Tuesday, July 17, 2012

Lessons from EKG Class

"Dr. Fisher, can you teach our residents EKG lecture series?"

Naively, I said "Sure!"

What I didn't realize is how hard this is to do today.

Much of this is not residents' fault.  They only have so many hours in so many days to attend lectures while caring for patients.  Thanks to residency work-hour restrictions, those hours have become even fewer.  To make matters much worse, through the year residents are torn to different rotations at different times and different hospitals.  Since topics for EKG interpretation span over many lectures, it is impossible for residents to attend every lecture over the academic residency year.  Just like when a student misses half the lectures for a college course, it's hard to get an A.

Yesterday, I stood before a crowded room of about 35-40 residents and interns for their first of many EKG classes.  There they sat, with their nicely pressed florescent-white lab coats ready to learn.  They were quiet and respectful as they sized up their middle-aged physician attending who apologetically arrived 5 minutes late after seeing an urgent consult in the Emergency Room.  They had no idea what to expect.  I some ways, neither did I.

I plugged in the obligatory USB thumb drive to the obligatory computer to display the obligatory Powerpoint presentation, then stopped.  Up came the image on the screen.  They turned toward it, oblivious how uninterested I was in the contents of the slide.  I asked them a question.

"How many of you don't know the first thing about an EKG?"

Their heads swung back to me, silently.  Much of the room smiled, not certain where I was going.  Hesitantly, a few hands rose in the air. 

I had never seen this before.  As their soon-to-be instructor, I could not help but ask myself silently what the heck these kids have spent at least $200,000 of their parents' money learning in medical school. How on earth can any student leave four years of medical school education and not know the first thing about an EKG? 

I pressed on.

"How many of you know something about an EKG and its basics but realize you need to know more?"

Relieved, I saw many more hands go up.

EKG reading is one of those basic skills that every physician should at least have a rudimentary knowledge.  Medical school's controlled classroom-like environment lends itself better to instruction of the basics rather than hurried clinical rotations.  Clinical rotations are where residents should fine-tune their skills in this area.  How and why some medical students are not even exposed to this basic skill before entering their internship is one question, but what these young doctors are receiving for their huge costs of education is even a more important one.

As pressures continue to mount on physician salaries in the years ahead and their corresponding debts mount, perhaps we should ask ourselves why our young doctors continue to pay huge sums for their medical education of when the quality of the instruction has been allowed to slip to this level.

Could it be their academic instuctors never attended an EKG class either?



Art Fougner MD said...

Relax - soon you'll be giving these classes to Nurse Practitioners.

Dennis said...

I suspect in the near and dear future, there will be a computer software 'doctor' evaluating the EKG as the real 'doctor' will not have the time for it. The results will arrive electronically in the patients file by and by and the doc will 'see' it moments before he sees the actual patient...

Anonymous said...

I asked the same question. I had to say ECG before i got a response. EKG (German) I found a lot of people think EKG is brainwaves and ECG is cardio. Go figure. In all fairness, the same is said over GORD and GERD, Same thing, one is latin and another is... I work part time in ED and our ElectroCardioGraphs do diagnose for us. I havnt completed med school I am still a PA.

Jeremy said...

Many residents may know something about a topic but not raise their hands. Often raising your hand in response to a simple question leads to pimping on harder questions. And no matter how much a class knows about EKGs, the lecturer is going to still give the same lecture. In the end: no upside to hand raising.

Anonymous said...

Really? As a biology grad student, we taught EKG basics to general zoology undergrads in lab.

How far knowledge will shift in the patient direction? I carry a pocket EKG machine with me on long runs as it sometimes triggers AVNRT (yes - it's a modified 1 lead piece of junk, but it's been extremely useful for diagnosing the problem). There are so many resources, both in terms of devices and understanding, that weren't available to the general public even 10 years ago.

Nothing I dig up will replace an experienced doc who knows these issues inside and out, but I'm starting to wonder if I can easily replace the random doc I happen to get when I walk into a general clinic.

Oh vey...

suesweeney said...

"What is the definition of a double blind study?"

answer: two orthopods looking at an EKG

Perhaps the orthopod has been unfairly maligned.

Anonymous said...

As I learned in my education, if you wait for someone else to teach you, you won't ever learn.

Things are much different now Wes, many medical/nursing students would just assume blow off most lectures and learn on their own once they figure out the faculty just doesn't care.

I think you might have some grateful students in that class of yours.


Anonymous said...

Dr. Fougner,

With all due respect, we DID have EKG interpretation in my Nurse Practoner course. In fact, I taught it to students in basic nursing classes at the associate degree RN level.

Please be aware of what our knowledge base is prior to making these type of assumptive comments.

Thank you.