Who Expert Level Is For:
Designed as a PGY-3 guide for emergency medicine residents who are expected to manage complex ECG-driven decisions and mentor junior learners. It is also appropriate for any acute care clinician who wants deeper expertise in rare syndromes, difficult rhythm differentials, and rapid integration of ECG findings with bedside physiology.
Expert Level Goals:
By the end of Expert, you should be able to:
- Recognize rare and complex ECG patterns and match them to clinical urgency.
- Integrate the ECG with vitals, exam, and bedside tools such as POCUS to drive immediate decisions.
- Manage advanced rhythm differentials safely when the diagnosis is uncertain but the risk is high.
- Teach junior learners how to interpret ECGs in a clinically meaningful way, not as isolated pattern memorization..
How to Use Expert 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: Rare Syndromes & High-Impact Pattern Recognition
What you should be able to do:
- Recognize rare ECG syndromes that change disposition, monitoring intensity, or emergent management.
- Avoid common mislabels (benign ST elevation vs Brugada, “weird T waves” vs long QT risk).
- Communicate urgency clearly to the team and consultants.
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: Advanced Rhythm Differentials Under Pressure
What you should be able to do
- Approach difficult rhythm differentials with a safety-first strategy when certainty is not possible.
- Use clinical stability, QRS morphology, and the overall context to avoid dangerous misclassification.
- Recognize polymorphic VT patterns and distinguish torsades physiology from other causes of polymorphic VT.
Recommended ECG STATs:
Module 3: Advanced Conduction Abnormalities & High-Risk Blocks
What you should be able to do
- Identify high-risk conduction disease patterns that predict deterioration.
- Recognize when conduction findings suggest ischemia, structural disease, or medication effect.
- Plan escalation and pacing readiness appropriately based on the ECG and physiology.
Recommended ECG STATs:
Module 4: Rapid ECG Integration with Bedside Physiology and POCUS
What you should be able to do
- Combine ECG findings with POCUS, vitals, and physical exam to make time-sensitive decisions.
- Recognize when the ECG is the early clue, and when the physiology is already declaring itself.
- Use ECG changes to prioritize competing lethal diagnoses (tamponade, massive PE, OMI, tox, metabolic causes).
Recommended ECG STATs:
Module 5: WPW, Pre-Excitation, and the "Do Not Give AV Nodal Blockers" Edge Cases
What you should be able to do
- Recognize pre-excitation quickly and anticipate unstable tachyarrhythmias.
- Identify AF with pre-excitation risk and avoid therapies that can precipitate VF.
- Teach others how to recognize the subtle forms of WPW and pseudo-infarct patterns.
Recommended ECG STATs:
Module 6: Teaching & Mentoring, Making ECG Thinking Transferable
What you should be able to do
- Teach juniors how to build a safe ECG approach and avoid predictable cognitive errors.
- Frame ECG interpretation as a clinical reasoning process: pattern, context, risk, and action.
- Give feedback that improves bedside performance, not just test performance.
Recommended ECG STATs:
Minimum Standard to Move On:
You are ready for the next level when you can:
- Recognize rare syndromes and explain their clinical implications without relying on the computer read.
- Manage advanced rhythm differentials with a safety-first plan when certainty is not possible.
- Integrate ECG findings with bedside physiology and POCUS to make time-sensitive decisions.
- Teach juniors a consistent approach and correct common errors in real time on shift.
Common Failure Modes to Avoid:
- Overconfidence in a single ECG finding without integrating symptoms, vitals, and exam.
- Trying to “win the diagnosis” instead of managing risk in unstable rhythm differentials.
- Missing pre-excitation and giving AV nodal blockers in AF or undifferentiated wide-complex tachycardia.
- Treating rare patterns as academic curiosities instead of disposition- and urgency-changing diagnoses.
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.
