Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Learning Objectives: Residents will be able to: 1. Recognize challenging territorial distributions of acute STEMIs. 2. Identify classic ischemic EKG syndromes: Wellen’s and de Winter’s T waves. 3. Apply modified Sgarbossa criteria to identify ischemia in the setting of conduction abnormalities.

Introduction/Background: As some emergency medicine experts advocate for a shift away from STEMI-NSTEMI to that of occlusive MI (OMI) - non-occlusive MI (nOMI), there is a need to enhance residents’ education of high risk ischemic EKGs within this new paradigm. We developed an EKG curriculum leveraging retrieval practice to improve EM residents’ diagnostic skills for recognition of ischemic STEMI and non-STEMI EKGs that can represent acute MI necessitating emergent catheterization.

Curricular Design: The curriculum was initially implemented over a one week period in July 2020 for PGY-2 EM residents and repeated for the next class in July 2021. The curriculum consisted of three didactic sessions addressing: 1) OMI pathophysiology and STEMI, 2) Differentiation of STEMI from non-ischemic STE, and 3) OMI patterns not meeting traditional STEMI criteria. Each session was separated by at least 1-2 days. Before the start of each session, a 10 question formative EKG quiz was administered representing topics from the previous session and answers were subsequently reviewed. A baseline EKG quiz was obtained at the beginning of the course and once again after the final session as a summative assessment, and residents were also surveyed about their attitudes and experiences.

Impact/Effectiveness: We provide an easily implementable curriculum to introduce residents to these topics. Following our first two years, satisfaction surveys demonstrate that all residents find the curriculum useful and the majority have increased confidence in approaching these EKG patterns. Although we did not appreciate improvement in pre and post summative assessments, future directions include earlier implementation of this curriculum in our program with further spaced retrieval practice to achieve superior retention and educational effectiveness.