The Goals:
- Enhance speed and accuracy in ECG interpretation through repetition and practice.
- Recognize subtler findings and expand your differential diagnoses.
- Integrate nuanced ECG changes into clinical decision-making.
- Mentor junior learners in developing strong ECG skills and clinical context.
Core Topics
- Advanced Arrhythmias & Conduction Blocks
- High-Grade AV Blocks (e.g., Type II AV block, 2:1 conduction)
- Wide Complex Tachycardias: Differentiate VT from SVT with aberrancy
- Advanced Bundle Branch Blocks & Fascicular Blocks
- Recommended STAT Posts
- Subtle Ischemic Changes
- de Winter T waves, Wellens Syndrome, Posterior MI patterns
- Correlate with chest pain descriptions and differentials, risk factors, and exam findings
- Recommended STAT Posts
- Complex Electrolyte & Toxicologic Disturbances
- Electrolyte Disorders: Hyperkalemia, hypercalcemia, etc., that present with challenging or atypical ECGs
- Toxicologic Emergencies: Sodium channel blocker toxicity, calcium channel blocker toxicity, beta blocker toxicity, etc.
- BRASH Syndrome and combined disturbances
- Recommended STAT Posts
- Leadership & Teaching Junior Learners
- Share systematic interpretation tips with students and PGY-1 residents
- Emphasize clinical correlation: “ECG changes are a clue, not an absolute”
- Recommended STAT Posts & Teaching Aids
- ECG Basics & Fundamentals (for reference when guiding juniors)
- Normal Cardiac Conduction (demonstration tool)
- Heart Rate & Rhythm Interpretation (teaching frameworks)
Teaching and Assessment Methods
- Focused Case Conferences
- Present tricky or subtle ECGs in group settings
- Discuss differential diagnoses, patient outcomes, and management decisions
- Peer Teaching & Junior Mentorship
- Facilitate mini-sessions where PGY-2 residents demonstrate advanced ECG interpretation to medical students or PGY-1s
- Reinforce the “ECG + clinical context” principle
- Weekly Rounds & Specialized Simulations
- Continue weekly ECG rounds with real patient scenarios—now featuring more complex conduction blocks or borderline ischemic findings
- Participate in toxicity and electrolyte simulation labs
- Self-Study & Quizzes
- Complete mid-level quizzes or modules from the STAT skills exam library
- Track progress, focusing on subtle ischemic findings and complicated arrhythmias
By following this PGY-2 (Intermediate) Curriculum, residents will sharpen their ability to rapidly detect subtle or complex ECG changes, refine their clinical acumen, and begin mentoring junior learners—all while integrating ECG data into comprehensive patient care decisions.
A place to start! Understand the basics of ECG waveforms, normal rhythms, and the importance of clinical correlation.
Solidify a systematic approach to ECG interpretation, learn to identify life-threatening arrhythmias, and get introduced to the many different ischemia patterns.
Continue building your skills with in-depth exploration of conduction blocks, subtle ischemic changes, toxicologic & metabolic ECG patterns, and advanced arrhythmias.
Rapid recognition of more rare syndrome and complex clinical scenarios. Continue learning about difficult rhythms, and develop nuanced clinical integration of the ECG patterns you have learned for rapid decision making.
Rapid pattern recognition, expert-level case discussions, and teaching strategies for mentoring the next generation of ECG experts.
