The Goals:
- Master rare and complex ECG findings and correlate them with clinical urgency.
- Integrate ECG data into immediate treatment decisions (e.g., combining with POCUS, vital signs, and physical exam).
- Mentor junior learners in applying ECG findings to real-world patient care.
Core Topics
- Recognition of More Rare Syndromes & Specialized Patterns
- Brugada Syndrome: Elevated risk of sudden cardiac death, characteristic ST patterns in V1–V2
- Wolff-Parkinson-White (WPW): Delta waves, short PR interval, risk of unstable tachyarrhythmias
- Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/ARVD): Ventricular arrhythmias, epsilon waves
- Other Uncommon Entities: Hypertrophic Obstructive Cardiomyopathy (HOCM), Catecholaminergic Polymorphic VT (CPVT)
- Recommended STAT Posts
- Complex Arrhythmias & Differential Diagnosis
- SVT with Aberrancy vs. VT: Use clinical stability, morphological criteria (e.g., Brugada or Vereckei criteria)
- Polymorphic VT / Torsades de Pointes: QT prolongation, electrolyte links
- Advanced Conduction Abnormalities: High-grade AV blocks, trifascicular blocks
- Recommended STAT Posts
- Rapid Integration of ECG with Clinical Status
- Combine ECG with POCUS: Identify wall motion abnormalities, tamponade physiology, or signs of PE
- Critical Decision-Making: ST changes + hypotension, wide-complex tachycardia + altered mental status, etc.
- Recommended STAT Posts
- Pericardial Tamponade
- High-Risk Pulmonary Embolism
- Altered Mental Status Related Emergencies
- Ischemia & Infarction (Review for advanced correlation)
- R on T Phenomenon
- Teaching & Mentorship
- Guiding Junior Learners: Demonstrate how to interpret unusual ECG patterns within the full patient picture.
- Encourage Clinically Relevant Teaching: Reinforce that an ECG is a tool, not a final diagnosis in isolation.
- Recommended STAT Posts (Review/Refresher)
Teaching and Assessment Methods
- Advanced ECG Rounds & Workshops
- Present complex or rare ECG cases, focusing on rapid management decisions
- Incorporate point-of-care ultrasound findings to reinforce integrative thinking
- Simulation Labs & High-Fidelity Scenarios
- Practice codes or peri-arrest situations where ECG drives immediate intervention
- Combine advanced arrhythmias with shock states, metabolic crises, or toxic ingestions
- Mentor & Teach
- Lead mini-lectures or “chalk talks” for PGY-1s and PGY-2s on high-level ECG patterns
- Oversee case-based learning sessions to refine junior residents’ skills in correlating ECG with clinical presentation
- Self-Study & Peer Review
- Complete advanced quizzes from ECG weekly workouts and exams from the ECG Skills section. Continue dedicating a small amount of time every week to improving your skills.
- Present complex ECGs to peers for feedback, fostering a collaborative learning environment
By completing this PGY-3 (Advanced) Curriculum, residents will gain expertise in identifying rare ECG patterns, synthesizing that data into immediate care decisions, and leading educational efforts that emphasize clinical context at every step. This final step readies them for independent practice as skilled EM physicians and ECG mentors.
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.
