Friday, August 22, 2014

Where To Teach?

As I begin another year teaching EKG's to our new residents, I find I am increasingly asking myself "Where to teach?"

I do not mean to imply a geographic sense to the word "where" (although this is difficult, too, as residents move from hospital to hospital in large health care systems like ours as they change rotations), but rather as more of a "level." What level do I teach our residents the art of EKG reading? Do I keep it rudimentary or do I teach it at the level of a good cardiology fellow? Are we striving for excellence or striving for adequacy in EKG interpretation? Said another way: do I teach at a Dubin's level of EKG interpretation or a Marriott's?

This is not an easy decision for those engaged in teaching medical students and residents.

Every year I am evaluated by the residents for my instruction, and every year I get good marks. But an e-mail received from our program director made me concerned, because a criticism they had heard from the residents was that my instruction was too advanced. (This was a first for me despite using similar core lecture materials year to year).

Which led me to wonder, is my curriculum too advanced for our newer residents or are medical students not receiving instruction on EKGs in medical schools before residency? Or has is the art of EKG interpretation evolving to simply reading the computer-generated interpretation at the top of the tracing? Should residents just be taught basic ACLS-level tracings or the more subtle findings of hypothermia and hypercalcemia?

I wonder why there's such a difference now, why there is a draw to spoon-feed our residents rather than to teach them basic principles upon which to grow their understanding. Perhaps residents are flooded. Perhaps they are scared. Or (more likely) perhaps we need to do a better job leading by example. Perhaps, as one fellow of mine said, our attendings in medical schools are so hurried to get back to clinic that they never do chalk-talks or EKG reading with residents any more. Maybe the pressures to make medicine more efficient is robbing from education.

Whatever it is, there is a change.

I'm sure I'm not the only teacher who's encountered the same difficulty knowing where to teach now. But I continue to believe that our youngest doctors can rise to any challenge they are given as long as they have enough time, so don't expect it to be any easier from now on, but maybe just a bit slower.

My time, after all, is unlimited. (* cough *)



Anonymous said...

As a patient, I've shown a couple of otherwise competent non-EP docs EKG's during appointments and the reactions have not been encouraging. It's pretty clear they remember very little and don't have the time or inclination to improve. I've seen undergrad A&P students with more understanding.

I've heard things like 'I remember PQRST or something like that' 'That looks really bumpy' and 'If the machine says it's normal, I do too.'

I'm not sure if that helps, but it gives some insight into what happens once the students have moved on.

I'd be tempted to focus on basic principles, so they can have a basis for self-education later if so inclined. After that, I'd id ~5 common and clinically significant items. In other words, what ~5 things do I want them to really remember 10 years from now.

Sad, I know, but you can't fix everything.

Anonymous said...

I've always thought it a poor use of resources to have EPs teach basic ECG interpretation. What IM residents need to know can be taught by general cardiologists, or perhaps even more appropriately, a *good* internist. When physicians need to learn how to predict the location of an AP, or when they need to learn how to determine the anatomic focus of a PVC, they should be taught by EPs. When they need to learn about lead reversal and ischemia, there are others who can more appropriately help them reach their goals.

Nobel laureates do not teach 100 level physics, you do not take your first guitar lesson from Buddy Guy, and Dr. Wes should be in the lab (burning!) instead of teaching future GIs how to determine heartrates during AF.

Greg-EP said...

Hello for south central PA
Was just perusing HRS start preparing for Board exam # 4 in 2021!
Agree with your sentiments about ABIM.
Still remember the comment of my Hopkins EP director after he shared his anxiety for taking the first board exam way back in about 1991.
"Listen." he told me, "The higher you get on the totem pole, the narrower it gets....sooner or later the wheat starts to fall!"

Anyway, also agree with EKG teaching which i also do for our residents.
Some get very good, others routinely dont show up

Nice seeing your comments