-first decisions.
- Identify subtle OMI patterns often enough that you reliably escalate the high-risk cases.
- Handle ischemia interpretation in wide QRS and paced rhythms without relying on the computer read.
- Recognize key tox and electrolyte ECG patterns early and connect them to urgent treatment.
- Teach a junior learner a consistent approach and correctly explain the “so what” behind your interpretation.
Common Failure Modes to Avoid:
- Trying to “prove SVT” in wide complex tachycardia instead of managing risk.
- Missing posterior and high-lateral occlusions because ST elevation is under 1 mm.
- False reassurance from baseline wide QRS, paced rhythms, or computer interpretation.
- Calling ischemia when the pattern is better explained by electrolyte or drug effect, or missing electrolyte or drug effect because the story sounds cardiac.
- Overfitting subtle ECG changes without using symptoms, vitals, risk, and serial ECG strategy
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.
