One of the most important weeks in a medical student's life is EKG week with me! During EKG week, students learn the art and science of reading EKGs.
I know that EKGs are "taught" in medical school. We all "learn" about EKGs. Unfortunately, the way EKGs are taught leaves a lot to be desired. It's taught in a very boring, isoteric way. And it's nearly impossible to really use that information practically.
So students never end up really applying that basic information to real life EKGs and real life patients.
I want my students to be able to look at an EKG and in 2-4 seconds be able to give you a diagnosis and know what to do with it.
I usually start off by giving them a quick EKG pretest to see how they do. They usually struggle and no one gets all the answers correct. Most haven't even gotten over 60%. That's bad.
The next step involves printing out over 200 EKGs and cutting off the tops. We start going through them in a systematic way.
First, I want the rate. Count up the QRS complexes and multiply by 6.
Then the rhythm. Is it sinus or not? P waves or not? P before very QRS?
Then axis. Left? Right? Normal?
Then PR interval. Long?
Then QRS duration looking for blocks.
Then evaluate the ST segments. Early repol? STEMI? Pericarditis?
Then evaluate QT duration.
Then look for abnormal Q waves.
Then everything else?
We go through each EKG section by section. Writing all of these things at the top. If they are unsure, I have them look up the criteria in the EKG criteria book. They look these up over and over again. All day long. This drills the criteria into their minds. They never forget the criteria!
I have a extensive list of tricky EKGs. Lots of weird stuff. Some very subtle STEMIs, some wide complex tachycardias that are not VTach. Some Wellens, some Brugada. Lots of goodies!
It's always fun, and the students are always amazed at how far they have come. I tell them that by the end of the week, they will be able to read EKGs better than 90% of full licensed practicing physicians.
And they can!
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